20160124 Ver 1_Shoreline Stabilization_20160208

State of North Carolina
DDiviDepartment of Environment and Natural Resources
sion of Water Resources
;W
Division of Water Resources 15A NCAC 02H.0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSCP 10-2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent
to: _
Division of Water ResourcesD 6Z,
401 & Buffer Permitting Unit D
1617 Mail Service Center 2 6 2 4 ��� ®� 2016
Raleigh, NC 27699-1617 I
1. Applicant Information 115A NCAC 02H .0502(a)]
1. Owner Information
Name: __7A m'5s
Mailing Address: \S10 • Lc7 "Ucc L
% o E.Fs V/CC4 /vC_ _) i f
Telephone Numben.? - Iyy �o Fax Number -
E -mail Address: Z !us Tc)y yYa G
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/­`591docs/regulatory/regdocs/Permits/SAMPLE AGENT AUT
HORIZATION FORM.Ddf) must be attached if the Agent has signed this application form.
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Person to receive the Certification Approval: ,S th�S __-Z fAIS TO /)
Il. 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. S Ir -F S 0 Y-- V F_ 1
2. Provide a detailed site plan showing property boundaries and proposed locations of
vegetation clearing, structures (buildings, retaining walls, docks, impervious surfaces,
etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations, and
FORM: SSGP 10-2013 Page 1 of 3

h
construction access corridors. You may use i
application form. SEZ AIW Wek> 4&
�- Attach a Ph of the shoreline/ buifier
Proposed to be stabilized. (include a stale of
some sort a yard stick, shovel handle, etc.)
4. Location of the property (where work is to be conducted)
County.- �� Nearest Town: �QDitF��tt i
Subdivision name or site address (include phaseAot number): 3)1 rt'y� nnn a M U-
Li}K� iVCti tont R1r G t.�C'`` � s�ru.€ r Ua 1-12-15
wc:uvns to site - please include road names and numbers, landmarks, etc,:
Iii
N 1 V ►(%
IsUrr Sctw�F 6E.ftCPF�C t.iiut �D
Latitude (m dedinml degne Longitude (dWnW ) o
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): VAvoDED Zees pem-x fAt- L—.Zyr
S_ Property size (acres): I. i pG rACSES
7- Lake/ river/ ocean adjacent to property.- LRV.FNp _Mpt"
& Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): OtA lM'i14 v� tAJ
�2� i zEn WVT4 F-19 Rri-JP 2-t 1' S>•4aft t.1 i.1 1
9. Will work be conducted from land? M From water? F1
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:
•Zit' �9 11W Z1tp sF
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: -211"A VWMW = 16$8si=
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): rA i W IROU LM PACT -
R\2 QRS aA ep Cf:C" w rf* rn 1 N %M c2 � 0kS-K�Whgr, 1€3 r3VM'O?--
Agown / s f 15A NCAC 02H .0502(f)] a
o, is sign is vtWd only if an authorkadon letterfrom the own is provided
. Page2of3
FORM: SSGP 10-2013

Full Pond/
Jorma) Water Level
Shoreline
La ke
(At Full Pond/ Normal Water Level)
P�S��?tLC3�V HtL f� - Rw9 RR.p Vu4ccD :tet
Sk�DST�-�aZi'� m�iJ inr,P �"
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.
S. 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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AREA 5UMMAKY
LOT 1725
1,10b AC -KE
48)Jb3 5Q FT.
r&Wr.
.jrjMft7ff,T1M
NUM
DELTA
ARC
RADIUS
Bir' GDISTANCE
C1
Matiaml-
33°37'06®_
11.74'
20.00'
IRIN
N33'y,02'E
11.57'
115
C2
3'04'00'
33.46
625,14'
--�-30-�71,"52"E
5 2 E
33.46'
33,6
=9100M
--
NUM
Ll
---
BEARING
5'T9 4YW
DISTANCE
.60.79'
LT
4376'44`W
42.64'
_L3
S84°29'25"W
L4
W45 -13'28'W
37 i()
L5
S68 °4039"W
24.11'
L 6
- §6—
(Y3�12-1-W-'—
5.26'
�8-2753-W'
95.74'
NOTES'
1) Area alcielmned by Coordinate C0m1PUt0u`sr Method
2) property subject to any facts that may be disclosed by a full
and accurate title search.
J) Property may be subject to any Restrictions,. Easaments, andlor
Right of Ways of record and those not a,' record if they exist.
4) A portion of Subject Property is lacc'ed in 0 Special Flood Hazard Area
(Zane AE) as desgnafed by the FEMA FLOOD INSURANCE RATE MAPS
See Map Number 371C -461400K - Efferf4e Date J17812008.
5) No Ceodetic Monument found within 2000' of Subject Property,
5) Subject Property zoning R-20.
1, Thomas E. Wwas, cartify that this Plot eas drawn -now My -'P—ixiuo
fron, on actual sur -y mode Under my s per(dowd desorption recorded in
Book 2294Fo9e 2042 w other ref -once AS NOTEti };
that the anoodare,, not surxyed we shown as broken lines drown from
information found in adding deeds and plots as noted,,
that the ratio of pracis is 7 : 10,( -f, and that this plot meets the
reavire-ants of The 51andords of Practice for Land Sjrm ying k, North Carolina
occwdg to North Carol" Adrrinistrati� Code Title 21, Chapter 56, Section 7600.
This sunray is of an existing parcel or parcels of land and does not
create a new street or change an existing street.
This 8th day of September, 2015
7homos F- Williams. NCPLS 4718
LECrE-tNTD
PROPERTY LINE (P11) IN,
RIGHT OF WAY (R/W)
BE LINE
ADXVNING PROPERTY LINE
FROM DEED OR PLAT "IN
h(INjA4,1JM BUILDING SETBACK
50' 4fGETATIW BUFFER
FULL POND
- - - - - - - - 100 YEAR F[ LINE
FENCE
EX EXTSPAIG
SIF SET #4 REBAR
Pp POWER POLE
BLDG 5 TORA GEIU 77LI TY BUILDIN C
40 0 40 80
LE3
SCALE: I' = 40'
PrM rRM' SUM AND MUNTIRM-M AS -%"YN (0, AU OMMS CAW-V"M PaWM (01'
Williams Land Survp--,'-- Inc.
Ljcenst- Number C-
274 Bakymculit Drive, 5%atesvifle, NC 28625
pho.tte:[phone] - emailzrunningoafaitb@belLmuth,net
filo, 15iCLTMI722-
S�
REAL
L-4718
Boundary and PhYsical Survey
317 Tuskarora Trail
Crescent Land iirnber
Lake Norman Recreation Lots
Section 6 Lot 172--5
Davidson Township, Iredel"I Coo torr ATC
PIN# 4614-94-5822 - D.B. 2294-2042 - RR 34-46
Current Owner George & Adrianne McKee