20191324 Ver 1_Shoreline Stabilization_20190930

{ State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Water Resources
10-
15A NCAC 02H .0500 - Water Quality Certification, Shoreline Stabilization
=�,VIFQN,".E- -AL QUALITY FORM: SSCP 02-2017
Shoreline Stabilization Application Form 2 0 1 9 1 3 2 4
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 Br rich
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC 27699-1617 Raleigh, NC 27604 $AEGi
SEP 3 0 2018
A. Applicant Information f15A NCAC 02H .0502(a)] n go;;rc�s
1. Owner information n �g �ecz�on
Name: �. sa H �e n r10'a
Mailing Address: 232 4 'SW ; Z* len d R I
Telephone Number: 21V A8. 35$&7 Fax Number:
E-mail Address: 0 ,-'X A i n cam. '►�'�'
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/Portais/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 115A NCAC Q2H .0502(a) & fb)]
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)
Nearest Town: vhay' 'e-
-T I Ile .r
Property size (acres): . 5 o—r'c'S
Subdivision name or site address (include phase/lot number):
Directions to site - please include road names and numbers, landmarks, etc.:
-�P
0-4,."e4 maP
County: 5kU4 14
Lake/ river/ ocean adjatent to property
Latitude (in decimal degreesXi�;--,kfe74 longitude (decimal degrees)
S. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Il`cz5i C c A-ia
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): 51\ o 64, 1 i ha - o6�'�i'Z�
r'
7. Will work be conducted from land? to 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:
a -Y, (,r-)' ':-- ( 020 " I
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, retaining walls, etc.) in square feet:
Temporary impacts (temporary clearing, construction 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):
--
11. Signatu e
8 t �
Owner/Agent's Signature [15A NCAC 02H .0502(f)l Date
Agent's signature is valid only if an authorization letterfrom the owner is provided.
FORM: SSGP 02-2017 Page 2 of 4

r
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 anv excavation or dredging below the Full Pond/ Normal Water Level elevation
Full Pond/ Normal Water
Shoreline
Plan View
FORM: SSGP 02-2017
Lake
(At Fell Pond/ Normal Water Level)
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MW
LYKA:` r I =
Plan View I V �k
Page 3 of 4

ti
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
QUO
AMPLE
Page 4 of 4

)RAKE, CERTIFY THAT THIS PLAT WAS DRAWN BY ME FROM AN ACTUAL
BY ME, DEED DESCRIPTION RECORDED IN DEED BOOK (AS SHOWN) PAGE (AS
BOUNDARIES NOT SURVEYED ARE CLEARLY INDICATED AS DRAWN FROM
-OUND IN DEEDS OF RECORD IN THE STANLY COUNTY, NC REGISTER OF DEEDS
THE RATIO OF PRECISION IS 1:10.000+. WITNESS MY ORIGINAL SIGNATURE,
NUMBER IS 9TH DAY OF NOVEMBER 2018
1XE, PLS
ER: L-4962
CA O '
•.,v
Q' . F NCC •�'9
- � s
�0"4/
q '.
N L�••°•
DARE FEET
ILD POINT
ON PIN (SET)
G IRON PIPE
G IRON ROD
0 SCALE
OF WAY
0 TOP PIPE
fIC SIGNAL
RON
Y IS SUBJECT TO ANY EASEMENTS, RIGHT OF WAYS,
RESTRICTIVE COVENANTS OF RECORD PRIOR TO DATE
IORMATION BASED ON MAP BOOK 5 PACE 105 AS
1 STANLY COUNTY REGISTER OF DEEDS.
1 ON CAROLINA POWER AND LIGHT PROJECT
L-0-8963 DATED NOVEMBER 1995.
WAS DONE WITHOUT THE BENEFIT OF A TITLE
DOES NOT CREATE OR CLOSE A STREET.
WDINATE METHOD.
LOT 8
127,
GRAVEL
"23224"
1" EIP
AXLE � •,
1- EIA"00
LOT 7
7.420 SO. FT.,
0.17 ACRES
DB 1031 PG 233
_ 1 ,HEC:
1'29'E •
Al O
33 6.16' i� - •.
Z SOIL DRIVE
P p"
"
;. ��.., LOT 6
"23220 ; 1 tF 8,457 SO. FT.,
,a�,., ua;. 0.19 ACRES
DB 862 PG 192
1" DP N86'10'36"W
ENBY 147.99
'LAKE TILLERY'
LOT 5
1' EIP
Z�
t GRAPHIC SCALEs�
40 0 20 40 80 1 V
EIP
� w/cAP
(
IN F'EE'T )
1 inch = 40 ft.
r,
LINE TABLE
Q
LENGTH BEA
6=LRI 940.776,N
BOUNDARY SUI
23220 & 23224 SWIFT
LOTS 6 & '
MAP BOOK 5 PAC
S. ALBEMARLE #1 TWNP, STAT
LANDSURVEYN
1525 BEAGLE CLUB
SALISBURY, NC 28.
704.746.4799
SURVEY FOR AI
DEBORAH TUCKER HUNEYCUTT PROERTIES 657E
18858A DUSTY RD. LTD. 6571
LOCUST, NC 28097 4035 RIVER FALLS DATE
AND SAN ANTONIO, TX 78259 1