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Home My WebLink About20191622 Ver 1_Shoreline Stabilization_20191125CK_ State of North Carolina Department of Environment and Natural Resources r 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 fes should be�slent 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 Raleigh, NC 27699-1617 512 N. Salisbury Street Raleigh, NC 27604 A. Applicant Information ['1 5A NCAC 02H .0502(a)] 1. Owner Info REWVE0JDEWV lJ" rt NOV 2 5 2019 Vvito( Reaourcas pern.iiwrng SQGbon Name: Pnd Q)Ol^A-_e_ \y()ry1 Gets-tr►U C'"",4cry'x Mailing Address: Sec) "i* 1I5 6` : -(- � �M75bc�- ,' _ NC-1 7 31)--- Telephone Number: CI fi RR 3 3� Fax Number. E-mail Address: L1 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. •1 i1��!"�•1tivv.' fi/Pc,—ais/59/flocs/raeufatoy/reedocs/Permits/SAMPLE AGENT AUTHORIZ ATION FORM.2df) Name: Company Affiliation: Mailing Address: Telephone Number: Fax Number: E-mail Address: B. Project Information [15A NCAC 02H .0502(a) & (b)] 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: Ok, A�r, Nearest Town: Lake/ river/ ocean adjacen to property:' ' r Property size (acres): Subdivision name or site address (include phase/lot number): Directions to site - please include road names and nu ;bars, landmarks, etc.: X. / Latitude (in decimal degrees) Longitude (decimal degrees) 5. Describe the existing land use or condition of the�,a�t the time of this application (residential, undeveloped, etc.): �f 5. Describe proposed work (include discussion as t9 liow 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: Temporary impacts in square feet: 'IIIIr'%J 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 walls, etc.) in square feet: 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): c 11. Signature Owner/Agent's Signature [15A NCAC 02H .0502(f)j 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 Shoreline Plan View FORM: SSGP 02-2017 Lake (at ruts aura/ eot nA v: nn k,-! ExisUng Dock Full Pond/ Normal Water Shoreline M.MR. .dMand d—in If nmftn y _f Plan View 3fl.lmft 8b. I.5 [mod/ WA 4RsI50R Rbme M pond/ NM Page 3 of 4 Je- Lake (At Full Pond/ Normal Water Lev S» 010 t_ Zvi c Side View CL 3 ft. below full pond water level 4 ft above full pond water level 2 t additional clearing `if necessary Existing bank 10 ft. bank Side Vi Of AMPLE FORM: SSGP 02-2017 Page 4 of 4 q p `pD Vol,¢ �` CeorR ds N SITE As-801 Surtay tar Fsund: ?; W E on9.ba 5 BRADLEY E. JOHNSON "°"°ude j VICINITY MAP SAMANTHA J. JOHNSON Lot No. 7 of The Ridge on Tillery, LLC Development Found: tram Reber f'f. Uwhorrie Township Montgomery County, North Carolina Dead Reference Book 828 Page 145; Plat Cabinet E Slide 127A. j 4 4 :I Surveyed by Thomas J. Fields, PLS-2906, in September 2006 thm April 2008. As -Built Survey and Revised Plat prepared on September itth, 2019. �l3 ; TOTAL AREA = 0.54 Acre by coadinotes 40 0 40 ! j 5 E 1 IIFounQ 0 71 FFt \\ S.W.Fast TieLi IroPipe S 88-37.07in 32.60 FT' E I N Fran the offlcs of O6W 05,05 16.46 FT+! I` I\ i / `. Found: 'Iron WRIGHT h FIELDS LAND SURVEYING ' Found: 5 Reber '37 07 E 143.05 FT Found: 1340 Albe n"'. Road, Su Its C Troy. N.C. 27377 Iron Reba —_ _ Farad: 10 Foot Setback Iron flebar Iron Raba, Phone No. 910-572-2449 T JO Foot Setback q� ,3 /A 1 Foundation b I gaag• I in place d. house Ld: Ir Pipe GENERAL NOTES,t d• / NC Nor th 1. Ths Parcel ID ber far subject property,.i limber AD 83 Is PIN: 6589-14-23-8613. Based the FEMA Flood M37106588". this /'\\®t� 2. on property lap e found in Zone X, on area of minimal flood �°n\ risk. 3. No NOGS Gdd Monuments are located within 2000 feet. f the subject property, however the plat —.Ided in Pi. Cabinet E Slid. 127-A record. a NAD 83 grid tk to NCOS GridMonument 'EFIRD*. V ' 4. The Montgomery County GIs records this property$ as being Zoned R-1. 5. Minimum Bu9dklg Setback.: Front ....... 30 Fast Sides ....... 10 Feet Found: Rear .... 20 Feet Lakeside 10 Fast 'Iron Pip ..... I awlNy that NM plot represents a survey of an elating parcel or parcels of land ondoes \' net —tea street or change on sad.tlnq street . �r\. - \ Symbol Legend Surw r "^.•.�... \. O ...... denote mnoend ...�... i _...� on tad . pll at. a .etas noted • ...... darrotee meawad pak * ...� no monv moot• found or W. NORTH CAROLMU MONTGOMERY COUNTY / I, Thomas J. Fldds, e.tIfy that this plat drawn / Line Legend from an actual wervey mein under my aparWden from l f—.tI- famd In Deed Book 817 P." 41 r Boundary Lines arch other hfomotion es refar.naed hwean; that the b_darim not —yed are Weedy indhated. as drawn ` O' . �FESSIpN'*..r , :� / MJaamt B°undarlae (not ampd) fromInformal.. mferesced harson; that the rotb of precieI- es ealwiatod is 1:15,DW.; that this plot = 1 a. , Tia Lines was prepared In ucdordance with the Standard. of = [ 7,-yg06 -`' - Practise. V6thesa my origMd sandturs, Ilcunes _.__..._.__.._. .. .. _..._..._.__..._ 5ho d ne — _ _Right-oi-W°y a mbar and w d this the 11th day of September 2019. 9y ''• Llnaa r 'r _— —_ Minimum e. � 2W BuAdinq Setbacks Pro/a.Nond Lane . PLS Fine No, 1055 Job No. 2019-97