20170004 Ver 1_Shoreline Stabilization_20161230

State of North Carolina
Department of Environment and Natural Resources
DWR1,,,_, Division of water Resources
Dlvlslon of Water Resources 15A NCAC 02H .0S00 — 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 O I 7 O 4
401 & Buffer Permitting Unit
1617 Mail Service Center DEC 3 1 2016
Raleig ID -1617
�E8 BUFFER Q TER PERMIT I
I A nformation [15A NCAC 02H .0502(a)l
1. Owner I rcfmation I (�
Name: 'o Y► Vc-d�1 DL � (`� oc z j
Mailing Address: I L 3 b t V i S
CIna2 I n c' zB Zz7
Telephone Number:
E-mail Address:
2. Agent/ Contact Person Information
Fax Number:
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 RUTH
ORIZATION FORM_ df) must be attached if the Agent has signed this application form.
Name: O)oL—R a 1I,*.- r2 --
Company
Company Affiliation: C, fr9L O(\ n -c L
Mailing Address: [ (7 S i g Q: o") a V 3�
11�QV A w.( 21:-i ( X R
Telephone Number: 70 3 % 0 b 1 to Fax Number:
E-mail Address: rJ C.n W� S�-
Person to receive the Certification Approval:jl 'D "&<Z -k
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. 55GP 10-2013 Page 1 of 3

etc.), rip rap, excavation or dredging below Full Fond/ 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: YY) O A) } Lrx Nearest Town:
Subdivision name or site address (include phase/lot number): _�_P n �•l��z�Q,t�b�
Directions to site - lease include road names and numbers, landmarks, etc.:
2 Ll AIef'v � eo r1t�
4- 6Glb N %bf'n✓y
Latitude (in decimai degrees) _T f-.3 to lo 9 23 Longitude (decimci degrees)� 30, 0 S D 3 9 i✓
5. Describe the existing land use or condition of the site at the tiTe of this application
(residential, undeveloped, etc.): R G Si�� �-MJ
6. Property size (acres): Q e- 2 17-
7.
-7. Lake/ river/ ocean adjacent to property: r
8. Describe proposed work (include discussion as to how hardening of oreline has been
avoided, or why it is necessary): 6�-M DO&"- l.%Omcl' 6&)qI✓`4-1 %
9. Will work be conducted from land? [�- From water? El
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:
F7 �c1oiJ 1/ 9ZVud
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: e2 U/ D f-7`/At .3 Z:_J",01)eC /--� // P- KJC)
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 feet landward to be impacted (numbgr of trees, for instance): /Il©t't$
./� 4
Owner/Agent's Signature' A NCAC 02H,0502 f Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10 2013 Page 2 of 3

La ke
>~ L
-T/qP,- --�
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 30 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
r°n1rQ

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESC' UMON:
LOT NO. 2 -1 `L PIAN NO. PARCELID: 6 S -V ! a&0 2 OT Y
STREF ADDRESS: o2 3 S- / /9 )ft )o a ,2 .7�e
Z�Ajq To, 2.rs -/- '2 . a 71
The undersigned, registered property owners of tt* above noted pro", do hereby auvwae
z4vj- InT L— , of "CaL 6S&L6a
(Contractor / Agent) u (Name of consubV form)
to &a on my Woolf and take all a !WM necessary for the processirgg, issuance ana acceptance of
this perm t or cet ttation and any and all standard and special aoa attact*d.
Property owner's Address (if dWerent thw property above):
L4 s- 3 S- P Rj t! -1-" c e 0 e- Ghxrz, l f io 4E Jl9_(S, 2 9Z2 i
Teleptwe:
we hereby cer* the above information submitted in this apOic3 ion is trate and accurate to the
best of our knowiedge.
%fid signature Auftrized Signm-re
Date: // Date: // S/� _

11/10/2016
Details hide
Parcels
Parcel No: 6589 19 60 7088
Parcel Address: 235 MALABAR DR
Owner: VAN DER NOORD RONALD
VAN DER NOORD MEREDITH M
14535 DAVIS TRACE DR
CHARLOTTE NC 28227
Tax District: COUNTY ONLY
Township: CAROLINA FOREST
Vol Fire: FIRE DS UWHARRIE
Neighborhood: CAROLINA FOREST (WATER)
Legal 1: CAROLINA FOREST
Legal 2: LOT 236
Legal 3: CAROLINA FOR #236
Deed Reference: Bk. 624 Pg. 848
Transfer Date: 20080901
Land Area: 0.64 acres
Sale Amount: 625000
Sale Instr: WD
QufiCode: H
Land Value: 256000
Major Imp Value: 287714
Misc Imp Value: 28486
Total Value: 572200
Appr Code: 01
Appr Desc: RESIDENTIAL
Class Code: 1
Class Desc: RESIDENTIAL
Year Built: 1992
Grade: C+010
Finished Area: 2852
Num Baths: 2.1
Num Bedrooms: 3
Attributes at point: N: 590132, E: 1686870
Fire Districts
Name: Uwharrie
Townships
Name: UWHARRIE
Proposed Voting Commissioner's Districts
District: 1
Zoning
Zoning: Residential 1
City:
111111IN:590345,E:11688309
Results ]Lat: 35'22'03.2", Lng:-80'02'44
,��
Montgomery County NC WebGIS
Y_.

North Carolina Department of Natural and Cultural Resources
State Historic Preservation Office
Ramona M. Bartos, Administrator
Governor Pat McCrory
Secretary Susan Kluttz
December 6, 2016
Robert Gallagher
Boat Houses on Tillery
10579 Willow Oak Road
Norwood, NC 28128
Office of Archives and History
Deputy Secretary Kevin Cherry
Re: Ronald and Meredith Vandernoord, Soil Disturbance, 235 Malabar Drive, Troy, Lake Tillery,
Montgomery County, ER 16-2114
Dear Mr. Gallagher:
Thank you for your submission concerning the above project.
We have conducted a review of the project and are aware of no historic resources which would be affected
by the project. Therefore, we have no comment on the project as proposed.
The above comments are made pursuant to Section 106 of the National Historic Preservation Act and the
Advisory Council on Historic Preservation's Regulations for Compliance with Section 106 codified at 36
CFR Part 800.
Thank you for your cooperation and consideration. If you have questions concerning the above comment,
contact Renee Gledhill -Earley, environmental review coordinator, at 919-807-6579 or
environmental.reviewer-ncdcr.gov. In all future communication concerning this project, please cite the
above referenced tracking number.
Sincerely,
Ramona M. Bartos
Location: 109 East Jones Street, Ralcigh NC 27601 Matting Address: 4617 Mail Service Center, Raleigh NC 27699-1617 Telephone/Fax: [phone]-6599