20040179 Ver 2_401 Application_20151020

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State of North Carolina
Department 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
1617 Mail Service Center
Raleigh, NC 27699 -1617
I. Applicant Information j15A NCAC 02H .0502(a)j
1. Owner Information
Name: (n i Chnp ] clod 1,I i I« _0lA0e,
Mailing Address: Ps K(>>X \I wu-) (line,
rn�c�cesv�ll �0' any
I = /!� V L5 U V ISM ���
II II
OCT 2 0 2015
U
DENR • WATER RESOURCES
401 & BUFFER PERMITTING
Telephone Number: F=RF5A Number: ,V)_%' -�
E -mail Address: ('fed 0 c�nfli`Ct��IS �)!` �tttik� tNc I6OC>e @ me., "mm
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.armv. mil / Portals /59 /docs /reizuIatory /reedocs /Permits /SAMPLE AGENT AUTH
ORIZATION FORM.odf) must be attached if the Agent has signed this application form.
Name: !?hl I "'1 o de a
Company Affiliation: LaKewsion DX'_Jdopme(1-� �i•(e�
Mailing Address: , l (1(l e—we 6+
he,� ;cos q091--> Nc agiD -1
Telephone Number: N4,15010 09(�l Fax Number:
E -mail Address:hl)R
Person to receive the Certification Approval:
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 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: I fe_(ieI t Nearest Town: mm�Sv111E
Subdivision name or site address (include phase /lot number): Anr <, LnM i hC
1q5 i�n�X�1�vJ \c��ne tYioc�ces�►Ile �C8)I� J L(�-# �.J
Directions to site - please include road names and numbers, landmarks, etc.:
rnooresdMe - -Fay_t --n soo�� PX i b Arep .
Kovp IP 1, 6( Y)e fts) on -Mo le +
Latitude (in decimal degreesj3 31 W01-14 Longitude (decimal degrees) _DV + 5ari 12 8
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): C- 6en l o,(
6. Property size (acres): o 3,3
7. Lake/ river/ ocean adjacent to property: LaKe_ Norma()
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): YRI :4 0 n�CP _. WaP God N4e_d- "Y'
}� �nreve�t- - �.rr� -►t�� ,
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:
11. Total amoun`t'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: 3(30 S -K_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):
:;3 +(ees and 9 hoS hes
Owner /Agent's 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-oUS JACKSON LOVE CERTIFY THAT THIS MAP WAS DRAWN FROM ANA6AA& SURVEY UNDER MY
DIRECT SUPERVISION, 'HAY THE RATIO OF PRECISION IS 1.10.00Op.EEF AWM ENTS; AND THAT
{ THE ANGULAR ERROR WAS < 7.5 SECONDS PER TURN ./,,� ••�
% g WITNESS MY *IAND AND OmCUU°k•'EI —,�.. FSAY OF
1 L!/!J
v
,. �1,f1..:�••y V 4 � SE
No CAI
1 51 No CIE Rc aR 4 BI4's "E_ - - 100.78' ._..�3s'v,4':'iS,,,r.' •�'
VICINITY mAP PIPE
NO SCALE
BaSEp
' Ma o s ��...
"� 19aT s •
I m
A
` LOT 4
0.82 ACRES
LOT 5
JOSEPH F. NEMECHEK Ill
& wf. ANDREA
OB 1078 -1626
PIN 4644 -08 --3861
PS 24 -149
of
N
r�
3
O
:)
Y ±'{S� GGNVV
X50 CONTOI�R ,L �
F'£I D LOCATED \
5/09/07
i LAKE NORMAN
1
1
I
1
L UR
N
0 • 15.sa'
u1
CONCRETE `� N
DRIVEWAY Cp
�z
�•e� 15.81'
2 STORY 7�
BRICK ^
LAKE NORMAN .
LOT 3
LEONARD J. WOOD
& wf. SELMA
DB 1071 -995
PIN 4644 -09 -3073
PB 24• -149
f�Y�sj
yNl y 3T'!ON
I, m
B 0 "."C' ICA NOTES:
FOR MICHAEL DANE & wf. PAULA I. MSS P � A ;PUTAT,ON.
PROPERTY OF JOSEPH F. NEMECHEK III & wf. ANDREA C M07E5 cWPUTEO PaNT. No YONUTffNT FOUND OR SET
195 KNOXVIEW LANE 5. No GRID ua UVEWIMS WITAN �Tm As aF THIS DATE
LOT 4 OF KINGS LANDING, PB 24 -149
DEED BOOK 965 -1879, PIN 4644 -08 -3983
DAVIDSON TOWNSHIP, IREDELL COUNTY
NORTH CAROLINA
MAY 23, 2007
Rl£ NAULDANE
RAPHIC SCALE -
LEGEND:
:rTY LINE
UNWRVEYEO IJW
------------------- BACK OF CUR9tUW OF PWT.
-- - - - - - - - -•. SE4 AM LDIE
CP COMPUIW POW
PP POWER POLE
50 100 150
iu,bJy, ,Wllur"ILbML.NIW+Tj PrRAMD LAM � mk vA11A/itr PA
P.O. X" 11 DAYA 1DN, NOR= Cd11111SM
FEET (704)@U -4S" RUM FAC=UN ,LOVN Z,,W 4

La ke
(At Full Pond/ Normal Water Level)
dLY7
Full Pond/ -'4 C n'a`\
Normal Water Level �p'
Shoreline
3i0c►c wCW
Flo C�eGC�n9
�e,CeSS0.��
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

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