20161192 Ver 1_Shoreline Stabilization_20161205

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 2 0 1 6 1 1 92
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name:1''PS" �01A)Ski
Mailing Address: 177 She lkou.rng 'Plate,
Telephone Number: 70y • W2-' 75 85
E-mail Address:
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can
http://www.saw.usace.army.miI/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pd ) I_must be attached if the Agent has signed this application form.
Name: IVI (',1 wi L r< /MJ
R�IZIWJF�R MI/
'•• � I moi.
Telephone Number:
E-mail Address:
IFIFIA ►�
Person to receive the Ce
I1. 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. 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:Nearest Town: t,j1211 CeSV ))�i
Subdivision name or site address (include phase/lot number):
1- -
Directions to site - please include road names and numbers, landmarks, etc.:
Latitude (in decimal degrees)66. 15) 457 D Longitude (decimal degrees) ' 50. 4q240�7 V v
5. Describe the existing land use or condition
"o�f the site at the time of this application
(residential, undeveloped, etc.): rC�JI(hG��"�I�LI.I P�'�o4�t'1� ,�hDre, I irV__
6. Property size (acres):03q1
7. Lake/ river/ ocean adjacent to property: DY_M
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): UA. lA &S AWAJ( 4P D?A 4&.
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: 2
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):
� XO I Z ► - z
Owner/Agent Signature* [15A NCAC 02H .0502(f)l Date
`Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

Norma
SI
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.
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

� _ � � � *wax►., � -

11/15(2016
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20160822154349resized.jpg

#'' Iredell
GIsfid 1 Printed August 05, 2016
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The maps prepared for this website are generated from recorded deeds, plats, and other public records. Users of these maps are hereby notified that the information %provided herein should be verified. Iredell County assumes no g w
legal responsibilities for any of the information contained on this site. Users are advised that the use of any of this information is at their own risk. All maps on this site were prepared using a 1000a€" Grid based upon the North
Carolina State Plane Coordinate System from the 1983 North American Datum. The delinquent real property tax overlay is updated monthly. The information r ded to be used or relied upon as official notice of
tax liens. For additional information regarding delinquent taxes, contact the Iredell County Tax Collector's office. A
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FINAL PLAT OF THE POINT 4N77.031
PHASE 11 MAP 1
OWNER/DEVELOPER: THE POINT ON NORMAN, LLC.
LOCATED IN DAVIDSON TOWNSHIP
IREDELL COUNTY, NORTH CAROLINA
THE POINT ON
NORMAN LLC
2214 BRANtEY SCHOOL ROAD
NODRESVILLE, N.C. 28115
[phone]

11/15/2016 My location to 177 Shelburne PI, Mooresville, NC 28117 - Google Maps
Go gle Maps My location to 177 Shelburne PI, Mooresville, NC Drive 7.9 miles, 15 min
28117
Brad Keslowski
i BeSI BUY
mk ,,r• Badcock Horne
Lake No,,,,,
.!0 My location " Fur a— emore
of Catawba ,
o 4 Mn<re
E�
EEO
R 15 min
79'r 1, .
,esx • Ed,pse Hau Studio
.. _.:.
E, ^Jeffrey's Restaurant
MI Mourne ,.
0
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De� e,
Sunup Cat
Chi
177 Shelburne Pled
Go gle
Map data ©2016 Google 1 mi t
https://www.google.com/maps/dir/35.5893925,-80.8731055✓177+Shel burne+Pl,+MooresviI Ie,+NC+28117/@35.5518778,-80.9394521,13z/am=Vdata=!3m 1!4bl!4.. 1/2

11/15/2016 My location to 177 Shelburne PI, Mooresville, NC 28117- Google Maps
My location
� 510 KI � 1
t 1. Head southwest on Williamson Rd toward Leaning Oak Dr
r 2. Use the right 2 lanes to turn right onto NC-1100/Brawley School Rd
t 3. Continue straight onto NC -1100
q 4. At the traffic circle, take the 2nd exit and stay on NC -1100
', 5. Turn left onto Torrence Chapel Rd
h 6. Turn left onto Shelburne PI
ie Destination will be on the left
177 Shelburne Place
Mooresville, NC 28117
These directions are for planning purposes only. You may find that construction projects,
traffic, weather, or other events may cause conditions to differ from the map results, and you
should plan your route accordingly. You must obey all signs or notices regarding your route.
0.4 mi
3.5 mi
1.7 mi
1.6 mi
0.3 mi
0.3 mi
https://www.google.com/maps/dir/35.5893925,-80.8731055✓177+Shel burne+Pl,+Mooresville,+N C+28117/@35.5518778,-80.9394521,13z/am=ttdata=!3m 1!4bl!4.. 212

11/8/2016
isffouchMapxom
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41-11 Address: 177 Shelbourne Place Mooresville NC. GO Mobile Version
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Latitude: 35.514578
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Latitude: 35 30 52.4808
Longitude: -80 55 36.4368
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