20191538 Ver 1_Shoreline Stabilization_20191106

State of North Carolina
Department of Environment and Natural Resources
DWR
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilisation
Division of Water Resources
FORM: SSGP;10-2013
Shoreline Stabilization Application Form
One copy of the application (including attachments) and the application fee should be sent to:
Division of Water Resources®�
401 & Buffer Permitting Unit
1617 Mail Service Center 10
Raleigh, NC 27699-16170� �4��
e4*q
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: o(Aa h5
Mailing Address: 150ob3 LY-de11to_na4,s Ln.
Telephone Number: U*JG- 523' ` 62$ Fax Number:
E-mail Address: +od6 aDat r toss I20.-b- i nG _ r_nm
Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http://www.saw.usace.army.mil/Portals/59/dots/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name:
Company Affiliation: �'AC.-I-Uro1. GAreen SCaAeg 6e_" kCeS , L_L—C_
Mailing Address: LoC�a (iCP2yc._r•nn Hwu .
('Cl oyreS v'► l\ e , VAC 2 R I I c�
Telephone Number: PloL4- 660 - 5I ll Fax Number: �1U�1- LsI�U-5gh9
E-mail Address: 0 V)0 sea.wct,l�,S (ra) L.. i nd-):hrea.m . ne4--
Person to receive the Certification Approval: Tan lce E.
II. 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 oo��Ltt�
of the property (where work is to be conducted)
County: IV tC1d-?,! Nearest Town: C
n
Subdivision name or site address (include ll__
phase/lot number): I Cnn(���1-0-/�
Directions to site - please include road names and numbers, landmarks, etc.: 1i�owr
Rd (,e4+ ck a&vt DPI kin 'L�t , V\in-%ln kk"K, oln ✓voh'��
Latitude (in decimal degrees) 3J, H(15 82-8 Longitude (decimal degrees) ' RMIULQ31
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): (2ecic&LV,�ia,l lakkl Ke?Yt)PeP,4(4
6. Property size (acres): U`� &W r tc
7. Lake/ river/ ocean adjacent to property: Nbywta4l
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): NI-0 iwwy, CoyL*kc-hq: aplact- extS�irtq
5-{a wed( , w k c f s s earc t J d0-a? rVcsmAYM .
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: t a)cove,
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): rn-A �y r
nr� 4-rees rernr�vred cn ► n', maA 0A y!> ur nee. +0 6&pve r-
Owner/Agent's Signature* [15A NCAC 02H .0502(f)] Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: S5GP 10-2013 Page 2 of 3

La ke
(At Full Pond/Normal Water Level)
V � �ields-Eome-
_, u�al1
NC) +re -es remove
f1r1 in �,(Y1C�.l C� isi-um%a nc2,
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ft x 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
Todd Wilkin
17200 Green Dolphin Ln.
Cornelius, NC 28031
FORM: SSGP 10-2013 Page 3 of 3

LINE
BEARING
DISTANCE
Lt
S 55.59 2� 7 W
6.08'
L2
N 26'02'35" W
31.12'
L3
N 08'44'07 W
21.09'
L4
N 23'S3'57 W
29.17
L5
N 282410" W
43.20
L6
S 22.41'09 W
23.89'
L7
S 63-57'02' W
17.21'
L8
S 4327 58' E
9.58'
L9
S 54'10 37" W
5.10'
- -- oL
Cr
pHZN �NE
40 20 Graph�OCSealc 40 REEN D W CMg• 17,`P..\ \
Puauc /
Scale OF Drawing l Inch =40 Feet 60EDG__ °f=P=vEM`
UNEi�'" 5
5 49•�, a �
1� 9
SRBF
N: 630,157.3T
E: 26,419.72
LOT 105 &'
-ADDITIONAL
35 Q.FT.
0.820 ACRES
z .y
2 STORY
VINYL
036
_
y
FEE: ]M9
GARAGE: 767.0r
RAFIC IC A. A. DAHAN
JILL DAHAN
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DB 30708, PG 04
(\
tr
WOOD
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50' F
SETS
FIELD LOCATED
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LAKE CONTO
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ADDITIONAL STRIP
ACQUIRED THRU
DB 9537. PG 246
NOTES
L NO NCGS MONUMENT FOUND WITHIN 2000'. NC GRID COORDINATES AS SHOWN
HEREON ARE BASED UPON GPS OBSERVATIONS UTILIZING NCGS NETWORK RTK SYSTEM
AND ARE REFERENCED TO THE NAD 83(NSRS 2011) DATUM. VERTICAL DATUM IS NAVD88
2. PROPERTY MAY BE SUBJECT TO OTHER COVENANTS. RESTRICTIONS, EASEMENTS OR
RIGHTS-OF-W'AY THAT MAY BE OF RECORD.
3. THE SETBACKS SHOWN ARE PER MB 17. PG 542.
4. A PORTION OF THE SUBJECT PROPERTY IS LOCATED WITHIN A SPECIAL FLOOD
HAZARD AREA ACCORDING TO FEMA FLOOD INSURANCE RATE MAP -PANEL
d371046220OK:. EFFECTIVE DATE: 03102/2009.
S. FLOOD ZONES DEPICTED HEREIN WERE NOT FIELD LOCATED BY -PPS AND ARE SHOWN
USING INFORMATION FROM FEMA PANEL 43710462200K. DATED 031022009. AND ALSO
USING INFORMATION PROVIDED BY MECKLENBURG COUNTY FLOODZONE MAPPING.
6. THE FLOOD MAPS ARE SUBJECT TO CHANGE WHEN FLOOD INSURANCE RATE MAPS
(FTR:4Ts) ARE UPDATED AND ADOPTED BY THE FEDERAL EMERGENCY MANAGEMENT
AGENCY (FEMA). THESE CHANGES SUPERCEDE THE RECORDED PLAT.
7. THE PROPERTY IS EXEMPT FROMIMPERVIOUS RESTRICTIONS PER TOWN OF
CORNELIUS.
8. CONSULT WITH GOVERNING AGENCY FOR PREVAILING LAND DEVELOPMENT AND
ZONING REQUIREMENTS PRIOR TO DESIGN OR CONSTRUCTION OFANY IMPROVEMENTS.
.•`! kk 1CAI? "I",,
DAR W'. LONG, P.L.S.
* e Q
18335 OLD STATESVILLE ROAD
3 - j gg1B�:
SUITE A
CORNELIUS.N.C. 28031�SURv�'��`��+
O
[phone]
4,, R........
CURVE I LENGTH 1 RADIUS I CHORD I CHORD BRG
C1 103.72' 139.47 1 101.35' IS 28'38'21 E
C2 19.72' 139.47 19.11 N 032422 W
NORTH
�FR
NCGR/��N4
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001-071-34
m ` ERNEST DAVIS
CONC. LORI DAVIS
DRIVE +� `+ DB 25771, PG 472 +
WOOD
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1 NNI �� ADIOINER'SA'
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MRETA KING WNLON �O'!' IV
REMNANT
APPROXIMATE LOCATION 10
0
YEAR
FLOOD UNEPERFEMAAND
MECKIENSURGCWNTYGR
WOOD DGCK
LEGEND:
8 PIER
IE
#4 REBAR FOUND
1" IRON PIPE FOUND
COMPUTED POINT
0
SUBJECT PROPERTY LINE
ADJOINER PROPERTY LINE
LAKE'
BUILDING SETBACK
IVORMAN
BBUURIIEEDUELECTRIC �.
WATER LINE —
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Topographical Survey of Lot 105 Crescent Land & Timber Corp, Section 2, and Additional Tract
Professional
WTM Property
FS11I'VeyOrS, Inc.
Property of:
P �
As Recorded in;
Site Address:
18335 Old Statesville Road Ste. A
Todd & Rebecca
Map Book 17. Pg 542
Deed Book 33766, Pg 920
17200 Green Dolphin Lane
Cornelius, N.C.
Wilkins
Deed Book 8537. Pg 246
Cornelius, NC
704-765-5134 Phone/hone/ Fax
Mecklenburg County
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Firm License: C-3666
09I819 03
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Job No.
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Error of Closure
Drawin Scale
Tax Parcel Number
Date
Drawing File Name
Sheet Number

Polaris 3G Map — Mecklenburg County, North Carolina
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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.

10/31/2019
17200 Green Dolphin Ln - Google Maps
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Project Name/address- 1—mol) Gy-tw -pol-pht"i LMA'w (""�SColunty: (Vt e c1e_t&_4tt-q
Print ' Signature
Print Sigbture
I I )e
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
Trees are not allowed to be removed from Zone 1of the Buffer (within30 ft ofthe 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 isallowed. [I54NCA[02B.0I4](6)]
Benching, grading in the buffer is not allowed. Excessive disturbance of ground cover, [15A NCAC 02B .0243 (6))
Beaches, impervious patios, impervious walkways, etc. are not allowed inthe buffer unless specifically approved
by the Division. There are limitation on size for decks. [15A NCAC 02B.0243(4) and (6)]
Work to be conducted from land must indicate an access and indicate any trees that are to be removed. The
work corridor should be described. The approved access corridor shall be restored. Staging, spoil, construction
material must beoutside the buffer. [15ANCACO2H.05O2and 15ANCACU28�D243(4),(6),(8)]
Stornxwater cannot be piped or channeled for direct discharge to the lake. All constructed stonnwater
discharges must be at the natural elevation and discharged prior tuentering the buffer directed asdiffuse or
sheet flow at non -erosive velocities tothe lake. [15A N[A[028 .0243(5), (6)]
Acknowledgement of Notification
|, -4 hereby state that | have been informed ofthe Catawba
Riparian Buffer Rule. Any work conducted inthe buffer, not specifically stated inthe application 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:
smie olNor xCarolina /ar/mnmnxuQuality |W*^,klesoumes
somsaliuvurvstf-ra / uaHai! Semicocox, | Raleigh, wcaav '/a/
^`^mzvnon