20150985 Ver 1_Shoreline Stabilization_20150924

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State of North Carolina
oft Dja ?ltriment of Environment and Natural Resources
�° Division of Water Resources
15A NCAC 02H .0500 - 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 20
1617 Mail Service Center 1
Raleigh, NC 27699 -1617
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: //V
Mailing Address:
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Telephone Number: Fax Number:
E -mail Address: Se Y"e't & co--
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
httr): / /www.saw.usace.armv.mil/ Portals /59 /docs /reRulatory /reEdocs /Permits /SAMPLE AGENT AUTH
ORIZATION FORM.0f) must be attached if the Agent has signed this application form.
Name: Damon, ScLia� Z
Company Affiliation: cud Al,- G -s /C-
Mailing Address:
Telephone Number: 711&4, Fax Number:
E -mail Address: dare'v. La'C'r4 t , eo. _
Person to receive the Certification Approval:_ 1,ctfZ
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

a
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: 4 •LNG e, 1, /- Nearest Town: D -0Av+er
Subdivision name or site address (include phase /lot number):
Directions to site - please include road names and numbers, landmarks, etc.:
Latitude (in decimal degrees) 36'. %9`I i`1 2 Longitude (decimal degrees) ` �� • 97 75�%l0
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): A Vd10,'74r`a L
6. Property size (acres): . e&3
7. ak river/ ocean adjacent to property: ale /Vo�.� -o N
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): �red��'.� , c6"PO& a,,P
A3&aj4-IA-a Q eeess v
9. Will work be conducted from land? ❑ From water? 0�
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:
. 007 Ae tees "/83 eo,6re- vA e s
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: _C:�
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 feet landward to be impacted (number of trees, for instance): -6�1
Own /Agent's Signature
� s
Printe Name
[15A NCAC 02H .0502(f)l
.Agent's signature is valid only if an authorization letter from the owner is provided.
D to
FORM: SSGP 10 -2013 Page 2 of 3

Full Pond/
Normal Water Level
�''
Shoreline ''
Lake
(At Full Pond/ Normal Water Level)
S-A 150
p,, it ?11'rd
q0
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OL
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

3210 Lake Shore Rd S - Google Maps
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3210 Lake Shore Rd S - Google Maps
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NOTES:
• PROPERTY ANY BE SUBJECT TO RECORDED OR
—
f
UNRECORDED RIGHTS OF WAYS DR EASEMENTS
NOT ED
/ V
• OWNER TO O R ALL SETBACKS AND ZONING
25.12'
O REGUL 710/S PRI OR ANY PLANNING OR
CONSTRUCTION.
1 L3 S 84'33'07" W
• DNENSIONS OF ALL IMPROVEMENTS SHOWN ON
THIS PLAT SHOULD NOT BE SCALED OR RETIED
50 0
UPON FOR DESIGN OR comsmUCT10N WITHOUT
Q
A FIELD VERIFICATION OF ALL DILIENSIONS. /
WO - G1
• DIGITAL COPIES OF THIS FILE ARE FOR REFERENCE
GRAPHIC SCALE -
ONLY AND MAY NOT BE USED FOR DESIGN WORK
• ALL UNDERGROUND ND UnUTIES ARE NOT y710WH HEREON.
14 PIN
� \a
LEGEND:
BOUNDARY LINE
SANRARY SEWER LINE
-- NATURAL GAS LINE
UNDERGROUND POWER
OJEPoIFAD UTILIITES
UNDERGROUND TELEPHONE
WATER LINE
FENCE (TYPE NOTED)
CP a COMPUTED POINT (UNMARKED)
R/W RIGHT -OF -WAY
E/P EDGE OF PAVEMENT
C/L CENTERUNE
0 URLRY POLE
s 35.23 /{ PIN
-Nc .
PART OF X1136
& ALL OF LOT X1137 &
PART OF LOT #138
PB C -129
JEFF ELLIOTT
j+
Course Bearing
L1 S 8433'07- W
Dietonce
49.88'
r L3
I L2 5 84'33'07" W
25.12'
PIER
J
1 L3 S 84'33'07" W
75.00'
J00
50 0
50
_ "LAKE - - _
M-0-0- -0
= = NORMAN = =
�_
DEDMON SURVEYS
GRAPHIC SCALE -
FEET
A PORTION OF THIS PROPERTY IS LOCATED IN A 100 YEAR ROOD PLAIN
AS DESIGNATED BY FIRM PANEL f 3710461400
EFFECTNE DATE: B -16 -2007
! NO PORTION OF THE RESIDENTIAL STRUCTURE IS IN A FLOOD ZONE.
Curve I Radius I Length
Cl 208.38' 105.83'
LOT #135 & \
PART OF #136
0.821 AC. +—
Chord Chord Bear.
104.70 N 66'28'39' E I
LOT #134
PB C -129
DAVID DOSS, JR.
APPROX FLOOD UNE
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PHYSICAL SURVEY
FOR
DANNY & MARY
KARTES
LOT #135 & A PORTION OF #136 OF WESTPORT
i 0 3210 LAKE SHORE RD S. DENVER, NC
U CATAWBA SPRINGS TOWNSHIP - LINCOLN COUNT/
a
SCALE: 1" = 50' 1 -15 -15
DEDMON SURVEYS
CHUCK POOVEY, PLS 83762
ROBERT DEDMON, PLS 83899
3704 NC HIGHWAY 816 NORTH
P.O. BOX 494- DENVER, NC 28037
PHONE: [phone]
FAX: [phone]
W WVI.DEDMONSURVEYS.COM
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L -3752
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I, DAVID C. POOVEY. CERTIFY THAT THIS PLAT WAS
DRAWN FROM IOU ACTUAL SURVEY MADE UNDER MY
SUPERVISION (DB 2490, PG Bt) (PB C. PG 129:
THAT THE RATIO OF PRECISION AS CALCULATED
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D(CES 1A000O: THAT THIS PLAT WAS PREPARED
IN ACCORDANCE WITH GS 47 -30 AS AMENDED.
WITNESS MY ORIGINAL SIGNATURE. REGISTRATION
NUMBER AND SEAL THIS 15 DAY JAN. OF , AD
2015.
L -3762
PROFESSIBNAL D D SURVEYOfr LICENSE N0.
SURV. BY: HL I DRAWN: CP I JOB/ LS3210
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