20201541 Ver 1_Shoreline Stabilization_20201208

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 Et Buffer Permitting Unit RE E ED
1617 Mail Service Center
Raleigh, NC 27699-1617 SEP 4 2020
1
Applicant Information
Owner Information
Name: Bill Coble
[15A NCAC 02H .0502(a)]
Mailing Address: 228 WOODWINDS DR.
MOUNT HOLLY N.C. 28120
NCD
Telephone Number: 704-996-0680 Fax Number:
E-mail Address: william.cobleCnovartis.com
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.armymit/Portals/59/docs/requtatory/
r jgd cs /Permits/ SAMPLE AGENT AUTHORIZATION_FORM.pdf) must be attached if the
Agent has signed this application form.
Name: IVED
Company Affiliation:
DEC 0 8 2020
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Person to receive the Certification Approval:
NCnF-"R/NPDES
H. Project Information [15A NCAC 02H .0502(a) Et (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,
FORM: SSGP 10-2013 Page 1 of 3

impervious surfaces, 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: GASTON Nearest Town: MOUNT HOLLY
Subdivision name or site address (include phase/lot number):
STONEWATER BAY PHASE I - LOT 47
Directions to site - please include road names and numbers, landmarks, etc.: _
OFF EXIT 16 ON 485. NORTH ON NC-16 BROOKSHIRE.
TURN RIGHT ONTO HORSESHOE BEND BEACH RD. GO 1.0 MILES
TAKE 3RD RIGHT ONTO STONEWATER BAY
TURN LEFT ONTO WOODWINDS DR.
HOME IS ON RIGHT.
Latitude (in decimal degrees) 35.350660 Longitude (decimal degrees)-80.963970
5. Describe the existing land use or condition of the site at the time of this
application (residential, undeveloped, etc.): RESIDENTIAL
6. Property size (acres): .5 ACRES
7. Lake/ river/ ocean adjacent to property: MOUNTAIN ISLAND LAKE
8. Describe proposed work (include discussion as to how hardening of shoreline has
been avoided, or why it is necessary): MAJOR EROSION. LOOKING TO
STABILIZE EMBANKMENT WITH RIP RAP
9. Will work be conducted from land? YES, FROM LAND From water?
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining
walls, etc.) below the normal pool take level/ Normal Water Level in square feet
or acres: APPROXIMATELY 1,000 SQ. F.T
11. Total amount of disturbance (including all clearing, back fill, excavation, rip
rap, retaining walls, etc.) above the normal pool take level/ Normal Water Level
and 50 feet land -ward in square feet or acres: APPROXIMATELY 1.500 SO. FT.
12. 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):
EXPECTING TO REMOVE 5 EXISTING TREES DUE TO DAMAGE OF ROOT SYSTEM
FROM EROSION
FORM: SSGP 10-2013 Page 2 of 4

Owner/Agent's Signature' [15A NCAC 02H .0502(f)1 Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
Lake
(At Full Pond/Normal Water Level)
DOCK
FL
Norma
SI
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 4

01/24/2005 15:19 ESP ASSOCIATES ►
N7.658 CO3
l4gS,
,.) TFIS PROPERTY WAY K 9"CT TO ANY
;ASEM T(S) AND OR RIGHT(S) OF WAY-
?,) Sug4cT TRACT IS NOT LOCATED N A
gl,ECML FLOOD HAZARD AREA AS SHOW ON
MMA FIRM (COMANVITY PANEL NO. 370158
DO30 B AS REVISED 2/3/93)-
3.) NO SURvEY POWOR11ED AT THIS TINE-
PMOM ORIEW2TIED To
to
N
eAR scALE
0 20 40
PRELIMINARY PLAT
NOT', acco lloN Ga•M.YAom ca SAM
/ LEGEND
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MAP.B" AND PAGE
SF
SQUARE FEET
Fp
EDGE OF PAVEMENT
1
WATER METER
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CLEAN OUT
pm PIN FOUND
IPS
IRON PIN SET
3 NMS
NO MONUMENTA71ON SET
f
.OT 47
61 PG 121
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ESP ASSOCIATE'S P.A.
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