20170102 Ver 2_Shoreline Stabilization_20200327

State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources 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
MAR 2 7 2020
DENR -WATER RESOURCES
I. Applicant Information [15A NCAC 02H .0502(a)]
TRANSPORTATION PERMITTING UNIT
1. Owner Information
Name:
Mailing Address: -D
Telephone Number: ''�ZALIOSOD 1-1 Fax Number:
E-mail Address:
2. Agent/ Contact Person formation
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. df) must be attached if the Agent has signed this application form.
Name: . Q �- '� l�.�.Q. f �i h `�sz t/) _ -
Company Affiliation: , _Y <D �5 b %,4
Mailing Address: I !) , Q � 41 JA
Telephone Number-JnL4 LIdC) ('1 2-( Fax Number:
E-mail Address: V- �
Person to receive the C4drtification Approval: rv,t�
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: /11!11 Al ]&6X_ Nearest Town:
Subdivision name or site address (include phase/lot number): L4 3 Z L�(p fe-2— L X-I
Directions to site - please include road names and numbers, landmarks, etc.:
nQ=k= 4 0,,� Q�A_
Latitude (in decimal degrees) Longitude (decimal degrees)
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.):��5`! Aa.:O. ,
6. Property size (acres): a ff
7. Lake/ river/ ocean adjacent to property:
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): --I-v S,6,16`, V,-Z.,
9. Will work be conducted from land? t� 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 ater Level and 50 feet land -ward in
square feet or acres: � 211- ^
12. Please describe the vegetation above the normalpool lake level/ Normal Water Level and
50 feet landward to be impacted (number of trees, for instance):
Owner/Agent's Signature
Printed Name
[15A NCAC 02H .0502(f)]
'Agent's signature is valid only if an authorization letter from the owner is provided.
Zo
Date
FORM: SSGP 10-2013 Page 2 of 3

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION: 2 �-� /
LOT NO. PLAN NO. PARCEL ID: � a`� b 3a 1 ! d ,
STREET ADDRESS: , `'� LA t' �� � r � d'� . J'�
Please print: 1
.Q Property Owner:
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
P CIZ o;`
(Contractor / Agent) (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):
-73
Telephone:
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Si nature Authorized Sign ture
Date: �� Date:

NOTES:
• PROPERTY MAY BE SUBJECT TO RECORDED OR
UNRECORDED RIGHTS OF WAYS OR EASEMENTS
NOT OBSERVED
OWNER 10 VERIFY ALL SETBACKS AND ZONING
REGULATIONS PRIOR TO ANY PLANNING OR
CONSTRUCTION.
• DIMENSIONS OF ALL IMPROVEMENTS SHOWN ON
THIS PUT 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.
• ALL UNDERGROUND UTILITIES ARE NOT SHOWN HEREON.
DEDMON SURVEYS
R/W
#5 PIN
FAIR OAK
DRIVE 50' RAD.
i
i
R/W
PIN
LEGEND:
BOUNDARY LINE
' SANITARY SEWER LINE
• NATURAL GAS LINE
UNDERGROUND POWER
OVERHEAD UTILITIES
- UNDERGROUND TELEPHONE
WATER LINE
-O • O FENCE (TYPE NOTED)
CP = COMPUTED POINT (UNMARKED)
R/W = RIGHT-OF-WAY
E/P = EDGE OF PAVEMENT
C/L = CENTERUNE
d = UTILITY POLE
s
PB 49-65
O
.O 1
o�
OFFSITE
SEPTIC AREA
f\�
` A PORTION OF THIS PROPERTY IS LOCATED IN A 100 YEAR FLOOD PLAIN
AS DESIGNATED BY FIRM PANEL 8 3710462900K
3-18-2008 EFF. DATE
Curve I Radius Length Chord Chord Bear. I /
C7 50.00' 25.39' 25.12 N 0T3317 W / a
41
#5 PIN
N -7551 15"E I
#4 PIN
�5 �/e 32 44iQ3 • av�/
0.578 AC. jjl� c f�
/ 25162
ry
3�
-APPROX. 760' CONTOUR
N0RR ~
~ ANY DOLK6, PIERS OR DRIER- ~
~Q�PROv4MENf5 eUILT ON ,IAKE�
� lARE NOT SHb1YN UN THLS �.. �.�
~ r �
#4 PIN �nl
c- �)Xv'
PB 49-65 40 0 40 80 120
GRAPHIC SCALE - FEET
PHYSICAL SURVEY
FOR
DAPHNE R.
WAGNER
LOT #32 NORTHVIEW HARBOR
8946 FAIR OAK DR - SHERRILLS FORD NO
MT CREEK TOWNSHIP - CATAWBA COUNTY
SCALF: 1" = 40'
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]
`1111T1unrh,
�$O�.vp Ff55/p �j�i
L-3762 =
� TI1111111I
I. DAVID C. POOVEY• CERTIFY THAT THIS PUT WAS
DRAWN FROM AN ACTUAL SURVEY MADE UNDER MY
SUPERVISION (DB 3055. PG 1620)(PB 49. PG 65;
THAT THE RATIO OF PRECISION AS CALCULATED
EXCEEDS 1:10000; THAT THIS PLAT WAS PREPARED
IN ACCORDANCE WITH GS 47-30 AS AMENDED.
WITNESS MY ORIGINAL SIGNATURE, REGISTRATION
NUMBER AND SEAL THIS 20 DAY OF JAN., AD
2017.
)LA C• I \ L-3762
PROFESSIONAL LAND SURVEXW LICENSE NO.
SURV. BY: FAL DRAWN: CP JOB# FRAK32
VICINITY MAP
X-'9'
SITE °
a�
o�
ZP
S�
�r
z° TS�N
0 p
T RD

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 a aining walls docks, etc.
5. Location of any excavation or dredging below the Full on Normal Water Level elevation
6. Location of construction access corridors
FORM: SSGP 10-2013 Page 3 of 3

8946 Fair Oak Drive Sherrills Ford, NC
Of
\Aonarch Mortgage
Northview Harbour lA
Owners Associates