20140532 Ver 2_Shoreline Stabilization_20150812

VA of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
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Div of Water Re urces 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 v Q'
Raleigh, NC 27699 -1617 AUG 1 2 2015
I. Applicant Information j15A NCAC 02H .0502(a)j °=NR -wAT[
1. Owner Information r 401 8 gUFFt (� ERMI TIN
Name: The Peninsula Club, Inc.
Mailing Address: Jared Nemitz
19101 Peninsula Club Drive
Cornelius, NC 28031
Telephone Number: 704 - 896 -4916 Fax Number:
E -mail Address: Jared. Nemitz(@ther)eninsulaclub.com
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
httr): / /www.saw.usace.armv. mil / Portals /59 /dots /regulatory /regdocs /Permits /SAMPLE AGENT AUTH
ORIZATION FORM.odf) must be attached if the Agent has signed this application form.
Name: Matthew Bare- Civil Engineer
Company Affiliation: McKim & Creed, Inc.
Mailing Address: 8020 Tower Point Drive
Charlotte, NC 28227
Telephone Number: 704- 841 -2588 Fax Number: 704 - 841 -2567
E -mail Address: mbare@)mckimcreed.com
Person to receive the Certification Approval: Matthew Bare
II. Project Information (15A NCAC 02H .0502(a) & NJ
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: Mecklenburg, NC Nearest Town: Cornelius
Subdivision name or site address (include phase /lot number):
Directions to site - please include road names and numbers, landmarks, etc.: 1 -77 to
Exit 28 northbound turn left onto Catawba Ave, turn right onto Catawba Ave. Proceed 1.1
miles and turn right onto Jetton Rd, left on Peninsula Club Dr, hole 18 is on the left
Latitude (in decimal degrees) 35.46958 N Longitude (decimal degrees) 80.91096 W
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Private Golf Course Country Club
6. Property size (acres): 22.94 Acres (Hole #18)
7. Lake/ river/ ocean adjacent to property: Lake Norman
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Existing Bulkhead /sea wall modifications /replacement
with sloped (1:1) enhanced boulder wall.
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:
0.11 Acres (Lakeside)
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: 0.15 Acres
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): Golf course green
and fairwav Grass
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Owner /Agent's Signature* (15A NCAC 02H .0502(f)l Date "
Agent's signature is valid only if on authorization letter from the owner is provided.
FORM: SSGP 10 -2013 Page 2 of 3

Full Pond/
Normal Water Level
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Shoreline
La ke
(At Full Pond /Normal Water Level)
=480' of ex. bulkhead /sea wall to be modified
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( =3.5', centered,
each side)
Please see
attached plans for
additional details
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

Hole #18
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Location Map
Cornelius, North Carolina
Mecklenburg County
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Location Map
Cornelius, North Carolina
Mecklenburg County
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