20170005 Ver 1_Shoreline Stabilization_20161230

State of North Carolina
Department of DWR Environment and Natural Resources
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
0 5
401 & Buffer Permitting Unit 2 0 1 7 0 0
1617 Mail Service Center D
Raleigh, NC 27699-1617
1 DECS
P Ec �
Applica Information [15A NCAC 02H .0502?a}j E' 2016
wner Information o JAI. -
Name: ,
�C Mailing Address:
iVD F/Z H Z L-/-
11`'7 Uj 2 7:
Telephone Number: Fax Number:
E-mail Address: cHAlvice-9 F6crt-4:0 L s. (-oM
2. Agent' Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
"ttp://www.saw-usace.army.miiZPorta's/59%docs/regulatory/reggocsrPermi,s%SAMPLE AGENT Alj T H
ORIZ.ATION FORM pdr) must be attached if the Agent has signed this application form.
Name: kDIr�rT (X ((104e
Company Affiliation: [ (Aggle ae Corrkaol'b" _
Mailing Address: I Oso rl Willow Oak 9d
Normal, tic- .28128
Telephone Number: 70Y __ _5 &a6_ Fax Number:
E-mail Address: _rbW Id y" WiAJciYi,,,in, A&
Person to receive the Certification Approval:
II. Project Information [15A 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 anc proposed locations of
vegetation clearing, structures {buildings, retairing wails, docks, impervious surfaces,
FORM. SSGP 1G -Z013 Page ; 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 pr6:��
perty (where work is to be conducted)
Y�
Count //••!! n.Nearest Town:
Subdivision name or site address (include phase/lot number):
Dire ions to site - please .nclude road names and numbers, landmarks, etc.:
✓ Ue2 (% R I a,✓t�i
,3S^ 30 J 07Longitude (decimoidegrees) � ty40' D76
Latitude (rnbecimal degrees) 0 r
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): ArAkC-
6. Property size (acres): A 8 3
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): 1/V a /1�'�'�� � aNG
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:
/;z o F71 Y 3 T -f 3G 6 s g /;r/ h&/a'✓ %// Avd
11. Total amount of disturbance (including all clearing, back fi(, 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: /a O ?L �,�'� �/ gNd
12_ Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 feet landward to be impacted (number of t
C r,n ,- /1 -r.P rlrS -k/e— i
for instance):
�2 00 (:C/
)2,112, b 4o
Owner/Agent's Signat ' (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

Lake
(tit f utt Pond/ Normal water tPvet)
�2LO� 3+-
3 t't> o S7 F-�-
bt�low `:Lll Porgy
Please approximately sketch the following information on this plan (provide dimensions for each
item, such os 10 ft x 100 ft)*:
1. All proposed vegetation clearing
Z. 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

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO
STREET ADDRESS:
�C_ 21756
Proper Owner,
PARCEL ID: 65% 0 Zg�1j$L%
A Vt
The undersigned, registered property owners of the above noted property, do hereby authorize
DICwt Q,� , of f / M A cihA .t V-<
(Contractor / Agent) (NaFe 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.
Property Owner's Address (if different than property above):
Telephone: - Z� Z�s�
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
f
Authorized Signature
Date:
Authorized Signature
Date:

North Carolina Department of Natural and Cultural Resources
State Historic Preservation Office
Ramona M. Bartos, Administrator
Governor Pat McCrory
Secretary Susan Kluttz
October 20, 2016
Don Underhill
157 Uwharrie Landing Drive
Mount Gilead, NC 27304
Office of Archives and History
Deputy Secretary Kevin Cherry
Re: Soil Disturbance, 157 Uwharrie Landing Drive, Mount Gilead, Lake Tillery, Montgomery County,
ER 16-1826
Dear Mr. Underhill:
Thank you for your application of October 3, 2016, concerning the above project.
We have conducted a review of the project and are aware of no historic resources which would be affected
by the project. Therefore, we have no comment on the project as proposed.
The above comments are made pursuant to Section 106 of the National Historic Preservation Act and the
Advisory Council on Historic Preservation's Regulations for Compliance with Section 106 codified at 36
CFR Part 800.
Thank you for your cooperation and consideration. If you have questions concerning the above comment,
contact Renee Gledhill -Earley, environmental review coordinator, at 919-807-6579 or
environmental.review�ncdcr.gov. In all future communication concerning this project, please cite the
above referenced tracking number.
Sincerely,
tf, Ramona M. Bartos
Location: 109 East )ones Street, Raleigh NC 27601 Mailing Address: 4617 Mail Service Center, Raleigh NC 27699-4617 Telephone/Fax: [phone]-6599

l U/J/LUl b
Details hide
Parcels
Parcel No: 6576 02 89 8184
Parcel Address: 157 UWHARRIE LANDING AV
Owner: UNDERHILL DON W
UNDERHILL BETTY SUE
157 UWHARRIE LANDING AVE
MT GILEAD NC 27306
Tax District: LAKE TILLERY FIRE
Township: UWHARRIE
Vol Fire: FIRE DS LAKE TILLERY
Neighborhood: UWHARRIE
Legal 1: UWHARRIE LANDING
Legal 2: LOT 1
Legal 3: UWHARRIE LANDING#1
Deed Reference: Bk. 669 Pg. 857
Transfer Date: 20110101
Land Area: 1.83 acres
Sale Amount: 699000
Sale Instr: WD
QufiCode: H
Land Value: 270750
Major Imp Value: 363846
Misc Imp Value: 30804
Total Value: 665400
Appr Code: 01
Appr Desc: RESIDENTIAL
Class Code: 1
Class Desc: RESIDENTIAL
Year Built: 2007
Grade: B+010
Finished Area: 3059
Num Baths: 2.1
Num Bedrooms: 3
Attributes at point: N: 569130, E: 1678853
Fire Districts
Name: Tllery
Townships
Name: UWHARRIE
Proposed Voting Commissioner's Districts
District: 1
Zoning
Zoning: Residential 1
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