20200217 Ver 1_Shoreline Stabilization_20200210

State of North Carolina
V�
Department of Environment and Natural Resources
DWR
Division of Water Resources
15A NCAC 02H .0500 —Water Qy,2ljj�y Ction, Shoreline Stabilization
Division of Water Resources �{,/ /D FORM: SSGP 10-2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the applic� -
to:
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
I. Applicant Information [15A NCAC 02H .0502(a
Owner Information
Name: J� e n CA n t n
Mailing Address: 5 c/ 2 (A) unA kaa) I an P,
Telephone Number: -16(4- Od- (aDi Fax Number:
E-mail Address: _�W r-i 2 I nncd,-t-oo WC, 0e4
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http://www.saw.usace.army.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: C 14Pi Ic Drf it i n COISJ ri eA-t an
Company Affiliation: n
Mailing Address: e_4. f K� .
L4 Ke Wy I(e s C. ag-( I o
Telephone Number: 3 e-�( -ed(e Fax Number:
E-mail Address: f cku jS ea r-41,1,n�-i-
Person to receive the Certification Approval: Za Cla 401-6Q
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,
FORM: SSGP 10-2013 Page 1 of 3

etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
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: ��/�. , u c Nearest Town: C1loIrlor't,P
Subdivision name or site address (include phase/lot number): 3 [
Directions to site - please include road names and numbers, landmarks, etc.:
v 5e e, � a
Latitude (in decimal degrees) `3 5, 0 5? ©S 57 Longitude (decimal degrees)
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): P"-r t,me-
6. Property size (acres): , V y
7. Lake/ river/ ocean adjacent to property: 4lr Ci
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): t9 ktUlt- St1,n hr dt tc✓Lr��
%ors avo , Yldc✓ ����-�.��,�,.� („>�.l��,as�_s>`�r-f��,zo-�-a%�.
9. Will work be conducted from land? From water? ❑
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:
0 sd
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: 42DO S4
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 feet landward/ to be impact/Jed (number of trees, for instance):
�% don C'eoLy-i'%�iG2� �'o Y& �Pir►'/� �
er/Agent's Signature* [15A NCAC 02H .0502(f)]
Date
Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

Full Pond/
Normal Water Level
S
Lake
(At Full Pond/Normal Water Level)
S��
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
FORM: SSGP 10-2013 Page 3 of 3

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 3
L PLAN NO.
PARCEL ID:
STREET ADDRESS: Ig 3o l 11 -OeAuy a F-{)Zz,
C )a ,r lc;- c A) C, a �9-7,P
Please print:
Property Owner:
Property Owner:
n
The undersigned, registered property owners of the above noted property, do hereby authorize
Jc' zG�c a J, C�� �/s✓`'i� of C� CS , (ie U{, J. �1 `Lit 5"li4(e-41 �
(Contractor / Agent) (Name of consulting firm) I
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
Telephone:
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized gnature thorized Signature
Date: I / � I / va Date: /- 5 / o2��ZL7

COLiL p-r"—
/ A Fall Pad x,200 4=
3" 00 Zf = Gd0 �.
3) 1,'V dG acc64s I-mak ;— huh
(No Clr.,ar'-5)
bddv Full 1964 ,Zoo Ilr-
i
,� A�odtr rul/ I�rry�
t,
02

Su�e-- f fo fe�•F,'a�
JtvPP+ n�
9t,

i'
tt
3♦
j,

6/4/2019 3990 Charlotte Hwy, Clover, SC 29710-8083 to 18301 Hideaway Rd, Charlotte, NC, 28278-8603 Directions - MapQuest
y
YOUR TRIP TO:C(
18301 Hideaway Rd, Charlotte, NC, 28278-8603
11 MIN 1 5.2 MI
Est. fuel cost: $0.52
Trip time based on traffic conditions as of 9:13 AM on June 4, Print a full health report of your car with HUM
2019. Current Traffic: Light �9 vehicle diagnostics (800) go6-25o3
1. Start out going northwest on Charlotte Hwy/SC-49 toward Blucher Cir.
Then 0.05 miles 0.05 total miles
In 2. Make a U-turn at Blucher Cir onto Charlotte Hwy/SC-49 (Crossing into North
Carolina).
If you reach Executive Ct you've gone about 0.2 miles too far.
Then 0.39 miles
T 3. Charlotte Hwy/SC-49 becomes York Rd/NC-49.
Then 0.85 miles
- 0.44 total miles
1.29 total miles
4. Turn right onto Grand Palisades Pkwy. Pass through 1 roundabout.
Grand Palisades Pkwy is 0.4 miles past Red Fez Club Rd.
If you are on S Tryon St and reach Langston Dr you've gone about 0.1 miles too far.
Then 2.93 miles 4.22 total miles
T5. Enter next roundabout and take the 2nd exit onto Snug Harbor Rd.
Then 0.77 miles - 4.99 total miles
6. Turn left onto Hideaway Rd.
If you reach the end of Snug Harbor Rd you've gone about 0.1 miles too far.
Then 0.23 miles 5.22 total miles
V 7. 18301 Hideaway Rd, Charlotte, NC 28278-8603, 18301 HIDEAWAY RD is on
1.
the left.
If you reach the end of Hideaway Rd you've gone about 0.1 miles too far.
00 Save to My Maps
Use of directions and maps is subject to our Terms of Use. We don't guarantee accuracy, route conditions or usability. You assume all risk of use.
https://www.mapquest.com/directions/iisU1/us/sc/cloverl29710-8083/3990-charlotte-hwy-35.106658,-81.041425/to/us/nc%hariotte/28278-8603/18301-... 1 /2

3990 Charlotte Hwy, Clover, SC 29710-8083 to 18301 Hideaway Rd, Charlotte, NC, 28278-8603 Directions - MapQuest
httpsJ/www.mapquest.comldlrecOonslilsVI luslsc/doved29710-8083l3990-charlotte-hwy-35.106658,-81.041425Athis/nc/charlottel28278-8603118301-... 212

3/4"IPF
CURVE
RADIUS
ARC LENGTH
CHORD LENGTH
CHORD BEARING
CI
476.07'
99.36'
99.18'
N 01 °30'45" E
C2
253.72'
1 29.94'
1 29.92'
1 N 05°10'47" E
k. i lL
3 W °�
LOT 33
i -
SECTION 43
PID #21717218
-
#s RBF °
MB 17 PG 512
- S 69°43'38^
b E )
10 DRAINAG
t.:
I & SETBEEASEIlENT
WO' Q:, ' (DB 3g82
886)
OVERHANG IS
PG
12.7' BELOW P/L
70 m z�
f ��_°, �1Qo
O-yj
E
N m
O
� )
- N L1 m
O
i - ,� 1
^5
p
#4 RBF
11
n
wnai Is inls ! any
living quarters?
SECTION 43 0
PID # 21717219 I
MB 17 PG 512
1-STORY I
WOOD .
l
1
•
Ir-
S pG
� 1
�'
i � 1 I
--�65.3' r 4
F_'
./.
0 it
10' 0
11
s
A
n
Z 11
II
� 41
W ARE
I
41332 S
1 �" I 0.949 AC
y m
O O
5 t I © I
t
10' DRAINAGE EASEMEN
& SETBACK
•O
A (DB 3882, PG 886)
#3 RBF
t
O
1#4 RBF
HATCH LEGEND
CONCRETE
BUILDING
WOOD DECK
GRAVEL
7.4•
;A
LINE
BEARING
DISTANCE
L1
N 25'43'24" E
188.83'
L2
N 86'11'00" E
30.00'
L3
S 13°43'34" W
207.15'
L4
S 23°51'23" E
26.15'
L5
S 17'40' 15" E
28.93'
L6
S 14031'43" E
12.49'
L7
S 10'09'54" E
13.44'
L8
S 01'51'13" E
1 1.73'
L9
S 02°34'09" W
23.95'
L10
S 06°09'49" W
49.36'
L1 1
S 07°27'28" W
47.44'
L 12
S 08034'38" W
34.32'
L 13
S 14°40'53" W
34.76'
L 14
S 10° 15'58" W
33.78'
L 15
S 51 *32' 10" W
16.52'
HARBOR VMH�GL�
j;
SITE
VICINITY MAP
(NOT TO SCALE)
LINE LEGEND
PROPERTY BOUNDARY
G
ADJACENT BOUNDARY (NOT SURVEYED)
—
—�� -- PROPERTY BOUNDARY TIE LINE ONLY
I
EASEMENT LINE
i —
— — — — — SETBACK LINE
10 o
o--�--- WOOD FENCE LINE
I
OU OVERHEAD UTILITY LINE
—
— BUILDING OVERHANG
C)
WALL
NI
—� -0
J
M o
ABBREVIATIONS
>I
DB
DEED BOOK
r PROPERTY LINE
MB
MAP BOOK
FOLLOWS THE
PG
PAGE N
570' CONTOUR
I• (L4-L15)
P/L
PROPERTY LINE
r
R/W
RIGHT-OF-WAY
I' J
SF
SQUARE FEET
CP
COVERED PORCH
I DOCK
-P
6
LAKE WYLIE
(ZONE AE)
QVI
V-
non-compliance
GRAPHIC SCALE
w
1 with 35' rear
0 25 50
45.9,
setback?
( IN FEET)
1 inch = 50 ft.
SURVEY NOTES:
1. ALL DISTANCES ARE HORIZONTAL GROUND DISTANCES.
2. AREA COMPUTED BY THE COORDINATE METHOD.
3. REFERENCE(S): AS SHOWN.
- BOAT 4. ALL BUILDINGS SHOWN LIE WHOLLY ON THE SUBJECT PROPERTY.
RAMP 5. LOT ZONED R-5 PER MECKLENBURG COUNTY POLARIS --
-- (05/17/2016). R-5 SETBACKS: 20' FRONT, 35' REAR, 5' SIDE -YARD.
6. THERE ARE NO ENCROACHMENTS OR PROJECTIONS EXCEPT AS
SHOWN.
7. PHYSICAL IMPROVEMENTS MAY EXIST ON THIS PROPERTY WHICH
ARE NOT SHOWN HEREON.
B. THIS SURVEY WAS CONDUCTED WITHOUT THE BENEFIT OF A TITLE
COMMITMENT REPORT. THIS PLAT/PROPERTY IS SUBJECT TO ANY AND
ALL RIGHTS -OF -WAY, UTILITY EASEMENTS, DEED RESTRICTIONS,
RESTRICTIVE COVENANTS OR AGREEMENTS WHICH MAY OR MAY
NOT BE OF RECORD AND APPLICABLE HERE TO THE DATE OF THIS
SURVEY.
9. ACCORDINGLY NOT ALL EASEMENTS ARE REFLECTED AND THE CITY
MUST BE CONTACTED TO FULLY LOCATE ALL EASEMENTS TO CONFIRM
IMPROVEMENTS CURRENT AND FUTURE DO NOT ENCROACH.
10. UNDERGROUND UTILITIES ARE NOT LOCATED AT THE TIME OF
SURVEY. IF SHOWN, UTILITY LOCATIONS ARE APPROXIMATE BASED
ON LOCATIONS OF ABOVE GROUND APPURTENANCES.
UNDERGROUND UTILITIES NOT SHOWN HEREON MAY EXIST.
1 1. PROPERTY DOES NOT LIE IN A SPECIAL FLOOD HAZARD AREA.
(FIRM MAP NO. 3710348800J, EFFECTIVE ON 03/02/2009).
I CERTIFY THAT THIS MAP WAS DRAWN UNDER MY SUPERVISION FROM AN SURVEY OF PROPERTY FOR:
ACTUAL SURVEY MADE UNDER MY SUPERVISION (DEED DESCRIPTION BEN & TRICIA CANON
RECORDED IN BOOK 3882. PAGE 886); THAT THE BOUNDARIES NOT
SURVEYED ARE INDICATED AS DRAWN FROM INFORMATION REFERENCED
HEREON; THAT THE RATIO OF PRECISION AS CALCULATED EXCEEDS 1:10.000; 18301 HIDEAWAY ROAD
THAT THIS MAP MEETS THE REQUIREMENTS OF THE STANDARDS OF PRACTICE LOT 34, SECTION 43 CRESCENT LAND & TIMBER CORP
FOR LAND SURVEYING IN NORTH CAROLINA (21 NCAC 56.1600). MAP BOOK 17, PAGE 512
WITNESS MY ORIGINAL SIGNATURE, REGISTRATION NUMBER AND SEAL.
THIS 17th DAY OF MAY ,A.D., 2016 . O'%jiIIIIIj CHARLOTTE, NC28278
CAR MECKLENBURG COUNTY
N 78°59'00" W 108.43'
LOT 35
SECTION 43
PID # 21717220
MB 17 PG 512
SYMBOL LEGEND
REBAR FOUND (RBF)
0 IRON PIPE FOUND (IPF)
A CALCULATED POINT (CP)
0 AIR CONDITIONER
Q WATER METER
WO WATER WELL
Q ELECTRIC METER
0 UTILITY POLE
- LIGHT POLE
LANO�f.�J-/:
( 1 _
SEAL
w -�- L-5057
WES LEDBETTER
NORTH CAROLINA REGISTRATION
Ott
SURVEYING
1421 Cyrus Drive Charlotte, NC 28205
p: 704.450.4779 1 www.EyattSurveying.com
NC FIRM LICENSE #: P-1380
FII F NAMP, 1R101 HIDFAWAY ROAD_DVJC3,_,.":' 11 L., PROJECT NUMBER: MHA-1604i
SURVEY DATE: 05/16/2016 DRAWN BY: WL