20191473 Ver 1_Shoreline Stabilization_20191024

State of North Carolina
Department of Environment and Natural Resources
Division of Water Res s'
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stab
FORM: SSGP
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 Streeta¢
Raleigh, NC 27699-1617 Raleigh, NC 27604
pC1 4 ZW)
I' t I f t' [15A NCAC 02H 0502(a)1
A. App scan n orma ion _ s
1. Owner Information
Name: /J%'�%r��ay1��; /i" /iCl�/C �' e �tn�►'�in9
Mailing Address: L-/ `7G s� i
Telephone Number: _7VI `05-
E-mail Address: (%.}t,k-cL��
2. Agent/ Contact Person Information
Fax Number:
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)& ;bi1
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

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) 1) ff
County: &I (e i Nearest Town:
Lake/ river/ ocean adjacent to property: Z ol�6 ,/, /%/-'
Property size (acres): , & ( —
Subdivision name or site address (include phase/lot number): c,4le' 126, 1,��
Directions to site - please include road names an.d.numbers, landmarks, etc.: 500jk ), Kvi-I 5
lie��n,? l��r�'►+S ,�',"uirtil-c�,� �z'�1a��1�, � ;����'�'�h �1, f_�,�k
Latitude (in decimal degrees)
Longitude (decimal degrees)
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): ft5,iXe`,, i{Ire �� oi-lead
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): lrle i i roc-y/c uc�;r,s/� -��9n c�o'��r� C I3e.�� B 1 (St6;
i=d , �We i I4,2 Ljzi i f raA r 1 �"f{'.if/�'f f
7. Will work be conducted from land? X From water? ❑
S. 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:
god 4,
Temporary impacts in square feet:
,boo 5 9, PA
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:
900 :5 /. fl
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):
I(
11. Signature
Owner/Agent's Signature [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 anv excavation or dredging below the Full Pond/ Normal Water Level elevation
lFll Fond/ ill ' ;
I Shoreline
FORM: SSGP 02-2017
Page 3 of 4

Survey for WILLIAM HAROLD SEITH and wife,
MICHELE MARIE SEITH
Subdivision EAGLE POINTE SUBDIVISION PH. It
Lot(s) 11 PLAT BOOK 23 PAGE 248
Tax Parcel 6575-03-12-1891 DB 1678 PG 1 104
Street Address EAGLE POINTE DRIVE
Township NORWOOD County STANLY State NC
y EGGS RtpCE LN
TALON Cr.
U � /_.
EAGLE ParA,� z oR I.
RANOALLS FERRY RD SITE
SR—T802
LAKE TILLERY
VICINITY MAP (NTS)
CURVE TABLE ,Q
CURVE fiADIUS ARC LENGTH CHORD LENGTH CHORD BEARING.
C7 260.00' 1 66.65'66.46" 56040'S0"E �%�
LINE TABLE
LINE BEARING DISTANCE
Li N7543'04W
L2 N46'4r'36"W 45.88' 1/2" EIR - .?'4,
2" DEEPSPB 3" p T� DI2 R/W
LINE TABLE — 71E LINES ONLY CTV
LINE BEARING DISTANCE NoPunr.,.edHarsantalcontmt TpEij SPB 01
L3 N46-12'33"W 3289' wtfhi,2OW'ofthis$o—Y-.
C ) x
L4 N4324'09"W 67-18 This S,uvey s oran existing Pam 1 o
15 N4323'10"W 30.32 drparslsoffand WM Z p
Survey Based m Existing Go— g S
1/2»EIR
Nn attempt has been made as a part of this
Foond nn Sile.
BoondaryS_y. obmrn m stww.data concenrin9
,�
existence, size, depth. corvM... espaaty. or
ef.
1—v- or—y'64 ortrwnidpal/pJHic-- f e ity.
For inkfion mgardvg tnese uuli9es or
N
fadlives, PI �e —tav the aPp'-Priate a9an-y.
�t5-e
DEVELOPERS,
INC.
enls.. EDGEWATER
Easernerts, Agfeemenls, to
IF—t
R19htof-xray nfracotd prrnr tc DB.
1218, PG. 710
da[e nflhx plat, Mich was not
wsfWear the Yune or my inspection.
LOT 10
�
7h.'s prat is subfed In a / facts
ry
thatmay be dlsdosed by a 1-98
N
accwate title sewcb.
tD
Z
'rY.IS MAP MAY NOT BE A CERTIFIED SURVEY AND HAS NOT
BEEN REVIEWED BYA LOCAL GOVERNMENTAGENCY FOR
COMPLIANCE 'WTTH ANY APPLICABLE LAND DEVELOPMENT
REGULATIONS'AND HAS NOT BEEN REVIEWED FOR
COMPLIANCE WITH RECORDING RE'QUIRFAfENTS FOR PLATS-
5/8- EIR
6" TALL
1.5" E1P
3" TALL <s
1/2" ERR
LEGEND 3" TALL \
�/
SP-EXISTINGIRONPIPE
X �
EIR-EXISTING IRON ROD
t\ hI
I
EP - EL CE OF PAVEMENT .V
1.5" E1P Q I
RPW-RIGHTOFWAY
WM -WATER METER 4' TALL(BENT)
_ p
ROp
Sep
BPS - SEWER PRESSURE BOX
! /CCU
COCATSN
I�
TWM WATER METER
I
CTV. CABLE TVBOX
112" EIR
MBL-MIN/MEWBU1LDINGLINE
3" TALL
NTS-NOT TO SCALE
LINE LEGEND
FG\ 1.5" EIP MBL
47
PROPERTY LINE SURVEYED 3" TALL(BENT)
-- — ADJ(NNER PROPERTY LINE P, 5/8"" NIR
— — — -- RfGIIT OF WAY ✓ FLUSH
— — — -- — MINIMUM BUILDING LINE D rJ�JSC-� /� 1
LEASE LINE VI \ /Ip
0' 60, 120'
Surveyed by
GARY KENNEDY
PROFESSIONAL LAND SURVEYOR
(910-220-2557) - (910-572-1708)
[e-mail]
703 Page Street
Troy, N.C. 27371
Scale: 1"=60' 1 Date: 9/20/2019 Precision 1:10,000+
Drawn: dGK Checked: gk Job: S-07219
4" DEEP
DB- 1678, PG. 1104
LOT 11
26,747± Sq. Feet
3 0.614f Acres
(D.M.D.)
O
O '
:D
n
O
o '
N DONALD SPIVEY and wife,
GENECA M. SPIVEY
DB, 1640, PG. 844
LOT 12
5/8" EIR
2" TALL
NOTE: PROPOSED HOUSE
LOCATION PER MEETING iMTH
BILL SEITH ON 9/20/2019.
afou"',e
CA
,•'per oFT_ssfoti ' �'G �:
SEAL
6>17 SS = f L-3883•
\GA RY +� ?
war�ioavtas4t`0 0
I certify that this map v drown under m➢ tmpervision from anaetual
survey made under my supendsion (deed description recorded In, .Book
1673 page 1104 or other reference source PLAT BOOK 23, PAGE 248 );
that the boundariea not eorreped are indicated as d— tram Mfortaati
Book page. or other "fare— somee
that the rntio or prodxdon or peaiti.-W ac .y is 1:10,000+
and that thin map meets the requirements of The Standard or Pr—tim
for S,—yLng S North Carona. (21 WCAC 6S. 1600).
This 20th day of September , 20 19.'
L-3883
This map does not meet N.C.G.S. i tand-atds 4730 and is rat

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