20200605 Ver 1_Shoreline Stabilization_20200504

State of North Carolina
Department of Environment and Natural Resources
DW�R
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
Four copies of the application (including attachments) and the application fee should be sent to:
Division of Water Resources
401 & Buffer Permitting Unit 'RECEIVED
1650 Mail Service Center
Raleigh, NC 27699-1650 MAY 0 4 2020
I. Applicant Information [15A NCAC 02H .0502 a`] NCDEQ/DWR/NPDES
1. Owner Information
Name: Ohf 8r
Mailing Address: i
FixrC Q
Telephone Number: Fax Number:
E-mail Address: mr,"(1(�"Pn r�(,'"()r'- P_ cv
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
htt ��,ti��°ea?.saw.usace.arr�7y.r lilfFcrtdlsl5°ldocslre�rlatc�ry/redcscslf�ermit. 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)j
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 4

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) l County: ��f���. Dearest Town:
Sub v'sion name or site address include phase/lot number):
"Allrr lls 2 _ Iv�-_7 d � 3
Directi/gns to site - please include road na /m`es nd/nnu�*mbers, landmarks, etc.: �•v /�
c�J ? o ��� s�-.I �s � fi�l( av- f
J 11, C>n r) a
S. Describe the existing land use or condition of to side at the time of this application
(residential, undeveloped, etc.): ��c,��;,V•E �-
5. Property size (acres): Fqkr
7. Lake/ river/ ocean adjacent to property: Z-,- e
8. Describe proposed work (include discussi n as to how hardening of shorelii a has been
avoided, or why it is necessary):.I 1,, ��., n�n� G �� �v ,sue,
9. Will work be conducted from land? I From water? ❑
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the no al ool lake le I/ pplorn)al Water Level ip square feet or acres:
o � � 7ae1a/ G S �f `.HG� LAY.►-�//r.' � Ab�
11_ Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool I k level/ Nor al Water Level and 50 feet land -ward in
square feet or acres:.,Ad
xx CIS
" d �
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 f t irdward to be impacted (number oftrees, for instance):
10/
f
Owner/Agent's ignature* (15A NCAC 02H .OS02(f)l Date
Agent's signature is valid only if on authorization letter from the owner is provided.
FORM: SSGP 10-2013
Page 2 of 3

Lake
(At Full Pond/Normal Water Level) -
Full Pend/
Normal lflater�Level =
Shoreline,
1 mC 1`\Ce—
Y 1GO
Z;
atcv `mot
Tease approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 f x 100 ft)*:
I. 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
FORM: SSGP 10-2013
Page 3 of 3

c to rba county Geospat°al Real Estate Search
AIAKIHG, LIVING. SETT€R. Information Services
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Parcel: 462801468060, 9667 ISLAND POINT RD SHERRILLS FORD, 28673
Owners: MADDEN CHRISTOPHER, MADDEN ELIZABETH
Owner Address: 2628 FOREST DR
Values - Building(s): $0, Land: $272,100, Total: $272,100
This map/report product was prepared from the Catawba County, NC Geospatial Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling information contained on this map or data on this report. Catawba County promotes and recommends
the independent verification of any data contained on this map/report product by the user. The County of Catawba, its employees, agents, and
personnel, disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect or consequential which arises or may
arise from this map/report product or the use thereof by any person or entity.
Copyright 2014 Catawba County NC
04/27/2020

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