20190155 Ver 2_Shoreline Stabilization_20200225

DWR
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization 10
Division of Water Resources
FORM: SSGP 10-2013
40
Shoreline Stabilization Application Form 7
;00-
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: uIlt-L I A u l
Mailing Address: , i }���,,1
Telephone Number: Fax Number:
E-mail Address:C.A )CA M (?Or r►-i,ef5 nM
e
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: 6r ( , , i M . ) C,-) do
Company Affiliation:
0
Mailing Address:
C L
Telephone Number: !`I I ) 100 Fax Number: --loy 6.Z
E-mail Address: LJ i CA60 ,;f Z/C</v; %�712 --. C,
Person to receive the Certification Approval: '-�L' L v-
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) v
County: M-ZC t
Nearest Town: /l-i/
Subdivision names or site address (include phase/lot number):
Directions to site - please include road names and numbers, landmarks, etc.:
Latitude (in decimal degrees) (J "i �y Longitude (decimal degrees) o"! "+
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): ow,>e 0V Pl k C "f
6. Property size (acres): I • d
7. Lake/ river/ ocean adjacent to property: tjIL4 g
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): *i2ge ) q d- ? Z kowe. e/tl' ov" wu e
9. Will work be conducted from land? ❑ From water? A
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
the normal pool la�je level/ Nor al 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: Md 1 � L `�j t-L L- �'Tl,i M- L �
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 feet landward to be im acted (number of trees, for instance): NONe , I N Au9 ;01
0 -10 le l - lce h/rA 1 30 PON or ? AV to . Iso V) -4
4PI FQT o; � Wks 1 S ZVot04 PLSI3+I 0 � .�tV ���" � . 04 dAAAI .1�I
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 10-2013 Page 2 of 3

Lake
(At Full Pond/Normal Water Level)
up
1 Full P nd/
Nor a eLevel
:
StMreline 7
r-0 ':,.
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 Now c. ko
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 brigs, retaining walls, deek*-ater
5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors N QN4
CiJiTn kv9)
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T r YG7
Sr, - �'► -� ,5 �y �s der Ve "lfq
FORM: SSGP 10-2013 ��"'� Page 3 of 3

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NOTES:
• PROPERTY MAY BE SUBJECT TO RECORDED OR
UNRECORDED RIGHTS OF WAYS OR EASEMENTS
NOT OBSERVED
• OWNER TO VERIFY ALL SETBACKS AND ZONING
REGULATIONS PRIOR TO ANY PLANNING OR
CONSTRUCTION.
• DIMENSIONS OF ALL IMPROVEMENTS SHOWN ON
THIS PLAT SHOULD NOT BE SCALED OR RELIED
UPON FOR DESIGN OR CONSTRUCTION WITHOUT
A FIELD VERIFICATION OF ALL DIMENSIONS.
• DIGITAL COPIES OF THIS FILE ARE FOR REFERENCE
ONLY AND MAY NOT BE USED FOR DESIGN WORK.
LAKE
\ANT IC
Curve I Rodius I Length I Chord Chord Bear. Coupe Beoring Dielonce
Cl 411.40 9.14 9.14 S 24'S9 44 W L1 N 58'23 N E 30.30
N 49'OS 00 E 38.45
L3 N 3642 00 E 34.80
120 180
/
N6 REBAR
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IR
PHYSICAL SURVEY
FOR
EQUITY TRUST CO.
10100 SAW MILL RD — CHARLOTTE, NC
LOT /5, SAW MILL PO4NTE
STEELE CREEK TOWNSHIP, MECI(LENBURG COUNTY, NC
SCALE: 1' - 60'
DEDMON SURVEYS
CHUCK POOVEY, PLS #3762
ROBERT DEDMON, PLS #3899
3704 NC HIGHWAY #16 NORTH
P.O. BOX 494 - DENVER, NC 28037
PHONE: [phone]
FAX: [phone]
SEAL
=. '_ L-3B99
I, ROBERT J. DEDMON, CERTIFY THAT THIS PLAT WAS
DRAWN FROM AN ACTUAL SURVEY MADE UNDER MY
SUPERVISION (DB 29960, PG 909)(PS 24, PG 698).
THAT THE RATIO OF PRECISION AS CALCULATED
EXCEEDS 110,000'; THAT THIS PLAT WAS PREPARED
IN ACCORDANCE WITH GS 47-30 AS AMENDED.
WITNESS MY ORIGINAL SIGNATURE. NOVEMBER 3. 2016.
%�� Q 3899
PROFESSO L LAND SURVEYOR LICENSE NO.
SURV. BY: WT I DRAWN: RD JOB# X16SMP5
VICINITY MAP
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