20150253 Ver 1_Shoreline Stabilization_20150309

2 0 1 5 0 2 5 3 State of Nort Car�'dli AM
Department of Environment and Natural gesources
DWR
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources 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 D /;Z' -
I. Applicant Information 15A NCAC 02H 0502 a ] D
pp [ MAR 0 9 2015
1 Owner Information
Name: L Y1 C� ��� DENR -WATERRE
Mailing Address. 7634 Q l U'h t ui i i G u JV— ERMITTING
0�e&I y e r a .lt C, 2103 7
Telephone Number- 70-6q+V HS Fax Number: 70'`I - - 6d 7y
E -mail Address- I (V1(- e-re`` A, 0 4 OTMGr, C0►'�'i
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 pd f) must be attached if the Agent has signed this application form
Name-
Company Affiliation:
Mailing Address
Telephone Number. Fax Number:
E -mail Address.
Person to receive the Certification Approval
II. Project Information [15A NCAC 02H 0502(a) & (b)]
1 Attach a vicinity map (i a 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 � N� �1('D 1 ✓1 Nearest Town 0 etwer'
Subdivision name or site address (include phase /lot number) "le S
Directions to site - please include road names and numbers, landmarks, etc : /
Fro m (kcArI -A� Ply ) l A vr�' A +v , 6,AS,t►'�Ss 161
i rryl rI(At on Ec:ir ;elA For (2" S'tvn
44r +k J1 h\,vV 73 '� Lec+4)jI. Lut ;S CAt ell & v J fUC %,Q.�
Latitude (in decimal degrees) Longitude (decimal degrees)
5 Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): ✓U C G n v
6 Property size (acres). o 65 C, C r e)
7 Lake/ river/ ocean adjacent to property [--(A k e /V0 ►''M C, M
8 Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): A k+ ✓1 y tu e I rl
�' rc.lI ftic f k yt, O V '
9 Will work be conducted from land? [r' 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
C �� sputw -e_
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc ) above the normal ool lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres: $ q LL re Pep—+
12 Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 feet landw rd to be impacted (number of trees, for instance). M It +i-ep_S
I l\-I & C
Owner /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

La ke
(At Full Pond/ Normal Water Level)
Full Pond/ �\ �
Normal Water Level I" 9MB MW Ow MIM Shoreline "-► /1 i► '
�ek rwl
Sores 5+ucry1 rekov,.1
c�,hov-Q- �.11 Con & 760 ),b
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YY rq foe4(�n
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150+ x 115 -�fi
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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Paae I of l
A4�t; cr, Lincoln County, NC
J - Office of the Tax Administrator, GIS Mapping Division
Lincoln County and Its mapping contractors assume no legal responsibility for
the information contained on this map. This map Is not to be used for land
fe * ;onveyance The map Is based on NC State Plane Coordinate System 1983 NAD
Date. 10/29/2014 Scale: iinch = 156 Feet
} YEAR 37104614000 55
X NO FLOOD HAZARD
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INF(?RMAiIOiY FOR 4634 -25-20
PHO I r P
PARCEL I
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Map 4614 -09 Mailing C/O CRAIG ELLIOTT WILLIS
Account 0150342 Address 7908 OVER NORMAN COURT
Deed 13E 515 Recorded 10/2312013 Sale Price 0
a L
Land Value $437,102 Total Value $505,074 P
® -
- - - -- All values are for tax year 2014 -----
Subdivision Lot 1 & AD] TR WESTPORT P
Description HOSTIW & 60'RD 1389 Deed A
Township CATAWBA SPRINGS Tax /Fire District EAST LINCOLN / EL SEWER
a T
Main Improvement SHORELINE IMPROVEMENT value $12,000
Photc Nat`
4x M
Main Sq Feet 260 Stories 0 Year Built 1970
Zoning Calculated Voting Precinct Calculated Acres
Avail, able S
"v A
Acres WESTPORT (WP32) 0
R -14 0 68
Watershed Class Sewer District 0 68
WS-IVC 0 68 In the sewer District
2000 Census County Tract Block
37109 071200 2000 0
✓ F
071200 2999 0
FloodZone Description
" S
SPECIAL F
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