20150162 Ver 1_Shoreline Stabilization_20150209

2 0 1 5 0 1 6 2 State of North Carolina
Department of Environment and Natural Resources
Q n Droision of water Resources
3 - i5A NCAC 02H.0500 - wa r- Qaalit CerY' icat'on, Shoreline Stabilization
'Division of Water iesources
FORMA: SSGP 10 -2013
Z Ll Q.
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resources D � (;:Z,
401 & Buffer Permitting Unit
1617 Mail Service Center FFEB 9
2015 I
Raleigh, NC 27699 -1617
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
,71\ -
Name: .0 o
Mailing dress
ffelephone Number(
E -mail Address
013% Mow- IDwe-1-
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 /reRdocs /Permits /SAMPLE AGENT AUTH
ORIZATION FORM pd f) must be attached if the Agent has signed this application form.
Name: d0nN;e_ R�ctidl c,
SGt,�sz Company Affiliation
4-5 Mailing Address v�-
Affv __,., ��ct�nncl�� L 2_fi U3Z,
Telephone Number- 764 qlq& -45.3 S Fax nNumber.
E-mail Address
Person to receive the Certification Approval. 17c�►'tinf a��� �.
II. Project Information [15A NCAC 02H .0502(a) & (b)j
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

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. G&5ror�' Nearest Town:�I
Subdivision name or site address (include phase /lot number): nILZ 1�vVt5�rd�M
Rd_ Rll �jc_ 2R6(-Z
Directions to site - please include road names and numbers, landmarks, etc.:
Latitude (in decimal degrees) 3 s— /7 0113 Longitude (decimal degrees)
5 Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc -e rn o�-
6 Property size (acres). 1'.
7 Lake/ river/ ocean adjacent to property- L'_�' �-
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary)
9. Will work be conducted from land? U-__ From water? ❑
10 Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool lake levey Normal Water Level in square feet or acres•
11 Total amount of disturbance (including all clearing, back fill, excavatioh,`F[jVrap,'
o�
walls, etc ) above the normal pool lake level/ Normal 'Water Level and 50 feert IanXrdleri a
square feet or acres: � I <)0�" +y l,y� CLAC) 17111.,
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 /I
feet landward to be impacted (number of trees, for instance).
1 Gam, 4 /AU bit
s J (f.b 3 ( �S_
Owner /Agent' Signature* [15A NCAC 02H .0502(f)] Date
`Agent's signature is valid only if an authorization letter from the owner is provided
FORM SSGP 10 -2013 Page 2 of 3

r
�aca
zm
°OD
ei«
°m
l °
�£ 6
P
HAM i
w
J
U
0
0
z
z
CL
0
F
Q
oa
(A Q
zo 1'— / Z. z
,�
r v,OZ
L1.1ZC�i
z a �a
c W o
r Q:DU)
o ° Wo0
? — 1,110
.e% .09 - avo2i 9NOULSMV HU07
Ip
skill
4b
6-.8 o
4m m Y Z ®1
s 8;g
§il
iI
gac
Iaf
m
M
a Go
An
C) 0n
J
N JC
,
zL
Z-
Z a Z
� o •
�L
JZ:) amo
_ c 0
N M z o
C •
Ln U) F)
Z o .�
w � °
N p
t
a

Gaston County GIS
F.-1 Urt , Ix %2L iii&
U 161 n IA', map
c IZA io {� �mS �m K`c-
5
�- 60ft N
I ,

Disclaimer4 The information provided is not to be considered as a Legal Document or Description. The Map & Parcel Data is believed to be accurate, I
Gaston County does not guarantee its accuracy. Values based on last general reappraisal - 2007
Z
u K D
t `1
a�•
� � 't r
J
ti
~ \• '�
ON
.�
f
dyr�� jA
4)lU B
Tax Information
Election Information
LOCATION: 862 ARMSTRONG RD
PRECINCT NAME: SOUTHPOINT
DEED TYPE: WD
POLLING PLACE: SOUTHPOINT HIGH
DEED BK : 4735 PG : 0503
SCHOOL - AUDITORIUM
,¢
DEED RECORDING DATE: 07/07/2014
POLLING ADDRESS: 906 SOUTHPOINT RC
SALES AMOUNT: $100,000.00
WARD #
TOWNSHIP: SOUTHPOINT
PLAT BK : 000 PG : 000
LEGAL DESC 1 :.
CONGRESS REPRESENTATIVE: MEMBEI
LEGAL DESC 2:
PATRICK MCHENRY
PHOTO NOT AVAILABLE.
STRUCTURE TYPE :
CONGRESSIONAL DISTRICT: 10
YEAR BUILT: 0
SQUARE FOOTAGE: 0
BASEMENT : No
HOUSE REPRESENTATIVE:
REPRESENTATIVE DANA BUMGARDNER
(REP)
Tax Information
PID #: 221155
PIN #:3592232303
# BEDROOMS : 0 # BATHS : 0
HOUSE DISTRICT: 109
NBHD #: 4CC01
MULTI-STRUCTURES: NO
SENATOR: SENATOR KATHYHARRINGTON
NBHD NAME: UPPER EAST SOUTHFORK
ACREAGE : 0.69
(REP)
WTR
TAX DISTRICT: SOUTH POINT FD
VOLUNTARY AG DISTRICT: NO
SENATE DISTRICT: 43
OWNER ID #: 03995683
Parcel Information
CURRENT OWNER 1: RIDDLE DONNIE M
LAND VALUE: $155,040.00
POLICE DISTRICT: GASTON COUNTY
CURRENT OWNER 2:
IMPV. VALUE: $0.00
FIRE DISTRICT: SOUTH POINT
MAILING ADDRESS: 117 N CENTRAL AVE
TOTAL VALUE: $155,040.00
EMS RESCUE/SOUTH POINT LIFE SAVING
CITY : BELMONT
PRESENT USE VALUE ASSESSMENT:
STATION #: GEMS STATION 12
STATE : NC ZIP : 28012 -0000
NO
FLOOD : AE
JAN1 OWNER 1: WALSER DONALD G
CENSUS TRACT: 032402
School Information
JAN1 OWNER 2
ELEMENTARY: BELMONT CENTRAL 2 -5,
PAGE K -1
MIDDLE: BELMONT
HIGH: SOUTH POINT
Printed On: 1/20/2015
Disclaimer4 The information provided is not to be considered as a Legal Document or Description. The Map & Parcel Data is believed to be accurate, I
Gaston County does not guarantee its accuracy. Values based on last general reappraisal - 2007
Z
u K D

lie
i�
" (S)
N
Sn
N
40m
ION N
rV

Full Pond/
Normal Water Level
Shoreline
5 x IZe�'
Lake
(At Full Pond/ Normal Water Level)
�_I24
/ 0% "
i 1 Li
F{cat�
>? 7
LID
'.x." ow.
bestow f-wt1
tirx �zLA
Please approximately sketch the following information on this plan (provide dimensions far 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

s
ti
w' it
� . fib. ". � `� , � s Q+•+ ♦, .
r
.. • Y ':. .�ja '' •1 a �` i
4.
VT
"
.v ` ,• � � • " %"yf�'� r X31 �+�..
y• y."�r a ; Ir�% � ^����j
x.
tR.

IMMA
3;

le

Y
V ��Ith

" �� :i ,.
r�
Vo. I
I Fm'