20080826 Ver 2_Shoreline Stabilization_20190603

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State of North Carolina
Department of Environment and Natural Resources
DWR 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
One copy of the application (including attachments)af'*Athe application fee should be sent to:
Division of Water Resources __
401 & Buffer Permitting Unit
47-4
1617 Mail Service Center
Raleigh, NC 27699-1617+
FUN3 2019
I. Applicant Information [15A NCAC 02H .0502 a] , T
1. Owner Information
Name: Mash 1-11"7, Ll_C_ / l)urf bu5Ch
Mailing Address: [ 5 L uQ= Lo.
�(Llc�o res v% t l e. KL a B I t'1
Telephone Number: 'log{ - ada - 8 t 5'5' Fax Number:
E-mail Address: n7 RL) 4656%. C.orrn
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:
Company Affiliation:
Mailing Address:
Telephone Number: "614- Cc Cvb - 5 11 1 Fax Number: ''7011- W g O - 5GCD q
E-mail Address: CSeoL,m.tl5� wi n�S4-rPaM . nC, --
Person to receive the Certification Approval: U JO n;c P r=.5Le4
II. Project 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.
2. Provide a detailed site plan showing property boundaries and proposed locations of
vegetation clearing, structures (buildings, retaining walls, docks, impervious surfaces,
etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
FORM: SSGP 10-2013 Page 1 of 3

Lake
(At Full Pond/ Normal Water Level)
J�
Full Pond/ boulder
NormahoiC��� � ► l I
Sreline�+ 0-6v e. NO +reeco re"Je-d
I�lo d',S�vr)oance -Vo
NO, 0' l e.n s+h b-,FVer
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
Kash 1717, LLC/Kurt Busch
170 Broad Sound PI.
Mooresville, NC 28117
FORM: SSGP 10-2013 Page 3 of 3

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: Tredell Nearest Town: lM00rG5v'' lie -
Subdivision name or site address (include phase/lot number): 1-7c)_l rn4d Sound PJ.
JLYlc� rG s� , l le _ NG a >3 l t 'l Lok # S :� to ►'lto � � n-%
Directions to site - please include road names and numbers, landmarks, etc.:
See C AACL Ined
Latitude (in decimal degrees) 35 . s aaa4 -t Longitude (decimal degrees) - SU. q 3 1p Lo LQ
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.):
6. Property size (acres): 1. ALiq acreS
7. Lake/ river/ ocean adjacent to property: JAerrYlar
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): je e '► S4 ► no uJ A - 'I n'b �a I l
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:
11. Total amount of disturbance (including all clearing, back fill, l 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: o l 0-6ve-
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):
Owner/Ag is Signature' SA NCAC 02H .0502(f)l Date
'Agent's si i only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

1. , . , , i I " ';' i•, ,

5342019 610 E Carter Ave, Maxeswlle, NC 26115 to 170 Broad Sound Place, Moores%ille, NC - Google Maps
Google Maps 610 E Center Ave, Mooresville, NC 28115 to 170 Drive 11.9 miles, 25 min
Broad Sound Place, Mooresville, NC
610 E Center Ave
Mooresville, NC 28115
t 1. Head south on Evergreen St toward E Center Ave
14 s (197 ft)
Take W McLelland Ave and E Plaza Dr to Talbert Rd in
Davidson
8 min (2.8 mi)
rI 2. Turn right onto E Center Ave
0.6 mi
41 3. Turn left onto S Main St
407 It
F* 4. Turn right at the 1 st cross street onto W McLelland
Ave
1.0 mi
41 5. Use any lane to turn left onto E Plaza Dr
.1 6. Turn left onto Talbert Rd
1.1 mi
2 min (0.9 mi)
Follow NC -1100 to Broad Sound PI
14 min (7.9 mi)
N 7. Turn right onto NC-1100/Brawley School Rd
48m(
t 8. Continue straight onto NC -1100
1.7 mi
9. At the traffic circle, take the 2nd exit and stay on
NC -1100
1 4 mi
ro 10. Turn right onto Broad Sound PI
1 min (0.3 mi)
170 Broad Sound PI
Mooresville, NC 28117
These directions are for planning purposes only.
You may find that construction projects, traffic,
weather, or other events may cause conditions to
differ from the map results, and you should plan
Mtpsltmw..google.corNnapaldir/610+E+Cer%er+Ave.+Mwme ille,+NC+28115170r&oad+Sand+Fl",+M—m4lle,+NCI@35.5716761; 80.9049202,13r1a... W
530'2019 610 E Center A%. Mcoreswlle, NC 26115 to 170 Broad Said Place, M—ille, NC - Google Maps
your route accordingly. You must obey all signs or
notices regarding your route.
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170 Broad Sound PI - Google Maps
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