20200177 Ver 1_Shoreline Stabilization_20200103

• �1
Water Resources
ENVIRONMENTAL QUALITY
2 0 2 0 0 1 7 7 State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H.0500 —
Shoreline Stabilization Application Form
Shoreline Stabilization
FORM: SSGP 02-2017
Three copies of the application (including attachments) and the application fee should be sent to:
I./sendingvia USPostal Servtce Ifsen&ngvia delivery service (UPS,FedEx,etc.)
Karen Higgins Karen Higgins
DWR-401 & Buffer Permitting Branch DWR-401 & Buffer Permitting B
ch-
1617 Mail Service Center 512 N. Salisbury Street ID(2@�2MRaleigh, NC 27699-1617 Raleigh, NC 27604 t=o ll
A. Applicant Information [15A NCAC 02H .0502(a)]
I. Owner Information
Name:
Mailing
i-hP.ICh�u �L 28bDI
Telephone Number: Fax Number: N I A
E-mail Address: b\/ Yd . ky {e Q rodc6ty-ia1 ( cnnn
2. Agent/ Contact Person Information
W'v 2020
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/docs/regulatorV/regdocs/Permits/SAMPLE AGENT AUTHORI
ZATION FORM odf)
Name: �nnl . %iniv,ic
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Fax Number: —
B. 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, 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

I 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: Niel W e'l I Nearest Town: & ani +e raJ IS
Lake/ river/ ocean adjacent to property: Hi &D Y q
Property size (acres): • 5 7 Zq 3 (o
Subdivision name or site address (include phase/lot number):
'SItV%J ac
Directions to site - please include road
/names and numbers, landmarks, etc.:
— See l�1�%chec(
Latitude (in decimal degrees) 3 5. 76010 Longitude (decimal degrees)_- $ I . ,3 8
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 discussion as to how hardening of shoreline has been
avoided, or why it is necessary): v re<<�► a ,'s eroc�,�� Sojt'r a s
Cary c
7. Will work be conducted from land?
❑ From water? 0____
8. Total amount of impacts below the normal pool lake. level / Normal Water Level
Perm nent impacts including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
93c%c. I--( ( J4,( �3ic ioo ` = 300 Sr,
Temporary impacts in square fe t:
A%e�ruc�iyr.
9. Total amount of impacts above -the normal pool lake level / Normal Water Level and 50 feet
land -ward
Permanent impacts (i/n°�cludin(}g� back fill, excavation, ri rap, retaining walls, etc.) in square feet:
SOD .S( /S(ivC �{�I t lulu
Tem /porar impacts/I (temporary c�learing, construction corridor) in square feet:.
orCP, 1 c S'�eti 7--
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): / - jvee 4e-,.,',. 40
Se reMoved. &ras 5
11. Signatur
Own r/Agent's Si nature' [15A NCAC 02H 0502(f)] 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 anv axravatinn ,,, l,o l ( i--i.....
.,-- o --•• ...� ' Vu , vnu/ rvUl ulal Water Level elevation
Lake
(At Full Pond/ Normal Water Level)
ull Pond/ Normal Water
Shoreline
pool 4.
Plan View
I
Lake
(A�FJI0.M/Normal Watttleuell
Existing Dock
30ha]h
3ha350h
Full Pondl Normal Water -vet ael Ulpon&jnia
�horeiine
Ripmp ft.a 17ft
2h. • ISO h. � W.W N
�nonalckan�y
n nrcessary
E AMP E
Plan View
�7`!3e/ar✓FI�P, 4
FORM: SSGP 02-2017
Page 3 of 4

(At Full Pond/ Normal Water
Side View
-
FORM: SSGP 02-2017
Page 4 of 4

.112412020 1173 Shiloh Church Road, Hickory, NC to 4846 Midway Sand Rd, Hickory, NC 28601 - Google Maps
a0 gle Maps 1173 Shiloh Church Road, Hickory, NC to 4846 Drive 9.3 miles, 16 min
Midway Sand Rd, Hickory, NC 28601
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Map data ©2020 2 mi
1173 Shiloh Church Rd
Hickory, NC 2860
t 1. Head southwest on Shiloh Church Rd toward
Rosenbalm Ln
387 ft
t 2. Continue straight onto Hubbard Rd
1.9 mi
t 3. Continue onto Icard Dam Rd
1.4 mi
4. Turn left onto Petra Mill Rd
0.9 mi
5. Turn left onto Grace Chapel Rd
4.1 mi
r► 6. Turn right onto US-321 N/Hickory Blvd
0.4 mi
https://www.gwgie.wm/maps/dir/1173+Shiloh+Church+Road,+Hickory,+NC/4846+Midway+Sand+Rd,+Hickory,+NC+28601 /@35.7844659,-81.43496... 112

1/24/2020. 1173 Shiloh Church Road, Hickory, NC to 4846 Midway Sand Rd, Hickory, NC 28601 - Google Maps
4, 7. Turn left onto Midway Sand Rd
0.6 mi
4846 Midway Sand Rd
Hickory, NC 2860
These directions are for planning purposes only.
You may find that construction projects, traffic,
weather, or other events may cause conditions to
differ from the map results, and you should plan
your route accordingly. You must obey all signs or
notices regarding your route.
https:ltw .google.mmlmapsldir11173+Shiloh+Church+Road,+Hickory,+NC/4846+Midway+Sand+Rd,+Hickory,+NC+28601/@35.7844659,-81.43496... 2/2

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(1.15A) ry°
5216
b
5291
6154 p (1.35A)
1.� 48W
3 a 8160
r�QB 70264946
4942
This map is NOT of land survey quality and is NOT suitable for such use.
Owner
BYRD KYLE FLOYD
Deferred Val
$
Caldwell County
BYRD DEBRA KAY
Assessed Val
$190,200
4846 MIDWAY SAND RD
1:803
HICKORY, NC 28601
Calc Acreage
0,57293601
0 0.005 0.01 0.02 mi
Land Units
1 (LT)
; ' , ,,
Acct Number
154504
Legal Desc
BK 1842 PG 1045 YR 2014 ST 530.00
0 0.01 0.02 0.04 km
Parcel ID
0871 1 22
NCPIN
2794107026
Plat Ref
/
November 7, 2019
Property Addr 4846 MIDWAY SAND RD

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