20141001 Ver 1_Shoreline Stabilization_20140919

State of North Carolina
DWR Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources iSA NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10 -2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) an licatiot�feeshg
to: a LDENR Division of Water Resources 9 2014 401 & Buffer Permitting Unit ' 1617 Mail Service Center R RESORaleigh, NC 27699 -1617 R PERf0 TTlNG
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: CC> o
Mailing Address: ZO cf A%oV uA4t14 c
Id be sent
Telephone Number: 3 ?Z fl q —Z1 60ax Number:
E -mail Address: .owl 0 kw-A , 60 M4
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.miI /Portals /59 /docs /repu_ latory /regdocs /Permits /SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form
Name: VLtV5PA
Company Affiliation:
Mailing Address:
Telephone Number:
E -mail Address:
Person to receive the Certification Approval:
Fax Number:
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 3

C, u VV tAi+ /tiv4
Full Pond/
Normal Water Level
�'''''
Shoreline
+.5.4.1 K� w a LI
Lake
(At Full Pond/ Normal Water Level)
ole? 6k(. Croo +-,-�-5
4k,df oerr3ln f eo-45
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Lake b -fbM
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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
'6'e-q- & L
FORM: SSGP 10 -2013
Page 3 of 3

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RECREATION LOTS SECTION 11
PLAT BK. 14 PG. 36
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EXISTING
5/8' REBAR
I/
/
Curve
Radius
Chard Bearing and Distance
Arc Length
C1
50.00'
N 3' 31' 23" E 80.72'
93.94'
LOT 71
a
RPN'P
�/�LOT 70
3 W 4Ff.
0.69 Ac.
O WELL
EXISTING
5/8" REBAR
GAP QA�`0 AR'A WELL
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L4 GRAVEL
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P DRIVE
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/P a 6
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EXISTING BENT 3
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LOT 1088
/ PLAT BK 19 PG 30
492.
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4 Mlahoel R. Bowden, certify that
this Plot was drawn by me from
an actual field survey made under
my direct supervfsioa; that the
boundaries shown are from the
record information noted hereon;
that the actual ratio of precision
exceeds 1.10! 000, and that this
plot represents an existing parcel
of land Witness my orfgfnol s1g-
nature, seal, and license number
this the Jgt&dgg of tree, 2014
tom. ,
i
E1S�1 #102
X NG 55
LAKE
NORMAN
LOT 70
RUE. W. GOBER and
wife VIRGINIA GOBER
DEED BK. 1678 PG. 1649
PIN #4638 -64 -3570
EXISTING 1 1
1/2" REBAR
\ 0 = PT — POINT _NOTHING SET
• = EXISTING IRON AS NOTED
0 = 1/2" REBAR SET
EXISTING SENT
f 20 I 40 :• REBAR
SCALE OF,DRAWING
NOTES:
1. TRAVERSE ADJUSTED BY COMPASS RULE ADJUSTMENT METHOD.
2. AREAS DETERMINED BY COORDINATE COMPUTATIONS.
3 ALL DISTANCES ARE HORIZONTAL GROUND DISTANCES.
4. THIS PLAT IS OF A SURVEY OF AN EXISTING PARCEL OR PARCELS OF LAND.
REFERENCES: DEEDS AND MAPS ARE SHOWN HEREON
0 _, U77LM POLE
REVVED = 7/15/14 — TO CMRECT DRIVE /%%
Line
Bearing
Distance \
L1
S 12' ,O6' 00" W
53.47' \
L2
S 37' 29' 42" W
87.08'
L3
S 34' 29' 17' W
30.07'
L4
N 89' 27' 48" E
64.40'
EXISTING
5/8' REBAR
LOT 71
a
RPN'P
�/�LOT 70
3 W 4Ff.
0.69 Ac.
O WELL
EXISTING
5/8" REBAR
GAP QA�`0 AR'A WELL
O
�o
\ �O
L4 GRAVEL
/P p\ 51b
P DRIVE
/ P A
/P a 6
��P U z
EXISTING BENT 3
5/8" REBAR i
°'
LOT 1088
/ PLAT BK 19 PG 30
492.
aP
m
z
0
v
o
0
0
m
Z
m
N --4
D
tD ?
Z
v'
Ns r
J
O
O
Z
O
T)
i
ar
I 1
i
4 Mlahoel R. Bowden, certify that
this Plot was drawn by me from
an actual field survey made under
my direct supervfsioa; that the
boundaries shown are from the
record information noted hereon;
that the actual ratio of precision
exceeds 1.10! 000, and that this
plot represents an existing parcel
of land Witness my orfgfnol s1g-
nature, seal, and license number
this the Jgt&dgg of tree, 2014
tom. ,
i
E1S�1 #102
X NG 55
LAKE
NORMAN
LOT 70
RUE. W. GOBER and
wife VIRGINIA GOBER
DEED BK. 1678 PG. 1649
PIN #4638 -64 -3570
EXISTING 1 1
1/2" REBAR
\ 0 = PT — POINT _NOTHING SET
• = EXISTING IRON AS NOTED
0 = 1/2" REBAR SET
EXISTING SENT
f 20 I 40 :• REBAR
SCALE OF,DRAWING
NOTES:
1. TRAVERSE ADJUSTED BY COMPASS RULE ADJUSTMENT METHOD.
2. AREAS DETERMINED BY COORDINATE COMPUTATIONS.
3 ALL DISTANCES ARE HORIZONTAL GROUND DISTANCES.
4. THIS PLAT IS OF A SURVEY OF AN EXISTING PARCEL OR PARCELS OF LAND.
REFERENCES: DEEDS AND MAPS ARE SHOWN HEREON
0 _, U77LM POLE
REVVED = 7/15/14 — TO CMRECT DRIVE /%%