20191363 Ver 1_Shoreline Stabilization_20191007

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, ShorelineStabilization
Division of Water Resources
FORM: 'JSGp 16,013
Shoreline Stabilization Application Form
One copy of the application (including attachments) and the application fee should be sent to:
Division of Water Resources
401 & Buffer Permitting Unit 2 0 1 9
3
1617 Mail Service Center i s 3
Raleigh, NC 27699-1617
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information 1' I REC�iV>�pjp��R/DW
Name: ab _r�- 0.n8C l'l r l CL QU+
Mailing Address: 2 O 5 :� 1 hef Wo Ln .
(76 r (\ e- i VS , NC Z R03 I Porro MID
Resources
+a�
Telephone Number: -10 K - 8q Z' 32 3y Fax Number:
E-mail Address: V- Vcko d) bel l 50o+h , nei-
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http:/Iwww.saw.usace.army.miI/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: Ta nice_ C -A --eD
Company Affiliation:
Mailing Address:
coo res v �i [le,1gC 228115-
Telephone
28115
Telephone Number: '70q- C"o-5l1I Fax Number: JOc{ -Coi ob - 5(409
E-mail Address: Cbc.!E a x,�t(� c� + U; nd5 - -recum . nC7�-
Person to receive the Certification Approval: J&:.vti i c e c5 t4
II. Project Information [15A NCAC 02H .0502(a) & (b)]
1. Attach a vicinity map (i.e. street map) clearly showing the location of the property with
respect to local landmarks such as towns, rivers, and roads.
2. Provide a detailed site plan showing property boundaries and proposed locations of
vegetation clearing, structures (buildings, retaining walls, docks, impervious surfaces,
etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
FORM: SSGP 10-2013 Page 1 of 3

and construction access corridors. You may use the diagram provided at the end of this
application form.
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale
of some sort- a yard stick, shovel handle, etc.)
4. Location of the property (where work is to be conducted)
County: CgpcKI&n U rQ Nearest Town: Co r ne-k X15
Subdivision name or site address (include phase/lot number): 20531 _+he 1wocj Ln.
Directions to site - please include road names and numbers, landmarks, etc.:
See (3_4 hed
Latitude (in decimal degrees) 35 , 489 ITS (.y Longitude (decimal degrees) — F30, 9 U y�(5 y
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.):I�esiACn-E-ia
6. Property size (acres): n • 9 2 -7.
7. Lake/ river/ ocean adjacent to property: t�nrrY an
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
9. Will work be conducted from land? ❑ From water? ET
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool lake level/ Normal Water Level in square feet or acres:
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres: I Qhnye-
12.
_12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 feet landward to be impacted (number of trees, for instance):
Owner/Agent's Signature' [15A NCAC 02H .0502(f)l Date/ 12-(s i /Ig
`Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

FL
Norma
SI
Lake
�a (At Full Pond/ Normal Water Level)
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Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ft x 100 ft) *:
1. All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
3. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
4. Location of any proposed structures such as buildings, retaining walls, docks, etc.
5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
Robert and Christa Faut
20531 Bethelwood Ln.
Cornelius, NC 28031
FORM: SSGP 10-2013 Page 3 of 3
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Slims 610 Fal Cala Mace, Mcae 11% INC b 20511 eelhaMcod Ln, Comelim. NC 78031- Google Maps
Google Maps 610 East Center Avenue, Mooresville, NC to 20531 Bethelwood Ln, Cornelius, NC 28031 Drive 10.8 miles, 22 min
610 E Center Ave
Mooresville, NC 28115
f 1. Head south on Evergreen St toward E Center Ave
14s(197 ft)
Take S Main St, NC -115 S and 1-77 S/US-21 S to Bethel
Church Rd in Cornelius
18 min (9.5 mi)
t" 2. Turn right onto E Center Ave
0.6 mi
41 3. Turn left onto S Main St
1.6 mi
t 4. Continue onto NC -115 S
2.1 mi
10 5. Turn right onto Langtree Rd
1.1 mi
E 6. Use the left 2 lanes to turn left onto the Interstate
77S/US 21 Sramp
0.2 mi
A 7. Merge onto 1-77 S/US-21 S
2.9 mi
S. Take exit 28 for US -21
0.2 mi
A 9. Merge onto W Catawba Ave
0.7 mi
Continue on Bethel Church Rd. Drive to Bethelwood Ln
2 min (1.2 m)
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THIS IS TO CERTIFY THAT ON THE L �'�" QAY OF ✓C.'0.5E/ ig 71? - I SURVEYED THE
PROPERTY SHOWN ON THIS PLAT, AND THAT THE TITLE LINES AND HEWALLS OF THE BUILDINGS IF
ANY, ARE AS SH?WN HEREON.
SIGNED
i�/ Rwnri�su �uwar9 -
WforSURVEY
;.+
MAP: P:

Polaris 3G Map — Mecklenburg County, North Carolina
Date Printed: 9/30/2019 12:01:09 PM
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This map or report is prepared for the inventory of real property within Mecklenburg County and is compiled from recorded deeds, plats, tax maps, surveys, planimetric maps, and other public records and data.
Users of this map or report are hereby notified that the aforementioned public primary information sources should be consulted for verification. Mecklenburg County and its mapping contractors assume no legal
responsibility for the information contained herein.

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