20200073 Ver 1_Shoreline Stabilization_20200113

State of North Carolina
DWR Department of Environment and Natural Resources
Division of Water Resources
00
15A NCAC 02H .0500 —Water Quality Certification, Shoreline Stabilization
Division of Water Resources
FORM: SSGP 10-2013 '
O
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should
to: _,'
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617 pu
Applicant Information 115A NCAC 02H .0502(a)]
1. Owner Information
Name: Harvey Bagshaw
Mailing Address: 173 Pinnacle Ln
Telephone Number:
Mooresville, NC 28117
7043604642 Fax Number:
E-mail Address: [e-mail]
2. 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/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: Dean Fisher, President
Company Affiliation: Lake Norman Custom Dock & Pile Driving, Inc
Mailing Address: PO Box 1439
Denver NC 28037
Telephone Number: 7044832144
Fax Number:
E-mail Address: [e-mail]
Person to receive the Certification Approval: Dean Fisher and Harvey Bagshaw
IL 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,
FORM: SSGP 10-2013 Page 1 of 3

etc.), 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.
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: Iredell Nearest Town: Mooresville
Subdivision name or site address (include phase/lot number): Lot 39
PINNACLE SHORES PH 03
Directions to site - please include road names and numbers, landmarks, etc.:
Take Hwy 150 E towards Mooresville. Turn left onto Pinnacle Ln. Property is ahead.
Latitude (in decimal degrees) 35.6092522 Longitude (decimal degrees)-80.9402638
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): residential
6. Property size (acres): 0_96
7. Lake/ river/ ocean adjacent to property: Norman
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Installation and grading of shorelmnp for hnnlder
Rip Rap with fabric. in front of cyiS}Ing wall
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: 2000 sq ft
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): Landscaped
areas with shrubbery.
Jo 0., "-C- 9
Owner/Agent's Signature 15A N C 02 5 Date
'Agent's signature is valid only if an uthorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

TY MAP - NOT TO SCALEI
LAKE NORMAN
FIELD LOCATED
PER PS 59-140
SHOWN IS MEASUF

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 39 PLAN NO.
PARCEL ID: 4628-42-0235
STREET ADDRESS: 173 Pinnacle Ln, Mooresville NC 28117
Please print:
Property Owner: Harvey Bagshaw
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Dean Fisher
(Contractor / Agent)
of Lake Norman Custom Dock & Pile Driving, Inc
(Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
'JIm-4
Aut orized Signature
Authorized Signature
Date: Date:

1/7/2020
173 Pinnacle Ln - Google Maps
Google Maps
117-1
Lake Effects Goat Rentals
173 Pinnacle Ln
Vicinity map
o y
Leka Noonan
TIM
b �6
'take Norman r �J O Goodwill
aey and Play Mooresville GhoDDe
S8 BTr Daddysan 0 ® (Ioansna.cr mmmey Queens Landing yaxe Norman
AM Storage Hwy, Cline Learning Center
150 Mowesvilk 0 O ® V W8
Foothills Marine
Carolina Cycle Concepts Q qD of take Norman
O
wghway T.- Y Auro s wee
O '
e@ Lake Norman Q
i station v °njNO. 4 Hlgll School
® b � PDPA marryQ
Hartis Teeter O
DOOLIE Q
l�
q
/ al }: " .. ... Lake Norman
Jam V Mbsbn iiefal CentxS r 1
+ w,
ys
therm NdlQ s
Gal O 3 P.Iffroad Q
'- PS POWM � ■`
rmllsmissbn�
Go gle
Chialmle Event Group
Map data ©2020 1000 ft
https://www.google.com/maps/place1173+Pinnacle+Ln,+Mooresville,+NC+28117l@35.6013914,-80.9303227,15z/data=!4m5!3m4!1 sOx8851530377R2735:Ox5dO8601916038a41!8m2!3d35.6092522!4d-... 1/1

^+�f:��
� r . ."p#
r � '� i . � yk��1 i
4�\ '� W.
' ., t
_ � � � ..
- - , ,, ;
- _.._ �