20191481 Ver 1_Shoreline Stabilization_20191028

State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources FORM: SSGP 10-2013
Shoreline Stabilization Application Form
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One copy of the application (including attachments) and the application fee should \be seA o:
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Applicant Information [15A NCAC 02H .0502(a)]
Owner Information DE�R°D'V
Name: `Doay tcl acne(�� (nno8 e-dson �E � 1
Mailing Address: 2by 22 lie �_r� Cove. C+_ OCT S g 2019
Co r t1 el u 5 . �4C_ 2 S031 y4wer
Telephone Number: r-Ioq - UD I - 17 50 Fax Number:
E-mail Address: e-d 7 Qmo , [ . Cam
Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http:/Zwww.saw.usace.armv.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: ibcl -U6Q - 5l (1 Fax Number: -1py - LtQ® - 5gCpq
E-mail Address: C kcSe.au_xlk�cD w ind6- r-eoa.rn. ne+
Person to receive the Certification Approval: Jan'i ce. EsiLip
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

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: _ 1'1'1Pc_Ih_�, V, Ir) () ro Nearest Town: Cor ne_I k35,
Subdivision name or site address (include phase/lot number): 2o+.i_2 Z _ g.Q Cue C-E-,
Cron I i os? Nr• 7 an � I L. + --o
Directions to site - please include road names and numbers, landmarks, etc.:
See (a__4a lnPc1
Latitude (in decimal degrees) 5.'- q o i-i 1 of Longitude (decimal degrees) q $ 8 y 3
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): l es tdky)+1GLt
6. Property size (acres): 1. Z cicms
7. Lake/ river/ ocean adjacent to property: 1-�ornnom
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): e. 310P i nsioJk ma44, n Q
�(l re5 filer n01 er r`I�
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, 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: ( I 0.�oVe-
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): nr +r&—en r mou d
`Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

Lake
(At Full Pond/Normal water Level)
3' be low
Full Pond/
Normal Water Level
Shoreline
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ftx 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
David and Janelle Godfredson
20422 Deep Cove Ct.
Cornelius, NC 28031
FORM: SSGP 10-2013 Page 3 of 3

1=2019 610 Fast Center Avenue, MoaesNlle, NC to 20422 Deep Cove Ct, Cornelius, NC =1- Google Maps
Google Maps 610 East Center Avenue, Mooresville, NC to 20422 Deep Cove Ct, Cornelius, NC 28031 Drive 10.6 miles, 22 min
610 E Center Ave
Mooresville, NC 28115
t 1. Head south on Evergreen St toward E Center Ave
17 s (197 ft)
r► 2. Turn right onto E Center Ave
l min (0.5 m)
Continue on S Church St to S Main St
2 min (0.6 m)
41 3. Turn left onto S Church St
0.5 mi
fO' 4. Turn right onto College St
0.1 mi
Take NC-115 Sand 1-77 S/US-21 Sto Bethel Church Rd in
Cornelius
14 min (8.4 mi)
41
5.
Turn left onto S Main St
1.2 mi
t
6.
Continue onto NC-115 S
2.1 mi
r'
7.
Turn right onto Langtree Rd
1.1 mi
8.
Usethe left 2 lanesto turn left onto the Interstate
77 S/US 21 S ramp
0.2 mi
9.
Merge onto 1-77 S/US-21 S
29 mi
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10212019 610 Fast Center Avenue, Mooresville, NC to 20422 Deep Cove Ct, Cornelius, NC 2BM1- Google Maps
Y' 10. Take exit 28 for US-21
0.2 mi
R 11. Merge onto W Catawba Ave
0.7 mi
Continue on Bethel Church Rd. Take Walter Henderson Rd
to Deep Cove Ct
3 min (1.1 m)
N 12. Turn right onto Bethel Church Rd
0.5 mi
* 13. Turn right onto Walter Henderson Rd
0.4 mi
41 14. Turn left onto Deep Cove Ct
® Destination will be on the right
0.2 mi
20422 Deep Cove Ct
Cornelius, NC 28031
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
your route accordingly. You must obey all signs or
notices regarding your route.
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Polaris 3G Map — Mecklenburg County, North Carolina
Date Printed: 10/21/2019 3:31:01 PM
Q
012 Miles
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This map or report is prepared for the inventory of real property within Mecklenburg County and is compiled from recorded deeds, plats, tax maps, surveys, planimetric maps, and other public records and data.
Users of this map or report are hereby notified that the aforementioned public primary information sources should be consulted for verification. Mecklenburg County and its mapping contractors assume no legal
responsibility for the information contained herein.

10/21/2019
20422 Deep Cove Ct - Google Maps
k MapS 20422 Deep Cove Ct
Imagery ©2019 Google, Imagery ©2019 Maxar Technologies, Orbis Inc, U.S. Geological Survey, Map data ©2019 50 ft
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10/21/2019
20422 Deep Cow Ct - Google Maps
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