20200577 Ver 1_Shoreline Stabilization_20200429

State of North car0Iina
Department of enukonment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Qual ty Certification, Shoreline Sb4al ation
SSGP 02 W17
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the �� should be sent to:
sending via US Postal Service
K if sending via delivery service (UPS, FedEx,. etc.)
Karen Higgins Karen Higgins
DWR — 401 & Buffer Permitting Branch DWR — 401 & Buffer Permitting Branch
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC 27699-1617 Raleigh, NC 27604
A. Applicant Information f15A ICACQZ 0502€ail
1. Owner Information
Dame:
upo �
�o w 1E Mailing Address: Zz- I D
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Telephone Number: qi D - LA1-1- 7,50 Fax Number: TRANSPORTATION PERMITTING UNIT
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E-mail Address: u�G4mac i `icon-�
2. Agent/ Contact Person information
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:
arm f milliGrraisiSg/dccsfreguigtory/regdocs Perrii;tsfS fvlPLE AGENT AUTI- O iL
ATION FORNI.Pdfj
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address.
B.. Project Information MA NCAC 02H .0502(a) & fbj
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

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. t=don of the property (where work is to be conducted)
County: NearestTown: MA
Lake/ river/ ocean a anent to p erty: L&0 -f 1 a 1 e v i
Property size{acres):---QLC rLS _.
Subdivisioon name r site address (include phase/iot number):_
TS Plar\-� O rV
birections to site - please Include road names and numbers, landmarlm etc:
Sao Mban Q A n
Latitude (in dechnol degr+eesj,� longitude (decimal degrees) �0• D�'%��
5. Describethe existing land use or condition of the site at the time of this application
(residential, undeveloped, etc): N -5 r OI a ,,- it
6. gibe proposed work (include discussion as to how hardening of shor ellne has been
avoided, or why it ds necessary): "v r&l ko d („ ; V ot-440-r—t
7. Will work be conducted from land? From water? E]
8. Total amount of impacts below the normal pool lake level / Normal Water level
Permanent Impacts(including all e� , b
1 nCaddip, rip rap, retaining walls, etc) in square feet:
Temporary Impacts in square feet:
9. Total amount of hnpatcts above the normal pool lake level / Normal Water Level and So feet
land -ward
Permanent impacts (including back fill, Edon, rip rap, retaining waft etc) In square feet:
Temporary, impacts (temporary clearing, construction corridor) in square fleet:
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): .-S e 0-
1L SWwwa re
/Ag s Signature [15A NCAC 02H .0502M1 pate
AWnt°ssfgnature is valid onlyif an =ffiwizadian letterfromtine owner& proWded
FORM: SSGP 02-2M7 Page 2 of 4

12. Please approximately sketch the following information on this plan and provide dimensions for
each Item:
a. All proposed vgeWon 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• t=t!On of anv excavation or dredging bAaw the Full Pand/ Nnrmal Wntar i
Pond/ Normal Water
� MU .
Shoreline
Plan View
FORM: SSGP 02-2017 1
WU
f
Plan View
Lake
(At Full Pond/ Normal Water Level)
,L/00,rO�Y►�r►��� .�
!��t•r'r r�Y 1�
Dock
3ha35DIt
��rfd,aWjNWi
s�a�a
44xno@
;IN MW W MR aav Am
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Page 3 of 4

Side View
U-
3 ft below fun pond water level 4 fc above full pond water level 2 fL `ddidonal clearing
L if necessary
Existing bank
10 ft. bank
height
Q�o�o
FORM: SSGP 02-2017
Page 4 of 4

L-S) way,

64
61 57 55 63
65 Water Oak Way
50 10 5 6'P7'41'E 4 87'13'17'E 7 62
R�272 50' 30 18
d12 38 04'
A-60 09
�m
w m Lot 42
Lot 44 0
Z82 3 1 ie
yi ie
ai io
1 10 3
4R 43 _
S87'13'51
11.28'
i c4-b
6PROPOSED 31
HOUSE
23 24
6
i
Lake Tillery
PLOT —PLAN for
MITCH DAVIS and TAMMY SIDES
Property of Robert M. Stonestreet and wife Vickie G. Stonestreet
located at 221 Water Oak Way, Pee Dee Township,
Town of Mt. Gilead, North Carolina
Deed recorded in Book 675 Page 817 being Lot 43 of
"Swift Island Plantation" recorded in Plat Cabinet E Page 10—A
February 13, 2020 Scale: 1" = 50'
GRAPHIC SCALE 1"=50'
0 50 100 154s�,ro�y(H cgRo`�,�
Plot -Plan prepared from noted recorded In documents
and prowded house plans, NO SURVEY 7NlS DATE
cSEAL v®�
E
d L-1466
QQ y F,�i a9ti 1oe =i
�F��!/
William G Martin, NCPLS GIALF00 �Jy
2733 Counfry Club Road
Wodesboro, N. C
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