20141195 Ver 1_Shoreline Stabilization_20141117

2 0 1 4 1 9 5 state of North Carolina
Department of Environment and Natural Resources
Division of Water rtes
15A NCAC 02H.0500 —Water quality Certification, Shoreline-Stab
Division of Water Resources FORM: SSGP
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent
to: tDENR C�:�RRR Division of Water Resources 401 & Buffer Permitting Unit 0 V 1 2014 1617 Mail Service Center Raleigh, NC 27699-1617 BU FERMIrRr NG
I. Applicant Information 115A NCAC 02H .0502(a)]
1. Owner
Name:
Mailing
Telephone Number: , °�'��1 " lny Fax Number:
E -mail Address:
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.pdf) must be attached if the Agent has signed this application form.
Name: % x
Company Affiliation.
Mailing Address:
Telephone Number: 45�>(S3 � �, ���'J Fax Number:
E -mail Address:
Person to receive the Certification Approval: ` k c-f­%
II. Project Information 115A NCAC 02H .0502(a) & (b)1
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 1of3

etc.), rip rap, excavation or dredging belowfull 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 into be conducted),
County: � - Nearest Town: e-
Subdivision name or site address (include phase/lot number): \-CA
Directions to site - please include road names and numbers, landmarks, etc.:
Latitude (in dedmol degrees). J� Dta►� Longitude - (decimal
5. Describe the existing land uses i
(residential, undeveloped, etc.,):
6. Property size (acres):.$
condition of the site at the timeof this application
7. Lake / river/ ocean adjacent to property:
8. Describe,proposed work (include discuss
avoided, or why it is necessary):����
9. Will work be conducted from land? ❑
as to how hardening of shoreline has been
From water?
N-
1.0. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool lake level/ Normal Water Lever in square'feet or acres:
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: N -I- N I a - �t�o �4\IV4
12. Please describe the vegetation above themormal pool lake level/ Normal Water Level and
50 feet landward to be impacted (number of trees, for instance):
Owner /Agent's Signature* Printed Name Date
115A NCAC 02H .0502ffl1
*Agent's ,signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10 -2013'
,Page 2,of 3

Fu
Norma
sr
Lake
(At full Pond/ NVf I17AWatP( Lpvrl)
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ftx 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
\A
FORM: SSGP 10 -2013
Page 3 of 3

AGENT AUTHORIZATION FORM
Property legal description
Lot No. 3� Plan No. Parcel ID:
Street Address
1 V3��
Property Owner:
The undersigned, registered property owner of the above noted property, do
here y authorize
contractor/ agent
oK
Business Name
To act on my behalf and tape 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 from above):
Telephone:
We hereby certify the above information submitted in this application is true
and accurate to the best of our knowledge.
A.ithorized Signature
Date:
t� t, dzed Signature
Date:

5850 Charlotte Hwy, Clover, SC 29710 to 18323 Hideaway Rd, Charlotte, NC 28278 - G... Page 1 of 2
Got,,
Ste Directions to 18323 Hideaway Rd, Charlotte, NC
28278
8.9 mi - about 17 mins
13 78 �Cp
STED E GREEK
1493 1115
1491 � �� 111b
1379 1113 , Sleg9
H 557
13115 �q�
• �C
Lak li
1116
McDowell
tit0 Nature Preserve
1 49
~ 1 _
state HdZ;- 46 1111
55 '��
�5 OV`
a c P`Wyfie r F1 1-0-21
I10T
49 .
1105
Z74
F�
1613 �
.1 %
S-et WMa 7 1100
4
,ry
Z74 37
14 GOOgle=r",d0ft CAB r
.�
https: / /maps.google.com /maps ?i =d &source= s_d &saddr =5 850 +Charlotte +Hwy, +Clover, +... 10/28/2014

VICINITY MAP cl 307.52' 1 202.17 - I N 27'11'20° E 1 198.55 -
►+� suuF UWE BEARING DISTAN(
' –Cl— 5 01'47 12 W 69.1
SfTE L2 S 08'11'00- w 39.1
L3 S 17'09'00" W 67.7
L4 S 06' 13 00' W 21.9
9 !.5 S 26'48'00' W 63.1
°C HIT)EAwAr ROAD L6 I S 33'57'00' W 65.2
$ L7 N 4553 00 E 16.2
LS N 08' 11 00° E 60.0
Z
4'P.ILIMUAf A._LOVIABLE IMPERVIOUS AREA=
24% OF LO' ARFA
LOl AHFA- 37,5,59.7 SF
MAXIYLIM :uPEFMOUS ARIA =9.009 -5 SF
TOTAL IIAPElMOUS AREA = 9175.6 SF
HOUSE- •3938 -1 SF
PORCHES & SiNR5w1162.6 SF
BREEZEWAY. GARAGE. & DRIVE= 2983.6 SF
BOAT HOUSE, SHED, & SIDEWALK= :791.3 SF
WOOD PSCKET FENCE
1 V� PAL
IRF r!<
� Oft
00-
ei RECAfWNG a0
Y:ALL
/ COKC-
/ DRnr
W�.L
Do-
Tq
34 1 o UNDER GROUND
PROPANE ACCESS
co
A.
f L13
IRF
LAKE WYLIE
PROPERTY UN:E FOLLONS
COWOUR ELEVATKY.i 570.0'
AS SHOWN ON MAP
BOOK 17. PAGE 512
P L3
r. V
N
18323
s
(p1ap'if" wl
f 2 STORY
} fi SIDING
4 fn=576.3
13.4 T
m �
m m
F�PLANE UK
FPE= 571.0' �F I.R.0 PANEL)
t -C 3
-� 17 0 i
22.0' 1 r
t z
O
-� ggqr
416'
a
C1
H I D EAWAY
30' RIGHT —OF —WAY
���.eenlo��rlatd
�� d . r" • �� �' GRAPHIC SCALE
• ASS`.' -,'- '.•
25 12 5 25 5o
1 RICH = 50 FEET
d�rop dp:tiria�i:i•
1�THS PROPERTY WITHIN F.ElIA SPECIAL FLOOD HAZARD ZONE
AE -570, AS SHOWN ON F.111-M. PANEL 37119C-MI-E. DATED
FEERUARY 4. 2004 -
G£NERN_ NOTES'
1. MMUREMENTS ON THIS MAP ARE LV FEET AND DECIMALS THEREOF.
2. ALL SET CORTM; ARE 112' IRON REBAR UNLESS DniERME NOTED.
3. THE PROPERTY MAY BE SUEUECT TO ADDITIONAL EASEMENTS, RIGHTS OF
WK(S AND RESMCi10NS NOT 9 SCEMISLE BY OBSERVATION AT Tilt
moo._ ne e..e.ffti — ....
ROAD IRF
LEGEND( usm)
t-,-IRON ROD OR RMAR FOU?,m
OF -PIPE FOUND
IZBL =61B7I wm WmNG LINZ
IRS -IRON RERAtR SET
FPE =FLOOD PROTECTION ELEVATION
PHYSICAL SURVEY
BARBARA LEE KINDSERG & B. LEE KI
LOT 35, SECTION 43

■
!Z ' C U•f
�'.� `• � It ; ,'r ',.�', Y � s �� � ,-� �§
Vii' �r �` v '.'.ti:.,, .Ppf`i`.•rl,• �.'• �A` ' �:4 i 'n ,'•' { y a
N „fix` t” tXi. �.�• �'' -� �� r.�•;�„ �R. .'• - � -�` . - -� .
MWWW
I now-
- if
_ •SKr

.:t
ill
4 �
ol
i
r
k c �
' sN
.rX
1p
ti � it .. ' � ` +, - 11r1► ♦ ,,
�r
r