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Division of Water Resources
lVater Resources 15A NCAC 02H .0500 — water Quality Certification, Shoreline Stabilization
ENVIRONMENTAL GUALI7Y FORM: SSGP 02-2017
Shoreline Stabilization Application Form a1'
Three copies of the application (including attachments) and the application fee should be sent to:
If sending via US Postal Service Ifsending via delivery service (UPS, FedEx, etc'.)
Karen Higgins Karen Higgins
DWR-401 & Buffer Permitting Branch DWR-401 & Buffer Permitting Branch
161-7 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:
Telephone Number:
E-mail Address:
2. Agent/ Contact Person information
Fax Number::
21 e�b" . q—Z V,-\
"aii", GO'iia3fl
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/dots/reeulatorvjregdocs/PermitslSAMPLE AGENT AUTHORI
ZATION FORM.pdf) \ \ r
Name: ��C�L. \tom
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
P
B. Project Information [15A NCAC 02N .0502{a) & (b))
1. Attach a vicinity reap (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, eta)
4. Location of the property (where work is to be conducted)
County: QGALsea Nearest Town: ycas
Lake/ river/ ocean adjacent to property:
Property size (acres): , P+to
Subdivision name or site address (include phase/lot number):
Directions to site - please include ro4&names and numbers, landmarks, etc.:
sew a�a�e✓
Latitude (in decimal degrees) 35•i,1 Longitude (decimal degrees) -'Sl . 3 stc
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.):
6. Describe proposed work (include di cussion as to hover hardening of shoreline has
been avoided, or why it is necessary): ssocc-ram . ' Q
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: Sr— Fy "/ i v4, ,o , A n vci * 165 C F
Temporary impacts in square i
-5--o S9F
3. Total amount of impacts above the normal pool lake level / Normal Water Level and
50 feet land -ward
Permanent impacts incl din back fill, excavation, rip rap, retaining walls etc.} in square
feet: S-40 �v� �
Temporary impacts (temporary clearing, construction corridor) in square feet-,
0 r'(�avI c /_ 'O0 51—_ +L--�'/JUv-7 rr,n-Vt �_
10. Please describe the vegetation above the normal pool lake level] Normal Water level
and 50 feet landward to bet impacted (number of trees, for instance):
1.aKJSC e W ii-1 l�tfof fi�C f" &'_ l a r Yee
n^vJ, d .
11. Signature �
w.�
FORM: SSGP 02-2017
Page 2 of 3
WBA RIPARIAN BUFFER NOTIFICATION F—RM
Project Name/address: �.
,� /\ Coun
Owner: ' Yy \ r ti m \%ll _
Print
Contractor/agent:
Print
Signatu
The approval is for the purpose and design described in your application. Impacts not indicated in the
application is a violation of the Buffer Rule. Site specific work should be provided in the application. [15A NCAC
02H .0506 and 15A NCAC 02B .0243(8)]
Trees are not allowed to be removed from Zone 1 of the Buffer (within 30 ft of the full pond elevation), unless
approved. Exception, those trees that are .severely undermined along the immediate shoreline can be
removed. Minimal shaping and sloping along the immediate shoreline is allowed. [15A NCAC 02B .0243(6)]
Benching, grading in the buffer is not allowed. Excessive disturbance of ground cover. [15A NCAC 026 .0243
(6)]
Beaches, impervious patios, impervious walkways, etc. are not allowed in the buffer unless specifically
approved by the Division. There are limitation on size for decks. [15A NCAC 02B .0243(4) and (6)]
Work work corridor should be described. The approved access corridor to be conducted from land must indicate an access and indicate any trees that are to be removed. The
shall be restored. Staging, spoil, construction
material must be outside the buffer. [15A NCAC 02H .0502 and 15A NCAC 02B .0243 (4), (6), (8)]
Stormwater cannot be piped or channeled for direct discharge to the lake. All constructed stormwater
discharges must be at the natural elevation and discharged prior to entering the buffer directed as diffuse or
sheet flow at non -erosive velocities to the lake. [15A NCAC 02B .0243(5), (6)]
Acknowledgement 0I Notification
►, kit , . �, hereby
-
ba
Riparian Buffer Rule. Any work conducted in the buffer, not specifically stated in th app cat on and
approved
by the Division of Water Resources (DWR), is a violation and subject to enforcement. Due diligence will be
taken such that the construction will be built within substantial compliance and intent of the 401 Water
Quality Certification and Buffer Rules, the approved plan(s) and specification(s), and other supporting
materials.
Signature (owner):
Date: I
3 -- 10 I' s
Side View
3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing
I *if necessary
Existing bank
10 ft. bank
height
FORM: SSGP 02-2017 Page 4 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
Full Pond/ li k
`X SG
XS ,e �U
Fr, I(
In
Lake
(At Full Pond/ Normal Water Level)
DOCK
Pp
----Lake --------------
(At full Pond/ Normal Water
Level)
Existing Dock
3a ft x 7 it
1
I
I
I" f 3itx 150 ft
Full al Pond/ NormrmWater Level
Below full pond/ NWL
e»,xalt��
Shoreline
Riprap
' a11x1501`t
stove full pond/NWL
1 7R.x 15U h.
addltional clearing
j
'if necessary
E
t
5
Mpg
Plan View
FORM: SSGP 02-2017 Page 3 of 4
r As 1,
YOUR TRIP TO'. CJZ
5664 Anchor Dr
17 MIN I 8.8 MI
Est. fuel cost: $0.83
Trip time based on traffic condiliana as or 12:40 PM on September Print a full health report of your car with HUM
17. 2019, Current Traffic: Light vehicle diagnostics (800) 906-2501
1. Start out going southwest on Shiloh Church Rd toward Rosenbalm Ln.
Then 0,05 miles 0.05 total miles
,r 2. Stay straight to go onto Hubbard Rd,
Then 0.62 miles
0.67 total miles
3. Turn right to stay on Hubbard Rd.
Hubbard Rd is just past Cook Ln.
1t you am on Cemetery Loop and reach Doberman Ln vouYe pone a little too far.
Then 1.38 miles
2.04 total miles
,r 4. Hubbard Rd becomes Icard Dam Rd.
Then 1.38 miles
3.42 total miles
S. Turn left onto Petra Mill Rd.
Then 0.88 miles
4.30 total miles
r+ 8. Turn right onto Rocky Mount Rd.
Then 0.02 miles
4.32 total miles
7. Turn right onto Grace Chapel Rd.
Then 1.32 miles
5.64 Iola[ miles
8. Turn loft onto Falls Ave.
Falls Ave is 0.1 miles past Hurricane Hill Rd.
Grace Chapel United West Chr is on the comer.
Ij you reach Ike Slarnes Rd you've gone about 0.5 miles too far.
Then 1,52 miles
7.16 total miles
9. Turn left onto Meandering Way,
Meandering Way is 0.2 miles past Oak Grove Church Rd.
If you reach Lake St vouYe gone about 0.9 miles too for.
Then 0.20 miles
7.45 total miles
K 1g. Turn slight left onto Myers Rd.
1
Myers Rd is just past Leisure Ln.
It you roach River Or you've gone about 0.3 miles too far.
Then 0.05 miles
7.50 total miles
it. Take the Is[ left onto Greens Rd.
If you reach Greens Or you've pone a little too tar.
Then 0.97 miles
8.47 total miles
12. Turn right onto Anchor Dr.
Anchor Dr is 0.4 miles past Beacon Ridge Dr.
If you reach Point Comfort Ln you've gone about 0.1 miles too jar.
Then 0.30 miles
8.78 total miles
�v e 13. 5664 Anchor Dr, Granile Fells, NC 28630.8695, 5664 ANCHOR DR is on the
left.
0nw-We,
in
�n
i aai
C..1
7391
"N-
ANfHOR DR
120
- A A A r-
�sr
This map is NOT of land survey quality and is NOT suitable for such use. %
Owner
VITTORIO MICHAEL J
Deferred Val
$
VITTORIO JANE H
5664ANCHOR DR
Assessed Val
$470,000
GRANITE FALLS, NC 28630
Cale Acreage
1.08738361
Units
1 (LT)
AccLand
Number
el ID
Parcel
Parc
08 SEC4T224N
Legal Desc
BK 1480 PG 1421 YR 03 ST 0.00
NCPIN
2795225173
Plat Ref
0017/0265
Property Addr
5664ANCHOR DR
891
Caldwell County
1:803
0 0.005 0.01 0.02 mi
0 0.01 0.02 0.04 krn
September 17, 2019
This map is NOT of land survey quality and is NOT suitable for such use.
Owner VITTORIO MICHAEL J Deferred Val
VITTORIO JANE H Assessed Val
5664 ANCHOR DR
GRANITE FALLS, NC 28630 Cale Acreage
Acct Number 121416
Parcel ID 08 SEC4T224N
NCPIN 2795225173
Land Units
Legal Desc
Plat Ref
Property Addr
$470, 00 0
1.08738361
1 (LT)
BK 1480 PG 1421 YR 03 ST 0.00
0017/0265
5664ANCHOR DR
Caldwell County
1:803
0 0.005 0.01 0.02 mi
0 0.01 0.02 0.04 km
September 17, 2019
nis map Is NU I of land survey quality and is NOT suitable for such use.
Owner VITTORIO MICHAEL J
VITTORIO JANE H
5664ANCHOR DR
GRANITE FALLS, NC 28630
Acct Number 121416
Parcel ID 08 SEC4T224N
NCPIN 2795225173
Deferred Val
$
Assessed Val
$470,000
Calc Acreage
1,08738361
Land Units
1 (LT)
Legal Desc
BK 1480 PG 1421 YR 03
Plat Ref
001 7/0265
Property Addr
5664 ANCHOR DR
Caldwell County
1:6,426
0 0.05 0.1 0.2 mi
ST 0.00 0 0.075 0.15 0.3 km
September 17, 2019