20140532 Ver 1_Shoreline Stabilization_20140527

.V
20110532
State of North Carolina
DWR 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 $ PAID
Four copies of the application (including attachments) and the application fee should be sent to:
Division of Water Resources n ��
401 & Buffer Permitting Unit ✓/I}
1650 Mail Service Center
Raleigh, NC 27699 -1650
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: k
Mailing Address
L oc^cA cur,
�� 0 (_
23� 2 00
C=�1[
7 14 i
Telephone Number: WO—aM- Fax Number:
E -mail Address: ia[P�t1Pvv�►�'2 t�el��i�S�� —c��� Co„y�
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 /dots /regulatory /regdocs /Permits /SAMPLE AGENT AUTH
ORIZATION FORM. df) must be attached if the Agent has signed this application form.
Name: -��C' -ry C-6
Company Affiliation: S <yrc�! ier r Inc.
Mailing Address: P "U RIC-IK
44 1
Telephone Number: 91 o Number: -7_ - l`?66
E -mail Address:
Person to receive the Certification Approval:
H. 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 roperty (where work is to be conducted)
County: A C Q Nearest Town: Co( -n2 \i Q �-
Subdivision name or site ad ress (include phase /lot number): ��
Directions to site - please include road names and numbers, landmarks, etc.:
L '` /� ///��� ���...���/// . /per %/- 1
1 kw l 7 N � �O ( + c ,To' r/x o 'C � VY
o �fo
5. Describe the existing land use or condition of the site at the time of this lica ion
(residential, undeveloped, etc.)': Sur�6,n a&cx- (yY4- & LcA app
6. Property size (acres): IM Acveer
7. Lake/ river/ ocean adjacentto property: plt Ak LiY�g�
8. Describe proposed work (include, discussion as to how hardening of shoreline has been
avoided, or why it is necessary): T6-- -s", w,1k �O b .
�t 1p,
9. i I wo b' con cte&fr'om I nd. OLeFrom water? ❑
'10. Total amount of disturbance (including II excavation, backfill, rip rap, retaining walls, etc.)
belowlthe normal pop lake, level/ Normal Water Level in square feet or acres:
0Y`e.,
'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: 706 -F-{
t
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 feet landward to be impacted
ber of trees, for instance):
o
S
Date
wrier is provided.
FORM- SSGP 10 -2013 Page 2 of 3
Are,

SAMPLE AGENT,AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO:
PLAN NO.
PARCEL'fD:
STREET ADDRESS: 1
9 A O k
pP A,I ✓\ S
y l°� C� y `Q (' ,
Csrne�<<�
NL
�R�31
Please print:
Property Owner: -T3-,R- PQ 1-1�1 C�w�
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby, authorize
of
(Contractor / Ag nt) (Name 6f consulting firm)
to act on my behalf and, take ail 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):
.Sck w -e_
Telephone: TS-0 - � — G Z `i` �
We hereby certify the above information submitted in this application is true and accurate, tothe
best of our knowledge.
J-,/� -
Authori Signature
Date: S Z Z
lee— v�,— J
c (
Authorized Signature Se�
Date:

Full Pond/
Normal Water Level
Shoreline
Lake
(At Full Pond/ Normal Water Level)
k� p�
� J
O� JC-L V" '(-C
lie cab at-e- w OV-1c- ka'-j- na+ cc (� 4�
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

4L
S
f�
4--
m
u
Qo
co
m
.m
J
Ln
Ln
a
c
V)
N
O
O
�p
OJ
�
N
O
-O
X
•E
Ol
t]A
r-f
•�
�
41
p
�
bn
O�
Ln
O
O
*
-0
(D
s-
O
�
W
C
�
u
•
O
u
t
•3
Q
_0
Ln
f6
tO
Q
�+-
p
•�
M
M
v
}'
a
-
m
Ln
-0
c)
N
M
Ln
tD
4L
f�
4--
m
L
m
Qo
co
m
.m
J
Ln
Ln
a
0
V)
N

3.2S-. f
i —tr
ff -
lei
P4772 40 OIIVR�'&�
r
S, erg , ;
cg-) ,S0c
12 &Y-WI. 1& aov
a i
0 A:;L• =::
i
P d t2
e'4mt ,

Lainuae ana Longitucie of a Point
Clear I Reset Remove Last Blue Marker
Center Red Marker
Get the Latitude and Longitude of a Point
When you click on the map move the marker or enter an
address the latitude and longitude coordinates of the point
are inserted in the boxes below
Latitude 35.:169364
Longitude - 80.910902
Degrees Minutes Seconds
Latitude 35 28 9.7098
Longitude -80 54 39.2466
Show Point from Latitude and Longitude
Use this if you know; the latitude and longitude coordinates of
a point and want to see where on the map the point is
Use: + for N Lat or E Long - for S Lat or L•L' Long
Example: [phone] 044636
Note: Your entry should not have any embedded spaces
Decimal Deg. Latitude
Decimal Deg Longitude
Show Point
Example +34 40 50.12 for 34.'V 40 50. ?2"
Degrees Minutes Seconds
Latitude
Longitude
Show Point

2
CL
M
N
N
C7
r
O
N
N
N
C
w
O cm
LI 0
V
O
n
O
V
aA
a�
x
a�
In
c�
L�
M
O
=IN

•
i•
4
R al:
4f 'CMt Mourne
� h
� s• •k'I
'Denver
r b
t.
t•; n
63
Q
• a
wVestport
A n
e ' o
�.
C,C'o n'e i I u's
b
V'
r.
r �
19161'peri;nsula:Club Dr. CorneliusAC
28031
4usA. '
•
�CaI
`�
ell
!
wj
ay;
b Lowesvtie
I '!
r
/
^Huntersv�lle
GooSIc earth
�•�•

Z-4_S1l1
133 20 �, � �
r
TRACT F
.N -
M824 PG 256
3
76'3440" o S
E
l
0
ary �c cr�,U
poi ^, 'O
,cn
3 �
TRACT E U'
824 PG 256
U
,MB24 PG 250
HOLE18
off, a
0
N 88'3�'4g• W •5 �•
Z 147.»1° N' N
V
0, vim
� O
f 9 4. S 27'50'05"
5' 11 12'
99 1 S 10 "5 4' 11 "
5 73'42 4212E 2 24 61'
73.42'12 14 73� S 05 "41'17"
,G S' 97. 12 7 31'
38•
S 13.44'5E
'6i�99 p� MB25 PG 116 s4 o09'3c
3 54'
UO T 105
66 5
94 3l

1w
f :
4
r .
� r
r ..

0 7e
LAN'...

rw
rd
G