20200830 Ver 1_Shoreline Stabilization_20200624

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
_DWK
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 R (�? v[2 0 v �%J
M
Raleigh, NC 27699-1617 D
g ' JUN 2 4 2020
DENR -WATER RESOURCES
I. Applicant Information f15A NCAC 02H .0502(a)] TRANSPORTATION PERMITTING UNIT
1. Owner I
Name:
Mailing
Telephone Numlwr 7!� }� �1��— 2�?-0 Fax Number:
E-mail Address: P�L,� (°% D e_!/ Z; ht 6.:/ , C-671-1
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: Fax Number:
E-mail Address:
Person to receive the Certification Approval:
II. Project Information 115A 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: /�I' �'°°�y Nearest Town: M�'�'x
Subdivision name or site address (i ude phase/lot number):
Directions to site -please include road na and nu !
'rWdndmarks, etc.:
Latitude (in decimal degreesj,, , i'��r ��' _ Longitude (decimal degrees) -
5. Describe the existing land use or condition of th�ittee at the time of this application
(residential, undeveloped, etc.):.W�`rc�
6. Property size (acres):
7. Lake/ river/ ocean adjacent to property:
8. Describe proposed work (include discussion as to how hardenin of shoreline has been
avoided, or why it is necessary):`
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 Wat 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 Lev I and 50 feet land -ward in
square feet or acres:
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 feet landward to be impacted (number of,"es, for insp.9ce):
Owr(°er/Agent'lYSignaturef (15A NCAC 02H_502(f)j \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)
Full Pond/
Normal Water Level
M � �
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
FORM: SSGP 10-2013
Page 3 of 3

PLOT PLAN for JOHN H. CAPELL and
KERRY L. CAPELL s� 1j81
Subdivision THE LANDING — MAP 7 OF 3
Lots) 6 _ PLAT CAS-
F SLIDE 48—D 1 0 rwin Harbor
b
Tax Parcel 6575-18-30-6812 DB 807 PG 370 c:
Sl1 Ston Point pr.
Street Address 119 COVE POINTE �"n9
a
Township PEE DEE County MONTGOMERY State NC VICINITY MAP (NTS)
—TINE TABLE
LINE BEARING DISTANCE NOTE: 10' DRAINAGE EASEMENT LOCATION
LI S32'50'08E 10.03' IS AN APPROXIMATE LOCA77ON AS SCALED
L2 N6100'13"E 77E 24.29' FROM THE REFERENCED RECORD PLAT
LS S694724"W 17E 49.16'
L4 IV33'16'20'W TIE 19.96'
L5 S2856'33'W 4160' /
L6 S28 49'41 "W 41.97'
7hs µins sir^( �leanya cl5 \ � Q � O flat rrbyW dsdtrtnd hV (pN6
rarrdte mm craw, �•F.� ll�' EIRF F LL
No PUQ451wap Hwrmmal Con✓N LOT 6 PP� A4,p R _�6 PB "d
mUrn 270° of ft' S p THE LANDING / Cp`1 g,` p� No CV BOXES
SUBDIVISION Y E
sl.. mmm. Agmeme+:Li oc A O ,�v �4J
lb
PLAT CAB. F-48—D E7RF Li �I
tla:e W Ws plal "Ilcir Wds rrol
.u�efe ar the Mrc ormy rnspac^cn 169��IRF Vs
S ry
No aaempt has ^Mr mach as a part a L^.a:
PLOI PIANO mIar"wshra.,dara__re g / LOT 5
av le— arc d PrAh mmh^ j n Pafy « 1-11
ro.;�txn Of any ur.3ry v InraunpaSyuNk servx faaLry h �,\ EIRF \ THE LANDING
F« m/wrtraLm� regamng Omu• vGT4e «
�uLars, yoaso mnlad ttre appopnam ngeruy .E /� �� b9. \ \ \ SUBDIVISION
AN /E \ \ _CO PLAT CAB. F-48—D
7hs SonaYrs o'an e+trslMg pars,( �$ `'� \
«Parcels m'IarA g'1 / �' �, �0 \ ,° DR. 807, Pg. 548
SuneyBaszd oe E+ erg Comers � y5 E to �`g 3� \ \
807, PG. 370 \ 10' DRAINAGE
EIRF � . �
LOT 6 �� EASEMENT
21,789t Sq. Feel
EIRF
0 0.50f Acres /
LOT 7 44-67 VACANT
2_,a' 75 El P (CP&L)
THE LANDING \ %� PROPOSED 3" IALL
SUBDIVISION ? o m HOUSE � EIRF
PLAT CAB. F-48—D ; SEE ATION �'01�5 �, DUKE ENERGY
DB 789, Pg. 539 , \� NOTE* 56� oy ` / PROGRESS, INC
19 \ 569 33 p1"W / dF_ RF LINE LEGEND
PROPERTY LINE SURVEYED
^' 60.8�, FENCE LINE
43 ElRF �_ 1 5" E1P(CP&L) ---- — OVERHEAD POWER ONE
.3" TALL — ADJO/NER PROP
TALLERTY UNC
1.5' r £t / - — RIGHT OF WAY
MINIMUM BUILDING UNE
5/8" EIR(BENT) /_ _ LiN / LAKE TILLERY PROPERTY UNE NOT SURWIE1
18 TALL ,a.uuunp,.
LEGFND a� a'( \' C A R O ��•
NOTE': PROPOSED HOUSE LOCATION PER MEETING EIP-IXfSTINGWON PIPE :a0� FEss/O
WITH JOHN H CAPELL ON SEPT. 2577-1 2O19. EIRF-YP•E)OSTINGIROVROOrLUSH : $ QQj
HOUSE ENVELOPE DIMENSIONS PROVIDED BY ICV-CRIIGAnONBOX Nr SEAL
THE OWNER JOHN H CAPELL PW-RIGHTOi WAY L-3863 �
WV -WATER VALVr "t—
'7711S MAP MAY NOT BE A CERTIFIED SURVFYAND HAS NOT WM • WATER AIFTE14 %7
9yo �O O
BEEN REVIEWED RYA LOCAL GOVERNMENTAGENCYFOR PB-POWERBO
COMPLIANCE WITHANYAPPLICASIFLAND DEVELOPMENT MBL-MINIMU&IBULONGLOINCER
REGULATIONS AND HAS NOT BEEN REVIEWED FOR NIS -NOT TO SCALE •., GA RY K�� as
COMPLIANCE WITH RECORDING REQUIREMENTS FOR PLATS " /' y` '• .r.r•.9�"�
Prepared by
GARY KENNEDY PLOT PLAN ONLY
PROFESSIONAL LAND SURVEYOR
[phone] [phone]
703 Page Street
Troy, N.0 27371 0' 50' 100, 150,
Scale. 1"=50' Date-9/25/2019 Precision 1:10,000+
Drawn. JGK Checked. gk Job: S-05419PP GRAPHIC SCALE
7ha map duos pa! meet N C G S swrdalrLc 4730 and a rrollw Rcap.oiry

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