20160641 Ver 1_Shoreline Stabilization_20160627

o 1810 a-4 1 $'PAID
State of North Carolina
Department of Environment an a ural Resources
D_ W I R
Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500 — Water Quallty Certification, Shoreline Stabilization
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 [15A NCAC 02H .0502(a)]
1. Owner Inform tion �'
Name: I=
Mailing Address: 1113 1gavb2rrt
Telephone Number: Fax Number:
E-mail Address:'
Agent/ Contact Person Information
R -M @ 9 0162=,nn
kUN 2 7 2016 U�
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
litt www.saw.usace.army.mii/Portals/59/docs/regulatory/regdocs/Permits SAMPLE AGENT AUTH
ORIZATION FORMnddf) must be attached if the Agent has signed this application form.
Name: j 14IJ A✓IIlIJ IAJI N
Company Affiliation: ��OGIV}7�S
Mailing Address: 755 Buis 15:6
A .
Telephone Number:, &5-92-7- B&Z-7 Fax Number: 82Y, -327
E-mail Address: sem, G Inc- . coko
Person to receive the Certification Approval: 5 TVN
II. Project Information [15A NCAC 02H .0502(a) & (b)]
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.
f3. 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: O. -W I,�l Nearest Town: Z �s
ubdivision name or site address (include phase/lot number):
All,Ai AA )_ f4'f-A/)
Directions tLljsite''-,1please include road names and numbers, landmarks, etc.:
Qt A6o__ 1-t(1'IrP44,—
Latitude (in decimal degrees) &I. { B I I q rl Longitude (decimal degrees)_ —91. 4-3Q400
5. Describe the existing land use or co clition of the site at the time of this application
(residential, undeveloped, etc.): .� j. I GLA
6. Property size (acres):
7. Lake/ river/ ocean adjacent to property: r1(7c��'1b5°5
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): lmw%k 5Lkjd ae_ 4Me' '4b 40,2 '�SLLCY�w-
`J\(4Ce, tMe- Qxt9S k e n Awd i"b i -L..._ Ie,I,. l
9. Will work be conducted from land? 19� From watear? ❑
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:
W.:
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: / sly g2yy` X°yVjJ �OoLl Ar«as &021&Yr)
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): /Z�'aL'Z �v
5,'Woll Ovmelr, 7w"o-f 4LLW4,s­ a A14 6&ia"jV5 L,4Mt�n2
�- - -
Owner/Ag is Signature* [15A NCAC 02 .0502(ffl Date
Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO.
5 O PLAN NO
PARCEL ID: b5 l *-1 Z S 0
STREET ADDRESS: IN be It-ll/C�
&(Ly , I+e' ral (e 04, ZSCa so
Please print:
Property Owner:
Property Owner: �q4< <- 5't D PA 141
The undersigned, registered property owners of the above noted property, do hereby authorize
S-rAlj Wq-tTPm'-jP" . of � W Assou f4'f��a
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
Telephone: - '32-'] - 9&,2'7
We hereby certify the above Information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature
Date: 6 I -LI /l'-;
W
Authorized Signature
Date: 6 JAI &

9/2/2014 Dnving Directions from 110 V1/ Union St, Morganton, North Carolina 1tStiw to tlroauHre= LA, ui ei nw redo, ivvI u i vas vin io cwvv I rneyWuw,
Total Travel Estimate: 18.75 guiles - about 27 minutes
Estimated Fuel Cost: $3.13
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V/ZIZU14 Drimng Directions from 110 W Union St, Morganton, North Carolina 28655 to Broadwater Dr, Granite Falls, North Carolina 286301 MapQuest
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Trip to:
Broadwater Dr
Granite Falls, NC 28630
18.75 miles / 27 minutes
Estimated Fuel Cost: $3.13
Notes
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110 W Union St, Morganton, NC 28655-3460 Download
Free App
1. Start out going southwest on W Union St / US -70 Bus W / US -64 Bus E toward N 0.08 Mi
King St. Map 0 08 Mf Total
2. Take the 1 st left onto S King St. Map 0.08 Mi
root & vine is on the left 0 2 Mi Total
If you reach N College St you've gone about 0.1 miles too far
41 aus 3. Take the 1st left onto W Meeting St/ US -70 Bus E / US -64 Bus W. Map 0.09 Mi
EAST
Calvary Lutheran Church is on the corner 0.3 Mi Total
� If you reach W Concord St you've gone a little too far
1$ 4. Take the 1st right onto S Sterling St / NC -18. Map 0.3 Mi
FRANKS PLACE #I is on the corner 0.5 Mi Total
If you are on E Meeting St and reach S Green St you ve gone a little too far
9 8
5. Keep right at the fork to continue on S Sterling St / NC -18. Map
2.2 Mi
2 7 M1 Total
6. Merge onto 1.40 Evia the ramp on the left toward Hickory. Mao
7.0 Mi
qVIf
you are on S Sterling St and reach Steakhouse Rd you've gone a little too far
9 7 Mi Total
7. Take EXIT 113 toward Rutherford College / Connelly Springs. Mae
0.2 Mi
9 9 Mi Total
8. Turn left onto Rutherford College Rd. Mar)
0.2 Mi
If you reach 1-40 E you've gone about 0 2 miles too far
10 0 Mi Total
9. Rutherford College Rd becomes Malcolm Blvd. Mae
0.4 Mi
10 5 Mi Total
EAST
10. Turn right onto US Highway 70 / US -70 E. Mau
1.7 Mi
C,
US Highway 70 is 0 2 miles past Alpine St
12 1 Mi Total
Y
If you reach Cocknll St you've gone a little too far

01fieu ty ummng utrec.uurte ii urn t ru vv union ax, morganton, North Carolina 28655 to Broadwaler Dr, Granite Falls, North Carolina 286301 MapQuest
19 Broadwater Dr, Granite Falls, NC 2863035-781142,-81.436545
(Address is appro)amate)
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11. Turn slight left onto Rhodhiss Rd. Mag
3.2 MI
Rhodhiss Rd is just past Setzer St
15.3 Mi Total
If you reach Knobs Lndg you've gone about 0.5 miles too far
12. Turn slight right to stay on Rhodhiss Rd. Mag
0.8 Mi
Rhodhiss Rd is 0.1 miles past Decker Rd
16 2 MI Total
If you are on Brown Cir and reach Dirt Rd you've gone a We too far
It
13. Rhodhiss Rd becomes Burke St. Map
1.2 Mi
17.4 Mi Total
It
14. Burke St becomes W Caldwell Dr. Map
0.6 Mi
18.0 Mi Total
t
15. W Caldwell Dr becomes Duke St. Mae
0.3 Mi
18.2 Mi Total
16. Turn left onto Duke Power Rd. Map
0.4 Mi
Duke Power Rd ►s just past Moss Ln
18.6 Mi Total
If you reach Everett Dr youVe gone about 0.1 miles too far
17. Take the 1 st right onto Broadwater Dr. Map
0.2 Mi
Broadwater Dr ►s 0.3 miles past Bumgarner Rd
18.8 Mi Total
If you reach Ferguson St you've gone about 0.1 miles too far
®
18. BROADWATER DR. Mae
Your destination isjust past Edgewater Ct
If you reach Deep River Ct you've gone a little too far
19 Broadwater Dr, Granite Falls, NC 2863035-781142,-81.436545
(Address is appro)amate)
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Notice. This SIIe Plan 3 Document Is For Conceptual Use Only Actual Lo®Ilons. Sizes Andidr jUndigom Mey Be CNanped By Ths Developeiln Order To Accommodate The Needs Of The Development This Plat
MoARkallon. This Is NQIA Flnei Plat For Recordation. NOT TO SCALE Vold Mars prohblleE by few Vent' ell eMalis and diman" d6,onthe recorded lot male
http://www.nclakefront. comlimages_property/communitiesliargeBroadwater%2OLanding%... 6/4/2014

La ke
(At Full Pond/ Normal Water Level)
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Full Pond/ l
Normal Water Level
Shoreline X X X
' S `�� r (L�{�12XL� I�Px� Hca' ��✓ti a
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Please approximately sketch the following information on this plan (provide dimensions foreach
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 1G-2013 Page 3 of 3

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