20141062 Ver 1_Shoreline Stabilization_20141007

2 0 1 4 1 0 6 2 State of North Carolina
Demsht 2,f Environment and Natural Resources
DWR
160 Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10 -2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent
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)]
1. Owner Information
Name: -teeS�I e lcine- LL-C_
Mailing Address: � k93Ti rasf _ Ln
l7enye'-r, Kl 's�Sy3`7
Telephone Number: Fax Number:
E -mail Address: 61(1nf1e_F(!' ke�+1, �3,t o�rlt��t _ l+,anA-
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 /dots /regulatory /regdocs /Permits /SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name:
f�
Company Affiliation: LCD r_ C+tY%c O �� �n-, hc) l 4
Mailing Address: l [ 5b -%Y 4-� VJ
Telephone Number: rj o4. sa6 • `74o[) Fax Number: !] Q4. Ste- -_�L}-OD
E -mail Address: I.AN Asa-al)ucJ & kAe. et,
Person to receive the Certification Approval:
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
�S SSA S 93

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: L ir1cctr-, Nearest Town: TY�Vc,—
Subdivision name or site address (include phase /lot number):
Directions to site - please include road names and numbers, landmarks, etc.:
Latitude (in decimal degrees) 35. 5(elI ( 1 Longitude (decimal degrees) — 0 U. `��l O5k
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): �P �J�,a, a
6. Property size (acres):
7. Lake/ river/ ocean adjacent to property: Lake_ fi0 rrnp n
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): na S-, hsrr 1, d ,ns. It,
T -
9. Will wor e conducted from land? ❑ From water?
LES
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: ( r X 300
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 /Agen
15A NCAC 02H .0
Printed Name
t_C,
Agent's signature is valid only if an authorization letter from the owner is provided.
Date
FORM: SSGP 10 -2013 Page 2 of 3

I
Nora
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

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CAT_AWBA Geospatial
Information Services
Real Estate Search
1 in =300ft
Parcel: 460604543806, 4883 TRESTLE LN DENVER, 28037
Owners: TRESTLE LANE LLC,
Owner Address: 617 N MAIN ST
Values - Building(s): $0, Land: $57,600, Total: $57,600
This map /report product was prepared from the Catawba County, NC Geospatial Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling information contained on this map or data on this report. Catawba County promotes and recommends
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personnel, disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect or consequential which arises or may
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Copyright 2014 Catawba County NC
09/25/2014