20191621 Ver 1_Shoreline Stabilization_20191125

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 02-2017
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sento.
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 1=5A NCAC 02H .0502(a)]
1. Owner Information
Name:
Mailing Address:
NOV 25 2011
Telephone Number: -)Vdba-2-810 Fax Number:
E-mail Address: 11/1-1 ZKL74 ftsY ^ S4 c t 0,4ec Cc
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:
�rJ `lv.+� r� say ��«c= �rm�; �ni!/Portals/59/does/regu[atorv/reedocslPermits/SAMPLE AGENT AUTHOR2
ATION FORM.pdf)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
B. Project Information [1.5A NCAC 02H .0502(a) & (b)j
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
4.
some sort a yard stick, shovel handle, etc.)
Location of the property (where work is to be conducted)
�,, Af .)n
County: Nearest Town:
Lake/ river/ ocean a jacentto property:
Property size (acres):-S2�e-,g _ J
Subdivision name or site address (include phase/lot number): /sae w4s,-
1 t YnLnl� Cam" 0
Directions to site - please include roA names anonui�pers, landmarks, etc.:
Latitude (in decimal degrees• a72�t Longitude (decimal degrees).:: - � X,'4!5'0
5. Describe the existing land use or condition of the at the time of this application
(residential, undeveloped, etc.):
6. Describe proposed work (include discussion as
avoided, or why it is necessary):
7. Will work be conducted from land? (�
of shoreline has
From water? ❑
8. Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent im cts (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
Temporary impacts in sgyare 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, excava� rip rap, retaining walls, etc.) in square feet:
Temporary impacts (terpppra4R 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
of tre9<1for instance):
11. Signature y �
/ - - I
Owner/Agent's Signature' [15A NCAC 02 .0502(f)1 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
'Full Pond/ Normal Water
Shoreline
Plan View
Full Pond/ Normal Water
Stio`relirte 4
21Lt 15U t.
addtIo,W d-&
' It-caury
1
l
FORM: SSGP 02-2017
Plan View J
La ke
(At Full Pond/ Normal Water Level)
/A �9�1
/0��/
Lake
(At FO fUad/ Nemal M&W U. Q Existing Dock
3 n:ISO 1t
Brba U Prod/ NM
41W. Wh
Rb"h0 PMW NWI
Page 3 of 4

North Carolina, Sternly County
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a.r.d pm . r... Las W—u- a --am r dl.w
trr tWl tW Mr d P..erra r rte.rrd r I/ Isarht
L+nceose No. P-0335
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C R. \ . 7ba for pl. a pd4•edd r am 4— .a► ma a-ap r
4278 Co mmy Chtb Najd. Wadnbao. N.C. 28170
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OB 05 19
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Date Professio' n�Land Sufveyor # L 4171
>rr 1— awn. 76.a d sander I
SURVEY STATUS
Watershed. CedSeafe of aoorow for lecordioa
X a Sat the --I ew.t. a .bdW— d trd .erred Ih. am d • e.wty
I mtl/y not the pit above b— a Vns bah w Tataabed Pretti-
er maaip.Uty teal bw b dwbee teat Mhft teal of rat
•. OM-- .W r •pM.-d W U. W.anbed It..ra t:..e.drt r U.
a.d.a. a D..& dace I
Cardficate of Ownership and Dedicatkm
I bay ewtRy that 1 m tb e ed the pbpwtp dbees ..d ddd.daed beww aai tbw f
I bat.W adept tft ina at a-bibbim aRb my bw eomut. Wabash mdaim m b.tldim ham f
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Lot / 59
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\ 1 D.B- 1574, PG. 313
is \\ LDt $ 60 / 1 P.H 25, PG. 28 /
0.75 ACRES
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Lot f 61 \ J / Lot / 58
EocElre7Ett
\ 1 DEVELOPERS INC. m' /
\V/ D.H 1225, PG. 102 A f
PM 6675-01-27-4626 Up
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LOCATION MAP (N.T.S.)
Notes: (x if applicable)
X 1. WIND Odd 7wad-.10"20madw tas
X 1ARdha-aaamh b.0dtdMa.raemmb
w. d....me.d W .add rerr.
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Sale: 1 bit$ - 401L
80' 120'
Plat of Property Surveyed For.
Edge Water Developers, Inc.
P.O. Box 4127 / W17mington, NC 28406
E Center Twsp., Sternly County, N.C.
For Reference See;
D.B. 1225, PG. 102 / PIN: 6575-01-27-4626
Dah; 08/06/19 - Dlmm W. UM - Nk a: 16219

ar•
Lake
(At Full Pond/ Normal Water Leve
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16rl _ ma's
z(A
3
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Side View
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3 ft. below full pond water level 4 ft. above full pond water level 2 ftadditional clearing
`if necessary
Existing bank
10 ft. bank a
height Dye'
Q�
pow
ter.FF IL
FORM: SSGP 02-2017
Page 4 of 4

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North Caroline, Stenly County
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'1i4 fC�"✓/Jac.._--- -
Date Professional Land Surveyor # L 4171
SURVEY
STATUS
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Dixie Lend Surveying, PLLC
uncense No. P-0335
4278 Cauntgr Club Mmd. Wadmbm% N.G'18170
phone: (/04}69S-2779
—&- dWehQvmdetream.at
Certificate of Ownership and Dedication
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\ I D.B. 1574, PG. 313
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0.75 ACRES i m
/ \\ 32510.2 SQ. FT. I /
YP \ 1
I \ / ! Lot / 81 `\ / J / Lot $ 58
EDGEWATER \ �
\ \VDEVELOPERS INC. IM D.B. 1225, PG. 102 �'
PIN: 8575-01-27-4826 t
gmd W20
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LOCATION MAP (N.T.S.)
Notes: (x if applicable)
X 1. No NC add Fmmd' 106m 2OW dthb We
X 2. N Nat —me hrimoW 60 rmauremmb
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0' Q. 80' 120'
Plat of Property Surveyed For:
ow
Edge Water Developers, Inc.
P.O. Box 4127 / Wilmington, NC 28406
F Center Twsp., Stanly County, N.C.
For Reference See;
D.B. 1225. PG. 102 / PIN: 6575-01-27-4626
Dme; 09/06/ 19 - Drawn Dr. UM - Plle #: 16919

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