20200242 Ver 1_Shoreline Stabilization_20200213

State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
Shoreline Stabilization Application Form
Three copies 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
Raleigh, NC 27699-1617
I. Applicant Information [15A NCAC 02H .0502(a
1. Owner Information
Name: Ronald A. Ruzewski
Mailing Address: 246 Bay Shore Loop
Mooresville, NC 28117
Telephone Number: 704-662-2002 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:
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Person to receive the Certification Approval:
Fax Number:
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,
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): Harbor View
Directions to site - please include road names and numbers, landmarks, etc.:
Travel North on Perth Rd from Hwy 150. Left on Hideaway Lane. Left to 217
(property)
Latitude (in decimal degrees) 35.6200 Longitude (decimal degrees)-80.8954
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):.77
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): Restoration/protection of the shoreline by maintenance of
the rip rap material. Smooth, fill holes, restore edge with Rip Rap to maintain the integrity
of the shore line. The current shore line is showing abuse from neglect over time
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:
approximately 900 sq feet (3' x 300')
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: approximately 1500 sq feet
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): none
?ZF�v 2a
Ow / gen ' - na ure' [15A NCAC 02H .0502(f)l Date
`Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

Lake
(At Full Pond/Normal Water Level)
Full Pond/ _
Normal Water Level
Shoreline
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 7
FORM: SSGP 10-2013
Page 3 of 3

GENERAL NOTES:
1) PROPERTY MAY BE SUBJECT TO RECORDED OR
UNRECORDED RIGHTS OF WAYS OR EASEMENTS
NOT OBSERVED AND/OR RESTRICTIVE COVENANTS.
2) OWNER TO VERIFY ALL 5ETBACK5 AND ZONING
REGULATIONS PRIOR TO ANY PLANNING OR
CONSTRUCTION.
3) ALL DISTANCES ARE HORIZONTAL GROUND DISTANCES
UNLESS OTHERWISE NOTED.
4) ALL AREAS SHOWN HEREON WERE DETERMINED BY
COORDINATE COMPUTATION
5) SETBACKS AS SHOWN ARE PER PB: 13-26
AND MAY DIFFER FROM CURRENT ZONING
OROINANCES AND/OR RESTRICTIVE COVENANTS.
6) A PORTION OF THIS PROPERTY DOES LIE WITHIN
A SPECIAL FLOOD HAZARD AREA AS DETERMINED
BY THE FEDERAL EMERGENCY MANAGEMENT AGENCY,
HOWEVER THE STRUCTURE DOES NOT LIE WITHIN
THE PORTION OF THE PROPERTY THAT IS SHOWN
TO BE IN A SPECIAL FLOOD HAZARD AREA.
FIRM INFORMATION:
COMM. PANEL k:
EFFECT. DATE:
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DB: 593- 941 /
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LEGEND:
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BOUNDARY LINE
OVERHEAD UTILITIES
FENCE (TYPE NOTED)
CP = COMPUTED POINT (UNMARKED)
R/W = RIGHT—OF—WAY
EDP EDGE OF PAVEMENT
C/L = CENTERLINE
"d UTILITY POLE
EX /4 REBAR
LOT 42
GEORGE R. KIRKPATRICK
DB: 2453-051
PB: 13-26
0' 40' 80'
LINE TABLE
LINE
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DISTANCE
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S 65 "f 0'00" E
26.63'
L2
S 42.46'00" W
24.72'
L3
N 14'00'00" W
36.48'
L4
N 27'46'00" E
59.22'
L5
N 315100" E
35.17'
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