20161050 Ver 1_401 Application_20161116

2 0 1 6 1 0 5 0 State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
Division of Water Resources 15A NCAC 02H.0500—Water Quality 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 Information
Name: T I lea.
Mailing Address: '401 Al2cet4onIck- 00-d'
� 4-
Telephone Number: f '��. I( � Fax Number:
E-mail Address: Man311 M 661 - Opal
2. Agent/Contact Person Info ation
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http://www.saw.usace.army.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be att ched if the Agent has signed this application form.
Name:
Company Affiliation: (t7 eoieCl��
Mailing Address:
r�c__ as (1)
Telephone Number: !028 Fax Number:
E-mail Address: V nC M
Person to receive the Certification Approval: i d( C �r�S
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

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.f 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)
�J
County: ,,M C DDWeI I Nearest Town: Adn,nd
Subdivision name or site address (include phase/lot number). _i2i q
311i f5e±, Q21 di-s.
Directions to site - please include road names and numbers, landmarks, etc.:
Latitude (in decimal degrees), '! DJr Longitude (decimal degrees)
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): i�&_nlje_ `od LV+
6. Property size (acres): .3(o _
7. Lake/ river/ocean adjacent to property:
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): I b e, Choce-1 i Ner_- �5' pb:
iV
%Dn f 'rr� 1J11oG�a`Y�C.
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 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: arC_ to
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 insta ce):
a" r k
c U..r\d.er
o -ao
(Owne /Agent's Si6a re* [15A NCA 2H .0502(f)] Date
is signature is valid only if an authorization letter from the owner is provided.
FORM:SSGP 10-2013 Page 2 of 3

La ke
(At Full Pond/Normal Water Level)
ky P �� ey
Full Pond/ 04-
Normal Water Level
Shoreline R �p
ky
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

Driving Directions to Sunset Point on Lake James:
• Take 1-40 West to Marion, NC
• Take Exit 86(Highway 226)off of 1-40
• Drive north on Highway 226 approximately 1 mile to traffic light
• Continue north on Highway 221/226 Bypass approximately 5 miles to traffic light; Taco
Bell on R)
• Go through that traffic light
• Tum right at next traffic light(Business 221/226)
• Take a quick left onto Hankins Road
• Continue on Hankins Road until it dead-ends at Lake James Road
• Turn left onto Lake James Road;follow it out
• Turn right to the entrance of Sunset Point, continue on Sunset Point Parkway
• Bear left unto Big Tree Way and follow to the and
--- - - - ---- -----------

OCINI TY MAP- M-:),)W=_COUNTY I.DOLPHUS E HARMON,PRqpO 5 rpAL LAND SURVEYOR.DO HEREBY CERTIFY THAT
------------------------ NIS D_A:WAS BRA*EyG{Ht[N CIFIJJyy SURVEY UNDER NY SUPERNSION:THAT MCDOV[ELL COUNTY NORTH CAROLINA
(NOT TO SCA;E) I. REEERENCES.OTED N EIn*EIRE• ;THAT THE RATIO OF PRECISION BY
LAT AND DED[S I Al BONOARY ONES NOT SURVEYED RENEW OFFICER OF COUNTY.CERTIFY THAT THE YAP FILED FOR REGISTRATON AT______O CLOCK___M THIS
ARE CFC v'I pTG D: PARED IN ACCORDANCE NTH OR PLAT 10 vii"THIS CGRAFICATKN IS AFFIXED MEETS ALL STATUATORY REWIREYEMTS FOR RECORONG
'551 N_.�x� f,M:N91,• �/� THE______DAY OF 20_--AND
-__ DALE
1H15 5i / - RECORDED IN PLAT BOOK AT PAGE
��IJq�O 'O,fyi ✓ �+� COUNTY MAI 15 RENEW OFFICER
UTA�I,Aafy4 Mf URONT A] =PARCEL$Oi LAND I(L(p b NFDFWNI Cwlt NC
Lake Ro00 / \� 'Q�V ��y _______ __ _ __ _
L N]NE55 M�NANp AN ^ - DSDl�7 POI ----- ELL C _ -
__ 6y.P6Tf.,f HNI, REGISTER OF DEEDS MCDOWc!L COUNTY
RM4t.F a7 D..6,
BOOK 7 PAGE 57
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-717 50O45'OO'E R6?' ORDINANCE(XS7E AT THIS THE ``-/`=�/y`1 405 SOOT. STERLING ST 433-5661
2-ALL OSTANCES ARE HGTIZONTAL R oATA
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