20151253 Ver 1_Shoreline Stabilization_20151204

Blue
PLLC
: Ridge • •
December 2, 2015
Division of Water Resources
401 Oversight/Express Review Perrnitting
1617 Marl Services Center
Raleigh, NC 27699-1600
Ref: Shoreline Stabilization Application Form
449 Stillwater Road
Troutman, NC 28166
924 Main Street, Suite 200
North Wilkesboro, NC 28659
[phone]
Firm #P-0205
via UPS overnight
To Whom It May Concern:
Attached you will find three (3) copies of the Shoreline Stabilization Form we have prepared for the above
referenced project, along with the $240 application fee. Please call me with any questions or if you need
additional information.
copy: Job File 15031
For the Firm,
Blue Ridge Engineering PLLC
W. Jesse H , PE
Engineer

State of North Carolina
Department of Environment and Natural Resources
DW_
Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500 —Water Quality Certification, Shoreline Stabilization
FORM: SSGP 30-2013
Shoreline Stabilization Application Form
PAID
Three copies of the application (including attachments) and-thesapplkation fee should be sent
to:
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center DEC 0
Raleigh, NC 27699-1617 e
I. Applicant Information (15A NCAC 02H .0502(a)j
1. Owner Information
Name: John Kindlev
Mailing Address: 114 Morlake Drive. Suite 201
Mooresville, NC 28117
20�5'2
53
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: ikindlev(@eciuitvcp.com
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.armv.mil/Portals/59/docs/reRulatory/reedocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: W. Jesse Hanlin. PE
Company Affiliation: Blue Ridee Ensineering. PLLC
Mailing Address: 924 Main Street —Suite 200
North Wilkesboro, NC 28659
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: [e-mail]
Person to receive the Certification Approval: W. Jesse Hanlin, PE
II. Project Information f 15 NCAC 02H .0502(a) & (b)j
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: Iredell Nearest Town: Troutman
Subdivision name or site address (include phase/lot number): 449 Stillwater Road„
Troutman, NC 28166 — Lot 72 Section 17
Directions to site - please include road names and numbers, landmarks, etc.: From 1-77N:
Take Exit 42 for US-21/NC 115 toward Troutman. Turn L onto US -21 N. Turn L onto Flower
House Loop, Turn R onto Clontz Hill Rd.. Turn R onto Perth Rd.. Turn L onto State Park Rd.,
Turn L onto Morrison Farm Rd., Turn L onto Dav Vault Cut. Turn R onto Stillwater Rd.. Site
will be on the L.
Latitude (in decimal degrees) 35.645413 Longitude (decimal degrees) -80.920671
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Undeveloped, one existing dock on site
6. Property size (acres): 0.768
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): This application is to obtain minor water auality
certification. The existing shoreline has eroded along the rear lot line of the propertv. The
proposed shoreline stabilization will remediate ongoing erosion.
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:
6'x190'= 1,140SF
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: 15'x190' = 2850SF
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): Cleared house lot with
no undergrowth
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Owner/AgSignature 115A NCAC 02H .0502(f)l Date
Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

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PROPOSED
DISTURBED LIMITS
PROPOSED (3,990 SF)
DISTURBED LIMITS
15'x190' ABOVE
NORMAL POOL L o T 72
SECTION I
0.768 ACR
M
/ STILLWATER ROAD /
EXISTING FLOATING DOCK
AND COVERED BOAT SHED
PROPOSED
DISTURBED LIMITS
6'X190' BELOW
NORMAL POOL
SCALE IN FEET I"=50'
0 25 50 100

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Pio FIDE

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION: BK 23s(0 //
LOT NO. � KI � J6
PLAN NO. I I PARCEL ID: `
STREET ADDRESS: 4H7STIt-c _0'4'VF—e'- Rin
Please print:
Property Owner:
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
4&NI-I PL , of -9GvtrR�QZG ti1G�IJFF=fZI�, PLLC.
(Contractor / Agent) (Name of consulting firm)
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.
Pro)plerty Owner's Address (ifdifferentthan property above):
//"1 IilORL ere-
Telephone: (�Oq) '7-Q9 - %Da—
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
�Authrized Signature
Date: %� f
Authorized Signature
Date: