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Home My WebLink About20160909 Ver 1_401 Application_20160916Department of Environment and Natural Resources DWR Division of Water Resources iflivlsisources 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 Resources le 0 401 & Buffer Permitting Unit 1617 Mail Service Center Raleigh, NC 27699-1617 1. Applicant Information [15A NCAC 02H .0502(all SEP 2 1. Owner Information DEQ 1 ?�16 Name: 11rw� 11. Sy� 401� VAFFRR� Mailing Address: _ _1_3 ? 2 CCAO< LAI 'P�gv,,,h,.-� r, i r RMin,F (b w,1 S 5 �.r • vH �+ .(l C " 7 Z r(/ eV Telephone Number: iiLLz - 5-5-5-9 Fax Number: E-mail Address: 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/docsZregulatory/r Rdocs/Permits/SAMPLE AGENT AUTH ORIZATION FORM. df must be attached if the Agent has signed this application form. Name: 111 an A)ti,,,. / Company Affiliation: Mailing Address: l 07SS /. ), V / r,. k Alp, QVC 2 -EI Telephone Number: Fax Number E-mail Address: n411-70,01�/u,,, CO Person to receive the Certification Approval: DCtr7•5 #f, rac.�c 1, 11. Project Information [15A NCAC 02H .0502(ai & (b)1 I. 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 rep, 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)/s l County: orns_r Nearest Town: /t' !'7� _ �•s/+ d Subdivision name or site addressinclude ha ( p se/bt number): PChj'k5. , „ W % r 14,111.1- Directions rM,f Directions to site - please include road names and numbers, landmarks, etc.- Ake - Latitude andecwaLongitude (dedinat ateg m) Q•S 21. l'• 5. Describe the existing land use or condition of the site at the time of this application (residential, undeveloped, etc.): ;r13C,/cc S4 6. Property size (acres): 42S 7. Lake/ river/ ocean adjacent to properly: T l k r y 8. Describe Proposed work (include discussion as to how hardening of shoreline has been avoided, or why it is necessary): --_ LIU rac 54C41 t 9. Will work be conducted from land? From water? 10. Total amount of disturbance (including all excavation, baddill, rip rap, retaining walls, etc.) below the normal pool lake level/ Normal Water Level in square feet or acres: 2 x 6-0, 11. Total amount of disturbance (including all dearin& back fill, excavation, rip rep, retaining walls, etc) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in square Meet or acres: _ V X GS 12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and 50 fleet landward to be impacted (number of trees, for instance): ►-f-MO l.i D� S '7�rGtS Owner/Agent' Signa#ure' [15A NCAC 02H 0502(fl1 Date *Agent's signature is valid arrly. if on oudwrizaition Winer from the owner is provided. Fes: ssGP 10-2oi3 POP 2of3 Norrr j� 11 14t445an Lake (At Full Pond/Normal Water level) 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. 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 V^ G jrt-es .V A S-eawa) 9/11/2016 Montgomery County NC WebGIS COJoI . T 6 1/2 Details hide Parcels Parcel No: 6575 14 43 9828 Parcel Address: 0 CRAIN CT Owner: HUDSON WILLIAM M HUDSON KATHERINE E 6322 CAPE WEDGEWOOD CR BROWNS SUMMITT NC 27214 Tax District: LAKE TILLERY FIRE Township: PEE DEE Vol Fire: FIRE DS LAKE TILLERY Neighborhood: PEE DEE Legal 1: PENINSULA AT LT Legal 2: LOT 9 Legal 3: PEN INSU LA AT LT #9 Deed Reference: Bk. 742 Pg. 119 Transfer Date: 20140919, Land Area: 0.16 acres +' Sale Amount: 98000 Sale Instr: WD a Land Value: 82200 Total Value: 82200" Appr Code: 01 Appr Desc: RESIDENTIAL q Attributes at point: N: 553886, E: 1674925 Fire Districts ,., Name: Tillery Townships Name: PEE DEE - Proposed Voting Commissioner's Districts District: 1 Zoning Zoning: Residential 1 + City: • i Voting District Precincts N: 553867, E:1674897 Vat: 35'16"01.0", Lng:-80'05'21.1' https://www.webgis.net/nc/montgomery/ COJoI . T 6 1/2 K �.� — "' - - � .ter-�=-.�-� �� " Vii'- �°^--.-�.. _. _ ICr-'-� ._ �_�,� ��..