20141218 Ver 1_Shoreline Stabilization_20141124

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P �� State of North Carolina
DWR Department of Environment and Natural Resources
Division of Water Resources
1SA NCAC 02H .OS00 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources FORM: SSGP 10 -2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center Q V
Raleigh, NC 27699 -1617 v
NOV 2 4 2014
I. Applicant Information [15A NCAC 02H .OS02(a)] DEN R `"
1. Owner Information 4pj $ BuFFERRESOURCE
MI S
ERMrTT1NG
Name: Jasper Builders INC
Mailing Address: 181 West Statesville AVE
Mooresville, NC 2811S
Telephone Number: 704 - 799 -9982 Fax Number:
E -mail Address: sean @jasperbuilders.com
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: Phil Rotella
Company Affiliation: LakeVision Development INC
Mailing Address: -89i q2- i-OC1xnye CT
Sherrills Ford. NC 28673
Telephone Number: 704 - 506 -0807 Fax Number:
E -mail Address: phil @lakevisiondevelopment.com
Person to receive the Certification Approval: Phil Rotella
II. Project Information [1SA NCAC 02H .OS02(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: Iredell Nearest Town: Mooresville
Subdivision name or site address (include phase /lot number): 769 Kemp Rd Mooresville,
NC 28117 County Parcel # 4626066650.000 Lc)+i*- 11-1
Directions to site - please include road names and numbers, landmarks, etc.: From
Downtown Mooresville — N. Academy St — Make Right onto W. Wilson Ave, Wilson to
Brawley, Continue down Brawley, Make Right onto McKendree, Make Left onto Kirkwall,
Make Right onto Kemp Rd property will be on the left
Latitude (in decimal degrees) 35.566583 Longitude (decimal degrees) - 80.948435
S. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Io-�-
6. Property size (acres): •F LID
7. Lake/ river/ ocean adjacent to property: �aK2 ti1oru, -,
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): if15�QIJ bity l, i,�o(l and rIJEC Coc t
in v
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:
35o Sfi-
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 SO feet land -ward in
square feet or acres: :f)5V 4>1'
12. Plea scribe the vegetation above the normal pool lake level/ Normal Water Level and
SO f ret n dward to be impacted (number of trees, for instance): No 4fe_eS
RCN i
r /Agent's Signature* [15A NCAC 02H .0502(f)]
11 �c 1
Date
FORM: SSGP 10 -2013 Page 2 of 3

Agent's signature is valid only if an authorization letter from the owner is provided.
Full Pond/
Normal Water Level
�''''
Shoreline
La ke
(At Full Pond/ Normal Water Level)
A '2$0. �.
s41-4 0 --lo
6L?3,r-1r P.:-It"!
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
friI:�Lr1ElieIi[i Pis)i
Page 3 of 3

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mapquest"
Map of:
769 Kemp Rd
Mooresville, NC 28117 -6625
2
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Notes
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