20201121 Ver 1_Shoreline Stabilization_20200831

State of North Carolina
Department of Environment and Natural Resources
YJ f �_ —I I Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
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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 RECEIVED
1617 Mail Service Center
Raleigh, NC 27699-1617 A U G 3 12020
1. Applicant Information [15A NCAC 02H .OS021a)] NCDEQ/DWR/NPDES
1. Owner information
Name: G r; f� _1J"0YC3
Mailing Address: 2:J Lo g q j.—++ L��
iW4_ i(`(loun rn , " 2-91)1
Telephone Number: 19 ` Y�2-2-TO Fax Number:
E-mail Address: �r j0 � �(3 /NtA-
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.mif/Portals/59/docs/reaulatory/`regdoc_s/­Permits/SAMPLE AGENT AUTH
bRiZATlON EtIRM.prff) must be attached if the Agent has signed this applicatio form.
Name: SAE /-%A>/0Z7^) //, G, P, 1,,-?A P2.7%.A) A6,-` S;�� CV
Company Affiliation: _sic_ ,f ma <: 7z) /.BS le:>
Mailing Address:
Telephone Number: �'��' ZZ�-Zd rfi7Fax Number-
E-mail Address: -'e�> Cap- c...t> /, Ca
Person to receive the Certification Approval:
II. Project Information 11.5A NCAC 02H .0502 a &Lb
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: J aC-k 5v ►N Nearest Town:
Subdivision name or site address (include phase/lot number):
Z�6 S94k 1ACA Mour\%i,n T,rn t l C tkflo4a , & 297)) _
Directions to site - please include road names and numbers, landmarks, etc.: .
/Zoe 67 i 41149 J4 e. AO .ya&* 7b Z�/Al-0-IMC4,06 6,IJ !-CfT
Ty /fO,eTj/,(l0187V n1 Tb Gyovds •na vti? /z� d G��T
Latitude {in decimal degrees) ,� Longitude (decimal degrees% "�3> `lo % 4f�
S. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.):
6. Property size (acres): l . 'I acre S
7. Lake/ river/ ocean adjacent to property: L kkt- GH-e-AV
8. Describe proposed work (include discussion as ko how hardening of shorelire has been
avoided, or why it is necessary): �r`J�/3-1/2lPc•Ys- �i�,�L� GL-
9. Will work be conducted from land? ❑ From Water?
10. Total amount of disturbance (including all excavation, backfiil, rip rap, retaining walls, etc.)
below the normal pool lake level/ Normal Water Level in square feet or acres:
DNG S1 ?06 S Q A7, 1,39-0 _
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:. /- y &�44-'god SO'
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 feetlandward to be impacted (number of trees, for instance). lUDNr fj
—C. —1-2c-Zo
Owner/Agent's Si natu e' [1 5A NCAC 02 H .0502fLi Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

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TIFICATE OF APPROVAL FOR RECORDING
PROPERTY IS NO' LOCATED WITHIN A PUBLIC
ERESUPPLY WADESHE AND
CAN BE RECORDED
TER WATERSHED ADMNISTRAT
RTIFY THAT THE PLAT SHOWN HEREON COMPLIES
THE WATERSHED PROTECTION ORDINANCE AND
PPROVEO FOR RECORDING IN THE REGISTER OF
)S OFFICE.
-- WATERSHED ADMINISTRATOR
;E: THIS PROPERTY ISLOCATED WITHIN A PUBLIC
R SUPPLY WATERSHED DEVELOPMENT
RICTIONS MAY APPLY
FCATE OF APPROVAL FOR RECORDING
'TIFY THAT THE PLAT SHOWN HEREON COMPLIES
THE SUBDMSIE AND MOUNTAIN AND HILLSIDE
APMENT ORDINANCE AND
PROVED FOR RECCRDING IN 'nE REGISTER OF
i OFFICE
I,W EDWARD HALL,CERTIPY THAT THIS PUT WAS DRAWN
UNDER MY SUPERVISION FROM AN ACTUAL SURVEY MADE
UNDER MY SUPERVISION(DEED DESCRIPTION RECORDED In
DEED BOOK 1010. PACE 724) THAT THE RATIO OF PRECISION
AS CALCULATED IS BETTER THAN i PART IN 7500 AND THAT
THIS NAP WAS PREPARED IN ACCORDANCE WITH G S 47-30 AS
AMENDED, AND THAT ONE OF THE FOLLOWING AS MARKED S TRUE:
)(_THIS PUT ISCF AN EXISTING PARCEL OR PARCELS
`N CAPOC/
OF LAND AND DOES NOT CREATE A NEW STREET OR
P Py
C+-WGE EXISTING STREET
2 ---THISPUTLAT CREATES A SUBDIVISION OF LAND WITHIN
THE AREA OF A COUNTY OR 4UNICIPAUTY THAT HAS
AN ORDINANCE THAT REGULATES PARCELS OF LAND
L_2976 V
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3 __ THIS SURVEY IS LOCATED IN A PORTION OF A COUNTY
OR MUNICIPALITY THAT IS UNREGULATED AS TO AN
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ORDINANCE THAT REGULATES PARCELS OF LAND
6
4.___THAT THE SURVEY IS OF ANOTHER CATEGORY. SUCH AS
f�AYARD`�Y.
THE RECOMBINATION OF EXISTING PARCELS, A COURT -ORDERED SURVEY
OR OTHER EXCEPTION TO THE DEFINITION OF SUBDIVISIONS
WITNESS MY ORIGINAL SICNATUREAEGISTRATION NUMBER
AND SEAL THIS 201H DAY OF JULY. AD. 2016
REGISTERED LAND SURVEYOR IL-2976
---�' PUNNING DIRECTOR OR DESIGNEE
STATE OF NORTH CAROLINA
D REFERENCE. 0 B 1010,PG 724
COUNTY OF
1 REVIEW OFFICER OF
T REF: PC 8 SL 516
COUNTY. CERTIFY THAT THIS MAP OR PUT TO WHICH THIS
RE ARE NO RECOVERABLE HORIZONTAL CONTROL
CERTIFICATION IS AFFIXED MEETS ALL STATUTORY
'ENT WITHIN 2000 FEET OF THIS PROPERTY
OWNER AT TIME OF SURVEY IS MITCHELL
REOUIREMENTS FOR RECORDING
A DETERMINED eY C k G COMPUTER PROGRAM
OF NORTH CAROLINA. JACKSON CCLNTY
REVIEW OFFICER DATE
)REGOING CERTIFICATES OF W EDWARD HAL_•
EREO LAND SURVEYOR i 2976 ARE CERTIFIED TO BE
CT, THIS INSTRUMENT WAS PRESENTED FOR REGISTRATION
ECORDED N THIS OFFICE IN CABINET (PUT BOOK)_-__ -.
(PAGE)-____TH!S__DAY OF________.
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HAMBURG TOWNSHIP, JACKSON COUNTY. NORTH CAROLINA
JULY 20. 2016 SCALE 1' = 30'
DRAWING / 3732 -DATE OF supVEY - jULY 2016
OWNER AT THE TIME OF SURVEY IS MITCHELL
PREPARED BY
W. EDWARD HALL, LS.
MAILING ADDRESS OFFICE LOCATION
P O. BOX 2D04 13EELIGHTNING LANE
CASHIERS. 2NO97 RT' CAROLINA OFFNORTONWCMOUN AI ROAD
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TEL - 828-743-9836
MOBILE - 826-507-00O3
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