20161202 Ver 1_Shoreline Stabilization_20161208

State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
Dtvlsioa 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 2 0 1 6 1 2 0 2
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name:
Mailing Address: 1l
2016
Telephone Number: (�" f.}�1 /!fUe) Fax Number: RCE;
401 & BUFFER PERMITTINI
E-mail Address:
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: A )c sQQ en -`L
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)]
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.
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.
%A 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: Nearest Town: A)L
Subdivision name or site address (include phase/lot number):
� .- - � V _moi' � •
Directions to site - please include road names and numbers, landmarks, etc.:
KI)
10a AprZe_ is cA- 44v-_ u- &_fy ��G
ry�W,V O� �
MSL6IewIbkctM
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.): CeSiclpn _�� �G,Ca✓ norr'►.c:,n��harc�� o_
6. Property size (acres): o 77 GLrn—
7. Lake/ river/ ocean adjacent to property:
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): 51Jnr6VVNP_ orcnuPY'i-
�., It; rxre L" CLg h A n .+ < I c of c&+ wctshli)
IJ
9. Will work be conducted from land? 91 From water? ❑ info +he, t4V'e.
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:
910 Sfi j l�� �o (i QP M c5� 4no(-Ai✓1 31c>C LDra of floe i#&)r,,S>
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%orN&
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): G i_0 SS C Ogj
�2y I arrr _ +r s
Owner/Ag is Signatur4tII--CAC02H .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)
is 2 70
Ft
Norma
51
33
Please approximately sketch the following information on this plan (provide dimensions foreach
item, such as 10 ft x 100 ft)*:
1. All proposed vegetation clearing.- none=
2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation-nVI)e-
3. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation - ShvwO
4. Location of any proposed structures such as buildings, retaining walls, docks, etc.- none -
5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation--none-
6. Location of construction access corridors — none- - iA&- witt cS r;ve,'iJ-'Vyh pry YCIld
FORM: SSGP 10-2013 Page 3 of 3

11/14/2016 ConnectGIS Feature Report
Iredell
ONNECTIGISPrinted November 14, 2016
WIF ur p;rr--arJ 1 r1T 13 1 ' See Below for Disclaimer
Addresses
• Infrastructure
NonResidential Use
Residential Use
Streets
Interstate
— Ramp
US Hviy
" State Hvoy
blain Road
wry r.
Local Road
4
' Residential
1.
Private
Inactive
a f Parcels Hooks
„ Parcels
,+ ❑
City Limits
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f' I -ake Norman
Iredell Couniyline
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,. NC Counties
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the maps prepared for this website are generated from recorded deeds, plats, and other public records. Users of these maps are hereby notified that the in ormatic
provided herein should be verified. Iredell County assumes no legal responsibilities for any of the information contained on this site. Users are advised that the use i
any of this information is at their own risk. All maps on this site were prepared using a 10005€" Grid based upon the North Carolina State Plane Coordinate System froi
the 1983 North American Datum. The delinquent real property tax overlay is updated monthly. The information presented is not intended to be used or relied upon
--1 - -,.;moo mf taw rianc rnr additional information reaardino delinquent taxes, contact the Iredell County Tax Collector's Office.

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DUKE POWER COMMy TO CRESCENT LAND 4
TIMER COMP- OEEO SOON Hl FADE $I•
DATED MY 1. Iso
BUILOINO SETBACK LINE{ AN 25 FEET FA0
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ONO 10 FEET FROM At Of LOT LIN[.
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PROPERTY LINE DISTANCE$ ARE COMPUTED TO
POINT M INIERKCTIW AT STREET CORNEAS•
PRMENTY LINES ONONN WHICH FOAM THE CODE
OF LANE NORMAN FOLLOWS CONTOUR ELEVATION
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c CRESCENT LAND 4 TIMBER CORP.
LAKE NORMRJ
MAP OFo
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SECTION.
N= LOTS 138-145
m DAVIDSON TOWNSHIP
IREOELL COUNTY, N. C.
SCALE 1" = 100' RM MAY 31. Isis
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c CRESCENT LAND 4 TIMBER CORP.
LAKE NORMRJ
MAP OFo
o } RECREATION LOTS
SECTION.
N= LOTS 138-145
m DAVIDSON TOWNSHIP
IREOELL COUNTY, N. C.
SCALE 1" = 100' RM MAY 31. Isis
RISC. BOOM NO. 4f4 S R. s. E ONO• No. C. F. 9 - J
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