The URL can be used to link to this page

Home My WebLink About20181439 Ver 1_Shoreline Stabilization_20181019SAMPLE AGENT AUTHORIZATION FORM PAID 2o1a14sa PROPERTY LEGAL DESCRIPTION: LOT NO. PLAN NO. �� PARCEL ID: STREET ADDRESS: , V 1 LA K C R I V E Cnanl 6Ti"E -NIC Please print: Property Owner: IA Property Owner: M 4 YZ C A K LT W 1,6P - The undersigned, registered property owners of the above noted property, do hereby authorize C` q -Vb H J�IZ 04 ✓V , of I -yr ✓' /z#r//U E' (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. Property Owner's Address (if different than property above): 9 3 L Td' Dell/ ase � r henry w /%-,lf',lC 2 V2 l Telephone: 17 0 Y S-13 We hereby certify the above information submitted in this application is true and accurate to the best of our knowledge. Authorized Signature Date: Yo -r -If ALkh irized4ig/o r- / Date: l o r ` `` nrT19201 ITI r�v_ State of North Carolina Department of Environment and Natural Resources Division of Water Resources Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization ENVIRONMENTAL QUALITY FORM: SSGP 02-2017 Shoreline Stabilization Application Form Three copies of the application (including attachments) and the application fee should be sent to: If sending via US Postal Service If sending via delivery service (UPS, FedEx, etc.) Karen Higgins Karen Higgins DWR — 401 & Buffer Permitting Branch DWR — 401 & Buffer Permitting Branch 1617 Mail Service Center 512 N. Salisbury Street Raleigh, NC 27699-1617 Raleigh, NC 27604 A. Applicant Information [15A NCAC 02H .0502(a)] 1. Owner Information Name— C, Mailing Address: TelephoneFax umber: E-mail dress: 2. Agent/ Contact Person Information A signed and dated copy of the Agent Authorization letter must be attached if the Agent has signed this application form. (A form can be downloaded here: htti3://www.saw.usace.armv.mil/Portals/59/docs/reeulatory/reedocs/Permits/SAMPLE AGENT AUTHORIZ ATION FM.pdf), _ Name: Company Affiliation: \\y Mailing Address: \\G Telephone Numb E-mail Address: 14ax Number: B�Iroject Information [15A NCAC 02H .0502(a) & (b)] 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. 4 Provide a detailed site plan showing property boundaries and proposed locations of vegetation clearing, buildings, retaining walls, docks, impervious surfaces, 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. FORM: SSGP 02-2017 Page 1 of 3 ..3Attach 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) Count �s� arest Lake riv ocean adjacent to property-' Property size (acres): =ck_% Subdivision nameor ite address (include phase/lot number): Directions t site - please include road names and numbers, landmarks, etc.:�'A\A Latitude (in decimal degrees) 5. Describe the existing land use jondition of (residential, undeveloped, et-. ): = Longitude (decimal degrees)�45,4� at the time of this application 6. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or why it is necessary): rQSe-s torJ )LLkq l Vc%)e, vc_f-4ec•,-c �,v4cGzc� - r� (�; s4,ay e- 7. -- 7. Will work be conducted from land? From water? ❑ 8. Total amount of impacts below the normal pool lake level / Normal Water Level Permanent impacts (including all excavation, ackfill rip rap, re Z_ taining walls, etc.) in square feet: y �� Temporary impacts in square feet: �� 9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet land -ward Permanent impacts (including back fill, ex avation, n�� rap, retaining walls, etc.) in square feet: l 211 sS. ► �`P f�J Temporary impacts (temporary clearing, c struction corridor) in square feet: 10. 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): /r -s6 4 rd T✓Zsj 11. Signature e � /e Owner/Agent' s S' ure` [15A NCAC 02H .0502(f)l Date *Agent's si nature is valid only if an authorization letter from the owner is provided. FORM: SSGP 02-2017 Page 2 of 4 12. Please approximately sketch the following information on this plan and provide dimensions for each item: a. All proposed vegetation clearing b. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation c. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation d. Location of any proposed structures such as buildings, retaining walls, docks, etc. e. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation Lake (At Full Pond/ Normal Water Level) Ci OO 6,0 Full Pond/ Normal Water Level J v� a d Gtr cxa p OC9(� Shoreline C) U L9 0 0 U O C3 00 6 60Q "7J '7C o 1 Plan View FORM: SSGP 02-2017 Page 3 of 4 Lake (At Full Paul/ Normal Water Level) Existing Dock 30 h x 7 ft 3axMft Below fUH pad/ NWL Full Pond/ Normal Water Level "Ihoreon- _ —4ft.Riprap Above full pond/ NWL 2 ft. • 150 ft. addItlonal clearing • if necessary E'KAMPLE Plan View FORM: SSGP 02-2017 Page 3 of 4 Lake (At Full Pond/ Normal Water L , C Side View 3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing if necessary Existing bank 10 ft. bank a height cue QUO�O FORM: SSGP 02-2017 Page 4 of 4 10/13/2018 Go gle Maps 2031 Lake Dr o 2031 Lake Dr - Google Maps 2031 Lake Dr Charlotte, NC 28214 ,eV You visited 2 weeks ago 82G9+26 Harwood Lane, Mt Holly, NC Go gle Map data @2018 Google 1000 ft k—kbq-m 9 https://www.google.com/maps/place/2031 +Lake+Dr,+Charlofte,+NC+28214/@35.325048l,-80.9907337,15z/data=!4m5!3m4! 1 sOx8856a4add1399979 O https://www.google.com/maps/place/2031 +Lake+Dr,+Charlofte,+NC+28214/@35.325048l,-80.9907337,15z/data=!4m5!3m4! 1 sOx8856a4add1399979 xv e t: ,a.► AA Jr a 14 1116 It". 7 fP vim , r ti lip j I ! 1. ` • �� ' it n r • ,[ i1 r - - 7�� JA • Vis_- °, ,. � � r�= ��% y 4, • S AA ate. ~rte •-"="e' � �� •.. ,�� ' . `'�e ��, � � 3 s �, va AA � �i��. ��v. ! s'4', �� •Y 1 .�'+ .'T1��A �y ;, "srry'' '_ � ''� s, . S i� •� � �� I�S � ,43 01��, .46 It low It v .. � i .r—� ° • r �� s �• � . i�, � �,pp , � !i ni9t+'� , t .�1 � y tt �j\ "y� �a•pu �� ;•s i � - - �i � •� 'tom � _ • �� ` \ �R• ALA ..e t t. 3 y a • � • y his �• _ -1 � .