20170119 Ver 1_Shoreline Stabilization_20170126

Shoreline Stabilization Application Form r_ i T
0 19
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
JAN 262017
• Applicant Information [lEAi��2H .0502(a)1 geS UR S
1. Owner Information 40E & SUFFER PERMIINC
Name:e� T� rQak
Mailing Address: 1.39 /,�/to.6nuss _i�lu.4 `AJ .
Y6k,s.c Z -t43
Telephone Number: 03 - ygS- (p 75 4 Fax Number:
E-mail Address:S-���+o�� cW,
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/docs/reRulatory/regdocs/Permits/SAMPL
E AGENT AUTHORIZATION FORM.pdf) must be attached if the Agent has signed
this application form.
Name: AAAJav4s0el �0.-45 A's ilc, aIc'�v�►�a F-
��nS�ru.�� ien
Company Affiliation: ©weer
Mailing Address: I&Os ;iesjm
1

Telephone Number: Sso3-831- &3IG Fax Number: 5
E-mail Address: rclawS35& eo.c{hl�nk, nsz+
Person to receive the Certification Approval: -Aa,Ai (',la.jSOr\
• 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.
• Provide a detailed site plan showing property boundaries and proposed
locations of vegetation clearing, structures (buildings, retaining walls,
docks, impervious surfaces, 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.
• Attach a photograph of the shoreline/ buffer proposed to be stabilized.
(Include a scale of some sort- a yard stick, shovel handle, etc.)
• Location of the property (where work is to be conducted)
County: C_rats-Han Nearest Town: _&el'%kon,}
Subdivision name or sit# address (incl de phase//dot number):
Woodl av%d —?)mi f�hocs� 1 Loa- 17 / 7,015 /albs.r,_ "Po;n+ !bc -
1�1 wwn.4-', Al -C • Ao t a- i /
Directions to site - please include road names and numbers, landmarks, etc.:
Monolzr& W -•y (s. , 4hzz� t,\;.0 r'un -.ni-o f- IZ wilt lae on lei=+
Latitude (in decimaidegrees) 3s°10.31. 7(0 "A/ Longitude (decimaidegrees)�l °
• Describe the existing land use or condition of the site at the time of this
application (residential, undeveloped, etc.):
• Property size (acres): /- 0 a5 OLCIMS
• Lake/ river/ ocean adjacent to property: La.LL_
2

Describe proposed work (include discussion as to how hardenin of shoreline
has been avoided, or why it is necessary): wv►
I ,
N ?
1. in 'tib I _5 /'i� j 5tint /w.. K z& O t`A e -r �[�GG.S 4're
• Will wdrk be conducted from land! ^Aj From water?
• 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: �z X 'CO " /—C' .2 zo :!4 fLI
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: fig x 0/-07 «�5
P t sl.n ���in f��a 4t.
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): a._,.A„ fj'r� 12 "4a -20 i�" /- V " a l/
s Signature' [15A NCAC 02H .0502(f)]
Date
`Agent's signature is valid only if an authorization letter from the owner is provided.

,��? - J o :'.."_. ..-- r _._..-i:'reset Fad-c-i•r.nt
. _ Hone Insert Design %nimeions Slide Sho:. Re+Ter. `&e:: 1.35er idi>_
'j J Layout
`Reset
Slide - ;.J Delete
-A
_ Full Pond/
Normal Water Level
Shoreline
Slide of 'Office Theme'
Lake
(At Full Pond/Normal Waterl-evel)
--------------
Please approximately sketch the following information on this plan (provide
dimensions for each item, such as 10 ftx 100 ft)*:
• All proposed vegetation clearing
• Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level
elevation
• Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level
elevation
• Location of any proposed structures such as buildings, retaining walls, docks, etc.
• Location of any excavation or dredging below the Full Pond/ Normal Water Level
elevation

• Location of construction access corridors

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 17 PLAN NO. PARCEL ID:
STREET ADDRESS: '70► 3 Lot VLe , d PO -Kt - he I kvu l � � /V •C-
Please print:
Property Owner:
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
of C� S c C "(L f .
(Contra r / Agent) (Name of consulting firm) J
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):
/3'7 31 tA� R .P . �o� ka S G • QM!i
Telephone: V13 - �6 - w 7 5 -
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
�7AA oriz Signature
Date: o? -'�? 94(

BOUNDARY SURVEY
VACANT LOT
LOT 17, WOODLAND BAY PHASE 1
SOUTH POINT TOWNSHIP, GASTON COUNTY, NORTH CAROLINA
MAP BOOK 70, PAGE 38
PREPARED FOR EVAN COUNCIL
THIS PROPERTY IS NOT GRAPHICALLY
LOCATED IN ANY FEMA DESIGNATED
SPECIAL FLOOD HAZARD AREA AS
IDENTIFIED ON COMMUNITY PANEL NO.
370099-37103582001, DATED 9/28/07.
ALL EIRS $ SIRS ARE FLUSH VATi
EXISTING GROUND LEVEL UNLESS
OTHERIMSE NOTED.
AREA DETERMINED BY
COORDINATE DETERMINED
PROPERTY IS SUBJECT TO DECLARATION OF
COVENANTS, CONDITIONS AND RESTRICTIONS
RECORDED IN DEED BOOK 3146 PAGE 356
DATE OF FIELD SURVEY: 10-13-16.
OWNER AT TIME OF SURVEY: ZARAR do
DINA MAHMOOO. OB 4660 PG W.
THIS SURVEY IS NOT INTENDED TO MEET
GS 47-30 REQUIREMENTS. THIS SURVEY
WAS PERFORMED PER THE STANDARDS OF
PRACTICE FOR LAND SURVEYING IN NORTH
CAROLINA WITH AN ERROR OF CLOSURE
THAT MEETS MINIMUM STANDARD OF
1:10,000 AND THAT THIS SURVEY IS
PREPARED MITHOUT THE BENEFIT OF A
FULL AND LEGAL TITLE SEARCH
THIS PLAT IS SUBJECT TO ANY
EASEMENTS, OR RIGHTS-OF-WAY OF
RECORD PRIOR TO DATE OF THIS
PLAT, WHICH WAS NOT VISIBLE AT
THE TIME OF OUR INSPECTION
NOTATION LEGEND
EIR EXISTING IRON ROD
SIR SET IRON ROD
MBL MINIMUM BUILDING LINE
R/W RIGHT-OF-WAY
MB MAP BOOK
PG PAGE
OB DEED BOOK
NTS NOT TO SCALE
CONC CONCRETE
EB ELECTRICAL BOX
UP UTILITY PEDESTAL
DUE DRAIN k UTILITY EASEMENT
LOT 16
MB 70 PG 38
5' DUE PERL
DB 3140 PG 356
UNETYPE LEGEND
— — — — — SET BACK LINE
PROPERTY LINE
ADJOINING LINE
(NOT SURVEYED)
TIE LINE
- - — DUE
E UNE-EIR-NTS
N 54'14'17' W
134.40'
1 1I
' \PIER ZONE/ '
LAKE WYLIE MB 70 Pc 38
1 ti
I
1
4
SCALE 1' = 50'
LAKE WYLIE
C$ RR
F1
I' I
L1 PROPERTY LINE
FOfLOWS 570 CONTOUR
MB 70. PG 38
1 '
IfoT 17
/ 1.025 ACRES±
rZ2,
W
I I I N
I (I I
I
I I
al I I�
I }
I 011 I� '
CA
I I ( I W
J
II00
A
I I I I
I
I v I I
I I I
1. •I
I I — J
i
1UP OPINE
1 AAES\Ad P �C �R a
TIE UNE -MAG µ8 10 PG
S 22'49'44' W
10.06'
ORIGNAL SURVEY WILL CONTAIN A CRIMP SEAL IF THIS CRIMP SEA[
DOES NOT APPEAR ON THE SURVEY. THE SURVEY COULD CONTAIN
CHANGES NOT CERTIFIED TO BY THE SIGNING SURVEYOR.
PREPARED BY:
DELTA LAND SERVICES INC.
Firm License # C-739
608-0 Matthews Mint Hill Road
Matthews, North Carolina 28105
[phone]
REVISED:
T:\Drawings\woodland bay\WB-0017.dwg
VICINITY MAP \
NTS vc \\
Z Z�
GNDUA ��
= µA
O
SITE
A
y 9�
O
M
S' DUE PER
OB 3140 PG 356
EM
18
MB 70 PG 38
10' DUE PER !O-
1 3140 PG 356
TIE UNE -MAG
S 3872'24' W
10.49'
OWN: JDA CKD: DATE: 10/1416

z. �:
�. h`
w d
r
.,
F ;Y � �•,
�.`� _ �
� y R
.,