20140521 Ver 1_Shoreline Stabilization_20140523

20 14052 1
State of North Carolina
DWR Department of Environment and Natural Resources
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
Four copies of the application (including attachments) and the application fee should be sent to:
Division of Water Resources
401 & Buffer Permitting Unit [�/�
1650 Mail Service Center RR V
Raleigh, NC 27699 -1650
hiA't' 2 3 2014
I. Applicant Information [15A NCAC 02H .0502(a)] Nit = ►y,� r
AL
wake.
1. Owner
Name:
Mailing
Telephone Number: Fax Number:
E -mail Address: 1' II 1'1 C.0_VK
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. df) must be at ached if the Agent has signed this application form.
Name: r
Company Affiliation: 1] 17 cks Dwner.
Mailing Address: 2:% 9,11 hnr nif R,4 .
AA n l r, 2S 11-7
Telephone Number:
E -mail Address:
Person to receive the
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�jie property (where work is to be conducted)
County: "red& Nearest Town: Moore5MV.
Subdivision name,or site addrnnel�s (include phase /lot nu ber ): L D- 11
HU,V\+i TA.Q -6A WbC4 S
Directions to site - please include road narfies and numbers, landmarks, etc.:
5. Describe the existing land use or condition of th&site at the time of this application
(residential, undeveloped, etc.): r e 5 l I har e e, r
6. Property size. (acres): Sh ow' e I e
7. Lake/ river/ ocean adjacent to property: N Or
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or-why it is necessary): S u �ze S6 ref I n-e e r o s i m
9. Will work be conducted from land?
From water? ❑
10. Total amount of disturbance (including all excavation, backfill, riprap, retaining walls, etc.)
,below the normal pool lake level/ Normal Water Level in square feet or acres:
?)i
11. Total amount.of disturbance (including all clearing, backfill, 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: A (
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): Y- S OA I
y
Owner /Agent's Signature` [15A NCAC 02H .0502(f)], Date
'Agent's signature ►s. valid only if an authorization letter from the owner is provided.
:FORM- SSGP 10 -2013 Page 2 of 3

AUTHORIZATION FORM
AQUA DOCKS
And Outdoor Structures
Mooresville, NC
www.aguadocks com
(704) 664 -5434
The undersigned, registered property owners of the noted property, do hereby authorize
AQUA DOCKS
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 standardvan&special conditions attached.
Property Owner's mailing address:
11 0
Please print.
Property Owner.
Property Owner:
Property Owner's Address (where work will be performed):
Phone:
We hereby certify the above information submitted in this application is true and accurate to °the
Authorized Signature Authorized Signature
Date: _ Date:

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Revenue Stamps: S852.00
Type CONSOLIDATED REAL PROPERTY
Recorded: 7/1712013 2:54 35 PM
Fee Amt $878.00 Page 1 of 2
Revenue Tax: $852 00
Iredell County, NC
Matthew J McCall Register of Deeds
BK 2254 PG 1475 - 1476
Recording Tune, Book and Page
Tax Lot No I Parcel Identifier No 4646 =97 -3343
Verified by County on the _ day of 120
Mall aftef recording to Grantee
This Instrument was, prepared by Laura S. Temple, Attorney at Law, Homesley & Wingo Law Group PLLC, 330 South
Main Street, Mooresville, NC 28115 www.fakenormantaw.com
Brief Descnphon for the index Lot 11 Huntington Woods
NORTH CAROLINA GENERAL WARRAN'T'Y DEED
THIS DEED made this 19th da of JuIv 2013 b and between
GRANTOR
GRANTEE
Cory J. Ott and wife, Jean M. Ott
Richard K Burgin and wife, Angela C. Burgin
Whose Address Is
Whose Address Is
PO Box 5285
182 Huntington Lane
Mooresville, NC 28117
Mooresville, NC 28117
The idesignahon,Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assipib, wid m,ad
include singular, plural; masculine, feminine or neuter as required by context
WITNESSETH,,that,the Grantor, for a valuable consideration paid by the Grantee, the receipt,of which is hereby acknowledged,
has and by these presents does grant, bargain, sell and convey unto the Grantee in fee simple, all that certain lot or parcel of land
situatedim Iredell County, +North Carolina and more particularly described as follows-
Being all �of Lot 11 of Huntington Woods, as shown on a map thereof recorded in Plat Book 13,
Pages 35 of the Iredell County Public Registry.
Pursuant to N.C.G.S. § 105-317.2(2), this certain lot or parcel of land includes the Grantor's primary residence.
R.O.T.C.
Book 2254 Page 1475 Page 1 of 2
1
3AS arQ ❑2

The property,heremabove described was acquired by, Grantor by instrument recorded in Book 1235,, Page 95
A map showing the above described property is recorded`in Plat Book 13, Page 35
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to the
Grantee in fee simple
And the Grantor covenants,with the Grantee, that Grantor is seized of the,premtses in fee simple, has the right to convey the same
in fee'sirnple, that title is marketable and free and clear of all encumbrances, and that Grantor will warrant and defend the title
against the lawful claims of all persons whomsoever except for the exceptions hereinafter stated
Title to the property heremabove described is subject to the following exceptions
1. ANY AND ALL EASEMENTS, RIGHTS OF WAY AND RESTRICTIONS OF RECORD.
2. ANY AND ALL ZONING AND PLANNING,ORDINANCES.
3. ANY DISCREPANCIES AS AN ACCURATE SURVEY OF THE PREMISES MIGHT REVEAL.
IN WITNESS WHEREOF, the Grantor has hereunto set'his hand and seal, or'nf corporate, has caused this instrument to be
signed in its corporate name by its duly authorized officers and its seal to be hereunto affixed by authonty of its•Board of
Directors, the day and year first above written
�
� D
Cory,14. Ott
P11; M. Ott
(Note Igo not place :cal
STATE OF NORTH,CAROLINA
outside this boa into the
COUNTY OF 1REDELL
margin)
1, LAURA ,S TEMPLE, a ,Notary Public of Mecklenburg County and State
aforesaid, certify that Cory J Ott and wife, Jean M. Ott, Grantor(s), personally
known to me or proved to me on the basis oFsatisfactory evidence to be'the
uluiI I�
individual whose name,is subscribed to,the within instrument,and acknowledged
AJto
me that,they/he /she voluntarily executed the same in [heir/his/her' capacity,
'for therein that'by their/his/her signature on the
*OUR S'
the purposes contained and
t4coak
instrument, they executed the instrument
Witness my hand,and official p orrseal; this'l9th day, of July, 2013
Notary P is
My Com ission ires Jan 28, 2017
Book 2254 Page 1475 Page 2 of 2