20191322 Ver 1_Shoreline Stabilization_20190930

State of North Carolina
i0rtrr nt of Environment and Natural Resources
Division of Water Resources
WaterResources P 15A NCAC 02H .0500 -Water QQQity;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: 2
If sending via US Postal Service If sending via delivery service (UPS, FedEx, etc.)
Karen Higgins Karen Higgins ,vwk
DWR - 401 & Buffer Permitting Branch DWR - 401 & Buffer Permitting Br�h��ji'(
1617 Mail Service Center 512 N. Salisbury Street RE ®019
Raleigh, NC 27699-1617 Raleigh, NC 27604 SEP 3
A. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Wiitr ���4c�eGtt®0
Name: c h.ar V I
Mailing Address: 5_17 k e'ic'',X`/ (i?
r t'10rr?sU, ! Ile 1116, 22 117
Telephone Number: C1 -LJ -23-7-_7Z22_ Fax Number:
E-mail Address: Cker)-I s'g(",I cP'ro,> 4.1-1
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:
http://www.saw.usace.army.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT_AUTHORIZ
ATION FORM.pdf)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
B. 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, 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

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: I re rhe I I Nearest Town: Moor e S U -e
Lake/ river/ ocean adjacent to property: L. o, ke A)c mc,ri
Property size (acres): ap l ( o,►cre
of
Subdivision name or site address (include phase/lot number):
.5-cl 7 k -en wc,v In 17,1onrQs,, I/p A.Ir 2 9i ! -7
Directions to site - please include road names and numbers, landmarks, etc.: ISD
�rn -77 ectk k l •, L on Fern L k�nwo.v
Latitude (in decimal degrees) 7'>._9Z X330 Longitude (decimal degrees) F0:`'i0?K 76
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): 9 -OS t d-e✓Ilta i
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Wilt be ccu-i+A5 to 3.' i S to f e
e +0 v\/0 vVe P✓'oc11n6 �nk . SjOor ne SlifoDPr e, �v
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, backfill, rip rap, retaining walls, etc.) i square feet:
4nn.^Y. f900 S4U.-4. k,�iDV,/ (4\nrPl'" 1 5 ex'pof'pd C -Un- 4l iz
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, excavation, rip rap, reta
walls, etc.) in square feet:
Temporary impacts (temporary clearing, construction corridor) in square feet:
Z lore sQVowe
10. Please describe the vegetation above the normal pool lake level/ Normal Water Level and50
feet landward to be impact d (number of trees, for instance): ,� kif Le S ©rlcA+
(e Corv\f' S +0 � S�orp �tn e on � rPi fi
11. Signature
Owner/Ag 's Signat re* [15A NCAC 02H .0502(f)] Date
*Agent's signature is valid only if an authorization letterfrom the owneris 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 orfill 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)
In vsl�zs
Zxlss
Full Po /
S oreHne � r
X S
� P
x
S �
Plan View f�
FORM: SSGP 02-2017 Page 3 of 4
Lake
(At Full Pondf N—nal Water Le ell
Existing Dock
30ftx7ft
3 If 150 ft
-
gel w full pond) NM
Full Pond// Normal Water Level
,
! ror Me— r�
_ a1-17ft
Riprap
Abu -full pond/NWL
2 ft.x 150 ft
additional clearing
' If --y
E)'KAMPLE
Plan View
FORM: SSGP 02-2017 Page 3 of 4

Lake
(At Full Pond/ Normal Water
Side View
i � fo
P�
�r
l
3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing
if necessary
FORM: SSGP 02-2017 Page 4 of 4

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 her^y I SV fplL P, -
Mailing Address: 5q 7 �-?n vymz 1P.
Telephone Number:
E-mail Address:
FA •
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:
httD://www.saw. usace.a rmv. mil/Porta Is/59/docs/reRulatorv/reRdocs/Permits/SAM PLE_AGENT_AUTHORIZ
ATION FORM.pdf)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
B. 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, 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

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: .Ir -me U Nearest Town: /L'LDores UI
Lake/ river/ ocean adjacent to property: (mac, f� /'1oIvo n
Property size (acres): Aa�lp�ok. Gt ire
Subdivision name or site address (include phase/lot number):
5� 7 V_-r.q ivcAy 10 Moor -e vE Re i IVC 24117
Directions to site - please include road names and numbers, landmarks, etc.: I.so w es -f- Fn9�►-1
77ism jZZ Re 124\ f! en EWA N,II IQ
Latitude (in decimal degrees) 70 Longitude (decimal degrees) 07ci 7,'
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): �(, de -4+1 a I
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): UG
/i I( lze LI++I Aj 0,,e (j n P +0 3
w�'v�s Fved�,•5 ban1� Shofeli�r s I rv,nP�(v �or�. r�o�- nofic��S o�,l r►►���y
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, backfill, rip rap, retaining walls, etc.) in square feet:
/000
I.
Temporary impacts in square feet:
I 6 sg()eye -C4-.
9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet
land -ward
Permanent impacts (including back fill, excavation, rip rap, retaining walls, etc.) in square feet:
Isco 59,i, fl-�
Temporary impacts (temporary clearing, construction corridor) in square feet:
2 i co 4 "et" Ffi
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): 3 I 6L);es .)/) PI�_A�
te-4S l ct f. a -,A �v-a S S cC6,"­45 +a .s h ore I 1I.n2611 4 ky CLL,
11. Signaturela J 5
Owner/ g 's Signatur [15A NCAC 02H .0502(f)] Date
Agent's signature is valid only if an authorization letterfrom 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 orfill 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)
CX,
ZXI�S
Full Po / c
S orelil?e �� c
iC
� E
S r\
-f'
Plan View }k
FORM: SSGP 02-2017 Page 3 of 4
La ke
(At full Pmdl N—tal Water Level)
Existing Dock
♦r��t rr���r♦
•��
Full Pond/ Normal Water Level
50
E)'(A
M
P L E
Plan View
FORM: SSGP 02-2017 Page 3 of 4

t._. Lake �E �,�oP �� -C-t
(At Full Pond/ Normal Water L vel)
S�
tv �
p 0
zf
-a
C
Side View
LL.
3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing
if necessary
FORM: SSGP 02-2017 Page 4 of 4

State of North Carolina
Department of Environment and Natural Resources
N' 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:
Mailing Address
Srep, c,er
517 ker\wc\y f pr
IV\rg0t'eS„II[P hJG I Z807
Telephone Number: ft ('1101-q �-728 Fax Number:
E-mail Address: C derre(
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:
htto://www.saw. usace.armv.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE_AGENT_AUTHORIZ
ATION_FORM.pdf)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
B. 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, 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

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: _tetJe[� Nearest Town: %lourPSUI ((e
Lake/ river/ ocean adjacent to property: Lade NormoLr\
Property size (acres): ' acre IInPrQx
Subdivision name or site address (include phase/lot number):
5-�J i IMI-esOIN rfc 19117
Directions to site - please include -road names and numbers, landmarks/ etc.: [5-0 wes f-
-( ,, -77, +Ur'n K c At4k, I— on FPt-n HtII, L Kinwa Sq'7
Latitude (in decimal degrees) 35' 6 2-5'33 0 Longitude (decimal degrees) 3010 7q 7,6/
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): I`1 OLi\+ trn(
1_-e n "/ Cr
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): WI(t Ise C(A+xAy Skeye(ir-tb cA 3, l of
Vj/'&,I,eS ems' «`j (Dar((, Ao/"e/m (i pat aw'4 -&,A Lu+ A0An(.l!4Gw( "ney-
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, backfill, rip rap, retaining walls, etc.) in square feet:
PPrx' I ®d[© S61(Jgr2 °E+ P (d c.✓ Cstio���«C (5 P,��J�se� Cu»^P/jf{YWL
Temporary impacts in square feet:
f 600 _a urA{e -Cee-f-
9.
FPe-f-
9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet
land -ward
P rmanent impacts (including back fill, excavation, rip rap, retaining walls, etc.) in square feet:
V4, --e -��
T ora impacts (tem orary clearing, construction corridor) in square feet:
2-106) Sa Z/,q re -Fee+
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): 3 b ",,_5- o /1 LI#�+ a J
�e-C - <'J _e o -A l y -a 5 S col -,Q-5 �o -N-e >r e 5+ r
11. Signat re
Owner/Ag 's Signatu ` [15A NCAC 02H .0502(f)] Date
'Agent's signature is valid only if an authorization letterfrom the owneris 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 orfill to be placed above the Full Pond/ Normal Water Level elevation
c. Location of rip rap orfill to be placed belowthe 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
La ke
(At Full Pond/ Normal Water Level)
Ex b�U n�``�S
�XI�S
Full Pon /��
S orehir�e �(d
P
� E
S K
Plan View ik
Lake
(At Full Pond/ Normal WaterLvI) Existing Dock
3L tt . 7 It
FORM: SSGP 02-2017 Page 3 of 4

La ke
(At Full Pond/ Normal 1
c
Side View CL
73
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
Side Vi
FORM: SSGP 02-2017 Page 4 of 4

(No subject)
Tue 9/24/2019 9:40 AM
To: The UPS Store #2193 <[e-mail]>
597 Kenway Ip Mooresville. Google would not let me print a street map or vicinity map.

(No subject)
Tue 9/24/2019 9:40 AM
To: The UPS Store #2193 <[e-mail]>
597 Kenway Ip Mooresville. Google would not let me print a street map or vicinity map.

(No subject)
Tue 9/24/2019 9:40 AM
To: The UPS Store #2193 <[e-mail]>
597 Kenway Ip Mooresville. Google would not let me print a street map or vicinity map.

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