20191479 Ver 1_Shoreline Stabilization_20191028

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 sMuldle-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)] OV,����®,�9
1. Owner Information
Name: 1►� 1 �c�.r� ,��
Mailing Address:
3 �� l�cau, .51r�et_ e L-rouy
1";CoflesVti4, NIL 26111
Telephone Number:-7y9`1e2 Fax Number: -
E-mail Address: 'frLc,",
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.armv.mil/Portals/59/docs/reaulatorv/reRdocs/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: [ Nearest Town:
Lake/ river/ ocean adjacent to property: L� V�rMar,
Property size (acres): --1 S
Subdivision name or site address (include phase/lot number): 315 54v-,,,p4 Cl-te
t. t�DprPSv►Ilo, >Jc 28(t"1 Pho�se 1`i Lar) l\S
Directions to site - please include road names and numbers, landmarks, etc.: Iw `I -7 "A
Vk�So . 2���� �. ��-u, L�� c^ Div �u a*x
.Latitude (in decimal degrees) 3 1�. � 3 0 9So Longitude (decimal degrees)_:�0- E �q 6 `! 9
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): VrnCr I
[7
Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
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:
Lf (oZ 5.17:
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:
` 62- Sf
Temporary impacts (temporary clearing, construction corridor) in square feet:
,v1A
10. Please describe the vegetation above the normal pool lake level/ Normal Water Level and 50
feet landward to be impa`ncte`jd� (number of trees, for instance): -r%YbZb IOt `C*s
11. Signature y�
�t �,-,
Owner/Agent's Signature* f 15A NCAC 02H .0502(f)l Date
`Agent's signature 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)
Full Pond/ Normal Water Level 0 D c' C )
Shoreline 0C;r
i� o�LtSk�
Lvt / 1 �
S 5
4
Dian View M60"-Y'A ,J( zg11�
Lake
(At Full Pond/ Normal Water Level) Existing Dock
/30ftx7ft
Full Pond/ Normal Water Le,
'Ihore' rine— — —
2 ft.x 150 ft.
additional clearing
H necessary
Plan View
w
( 5Li FIP 4'P
t ltx �111 eU00' - njwL--
'I 15`-i I 'R'i� �P
-�'II0vY)- �Vs�
FORM: SSGP 02-2017 Page 3 of 4

( —od�1
f rfusy)
l
w Q
- -- - - Lake/Leve�_
(At Full Pond/ Normal
Ic
o
v,
.Q
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
Side Vi
FORM: SSGP 02-2017 Page 4 of 4

:DON ALLEN .&AEISO CIA:TES P. A
"Since 1971"
CoMrnereia[ * Residentiat * Mortgage Surveys * Multi—FamFly
Construction Staking * Subdlvle,an Design * Topographical
131 Crb."toke Park: Drive Suite 102 * Mooresville * NC * 25117
QD4j 664-7029 (704) 664--8041 :Fox
I, certify that this mop was drawn under my supervision from an actual
survey made urider my supervision recorded in deed botak—. , page__ _„ and/or
plat book— 13, page`_3L that the ratio of precision is 1':.1010DO, that this map
was prepared in accordcince with the General Statutes of North Carolina :Chapter 89C.
my hand and seal co 'tha ,:.day of . Mlzy
A.D., 20. 19 PLOT PLAN AUG. 15,2010 .. .
CURVE TABLE
CURVE
I RADIUS
1. tENGTI4
I SEAR4140
CHORV
Cl:
1 725.97'
1 159.20'
71'41'0 4" W
58.88'
LOT 117
J"FS LONG
Rsov\1311
1 LA
NORMAN
�1
�4 L ��
700 CONTOUR PER lNSg`26 ltiy
'ACTUAL SURVEY �- J
5VN0C"U,-a
VICINITY MAP***NO SCALE'
63:5 '"y LOT '118
-- , VACATION AT LAIC'
cnNE w ' NO.RM'AN LLC
DR'
s a PROPOSE.D 6
HOUSE EX
i 9< vs �
-_" Loy' 11.8
& 78 AC.
Na4'1:9`51"E
LEGEND �r
q). = P.P. = POWER. POLE.
�pUB R`
r NOTES
= POWER. TRANS.
E.I.P. =EXISTING IRON FOUND
LP:S. = '#4 RE8AR SET
R/W' = RIGHT-OF—WAY
-= WELL
%
,,..•■" ) THIS PROPERTY MAY BE SLJBX T TO
ANY EASEMENT AND/OR RIGHTS —OF —WAY
OF 2) AREA COMPUTED BY THE COORDINATE
METHOD.
3) EX(S*G 76Q' & 761' CONTOUR ELEV-
KnON BASED ON LAKE.NORMAN LAKE
LEVEL AT COWAN'S I ORD DAM (READINC
ON 7\25\19:
CP _ COMPUTED POINT
4) UNDERGROUND POWR
5 NO GRID MONUMENT FOUND WITHIN
2000 FEET'
0. 25' ED' 1 QO' PLOT. p L A. SURVEY
_.. OF
SCALE 1N FEET 315 STUMPY CREEK RD
LOT 11& CRESCENT LAND & NBER CORP. SECT. 14
SCALE �,� 50' 11AV- 10:SON TVVS:R_ IREDE:LLL Co.:, 'N,C. FIELD adoie $14
F11.E CL7 110 514
ACQUIRED BY; TIM .& TRACY CARR oc FILM:
TAX MAP H(r. 46=95WS

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Printed October 15, 2019
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