HomeMy WebLinkAbout20140409 Ver 1_Shoreline Stabilization_201404212 0 1 4 0 4 0 9 State of North Carolina
D-W"IR Department of Environment and Natural Resources
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 APR 2 1 cu t4
1650 Mail Service Center
Raleigh, NC 27699 -1650 _ _ -_ - _, I _���+,
1.
Applicant Information [15A NCAC 02H .0502(a)]
Owner Information
Name:
Mailing Address: /S-?Zl /t,2e"x %
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14, e r: i1W.
Telephone Number: Fax Number: i
E -mail Address: T
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 /repulatory /regdocs /Permits /SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name:���+?a•���
Company Affiliation:
Mailing Address:
Telephone Number: 7c5,4 -- 4gs- -35f72r Fax Number: 7eYy•-
E -mail Address:
Person to receive the Certification Approval: Z
II. Project Information [15A 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 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) �!
County: jdec le;2bylet Nearest Town: C.�0Z17e -/'tS
Subdivision name or site address (include phase /lot number): _
/,d� * is
Directions to site - please include road names and numbers, landmarks, etc.:
�f- /10,o e? .jjt- �Z_� .44 7t 77 f'7-ah -e ]egIv.1Ikt .1������_ aye 5 $4. '7-w lJ� 1/4,,v4 r= `
Y-fy,,( C Cyey( i l _j,� l e,4+ f9/1 f'it'.:' f�:� 4;1 4 e- 134/b . -TwIx Zdf f,.I 1A..
W :4 ii -_4 64W./9 4V %u t%? �V y 6 r epel �11141ife n,tZx 3,4-
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): ?e<s.`dc,�t
6. Property size (acres): & 4ct`es
7. Lake/ river/ ocean adjacent to property: _(1le /144 cc, I
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): F l�lrG//f`54 014
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 Water Level in square feet or acres:
q' x z-Z 7' 5,6 4ee f
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: � � �R1.; $r 7z4& f��� �4uc: b y `�� ��te =�� L�c> if
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): 610 �k e ,-s uXc"/`
60 . Q!) &1 9 1149e -,,1 eelall �, 01!1f 4, 'Hrc✓
q 1 7 lt�
Owner /Agent's Signature* [15A NCAC 02H .0502(f)] Date
*Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10 -2013 Page 2 of 3
Full Pond/
Normal Water Level
51
Lake
(At Full Pond/ Normal Water Level)
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
Daryl W. Long
Professional Land Surveyor
18335 Old Statesville Road, Suite A
Cornelius, N.C. 28031
Phone / Fax 704 - 765 -5134
Subject: 16447 Pinwhenny Road
Cornelius, N.C. 28031
This is to certify that a portion of the above referenced property is
located in a special flood hazard area according to FEMA flood panel map
3710462200K, dated March 2, 2008. However, the building envelope is
located in Zone X, above the FEMA Base Flood Elevation.
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Dary . Long Profess n and Surveyor L -4918
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SURVEYOR'S REPORT
1 hereby report that 1 have made an accurate survey of the premises situated at:
Cornelius
_ city
Known as Street Numbers: 16447 Pinwh
Mecklenburg N.C.
County State
nv Road
and shown on the accompanying map. I made a careful inspection of said premises on
June 6th , 2013 , and at the time of inspection I found to be in possession of said
premises: Albert V. Inscoe Jr. and Sh
W.Inscoe as Owners
(tenant or owner)
I made a specific examination with respect to the following items and report the existence of the following (If
none, state "None "):
1. Rights of way, lanes, driveways or walks across said premises serving other property:
None
2. Streams, ponds. or lake located bordering on or running through said premises:
Yes, Lake Norman
3. Telephone, telegraph or electric power poles or wires overhanging or crossing said premises and serving
other property: Overhead Service Wires
4. Underground installations such as sewers, water pipes, gas or oil pipe lines, conduits, across said
premises: Underground Service Lines _
5. Drainage ditches or underground drain tile across said premises:
None
6. Joint driveways or walkways, party or curtain walls: No _
7. Encroachments or overhanging projections including (fences, walks, drives or similar adjoining structures
encroach upon premises, specify: None
8. Physical evidence of boundary line on all sides:
9. Any unusual elements of use or possession affecting said premises (cemeteries, parks, etc.):
10. Evidence of commenced or newly completed construction:
11. Does the premises adjoin a publicly maintained road? Yes. See Map
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Property
Property of
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Surveyors, Inc.
18335 Old Statesville Road
Steven and Connie
16447 Pinwhenny Road
Cornelius, NC 28031
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LAKE NORMAN
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OVERHEAD OTILITIES
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(704) 765 -5134
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LENGTH
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CURVE TABLE
CURVE
LENGTH
RADIUS
CHORD
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Graphic Scale
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130.51'
67.66'
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Cresent Land & Timber Corp., Lake Norman
Professional
Property
Property of
Site Address:
As Recorded in
Surveyors, Inc.
18335 Old Statesville Road
Steven and Connie
16447 Pinwhenny Road
Cornelius, NC 28031
Map Book 17. Page 544 and
Ste. A, Cornelius, N.C. 28031
I tOIItnget
Mecklenburg County
Deed Book 10007, Page 447
704- 765 -5134 Phone /Fax
Firm License: C -3666
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Tax Parcel Number
Latitude and Longitude of a Point
Page 1 of 1
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Address: 16447 Pinwhenny road, Cornelius, nc GO
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Latitude: 35.463168
Longitude: - 80.933349
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Longitude: -80 56 0.0564
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SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 137 PLAN NO, PARCEL ID:
STREET ADDRESS: !�' `t`t
Please print: rr,
Property Owner:
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above): D 3 t ;z'
�ey5.,1
Telephone: 7"`r — 9Ga� J Scr�G S APR 2014
W TE Qt1ALnY
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
uthorized Signature L Authorized Signature
Date: y f ` � 6 —� ` Date: