20170177 Ver 1_Shoreline Stabilization_20170210

20170177
State of North Carolina
Department of Environment and Natural Resources
DWR
Division of Water Resources
Division of Water Resources ISA NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 30-2013
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
1. Applicant Information 115A NCAC 02H .0502(a)]
1. Owner Information
Name: Anthony T. Fertitta, Jr.
Mailing AddrPcr 17110 Ra randt Cim1p
Charlotte NC 28211
Telephone Number: 704/576-7957 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:
httr)://www.saw.usace.armv.mil/Portals/59/docs/reeulatory/reedocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: N/A
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Person to receive the Certification Approval:
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 4

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: Montgomery Nearest Town: New London
Subdivision name or site address (include phase/lot number):
Lot 24, Porters Glen Section, Uwharrie Point
Directions to site - please include road names and numbers, landmarks, etc.:
NC Hwy 49 to Badin Lake Road (SR 1162), south to old North State Club entrance see
gate attendant for directions to property.
Latitude (in decimal degrees) 35.27.56 Longitude (dedmol degrees) 80.05.29
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): developed lot in existing subdivision
6. Property size (acres): 1.69 acres
7. Lake/ river/ ocean adjacent to property: Badin Lake
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): To stabilize and eroding shoreline and protect it from
further erosion.
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:
300 So. Ft.
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: 1470 Sq. Ft.
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): 6 to 10 trees of varied
species, size and condition will be removed in order to complete the stabilization project.
Owner Agent's Signatur A NCAC 02H .0502(f)1 Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

Lake
(At Full Pond/Normal Water Level)
Full Pond/
Normal Water Level
Shoreline
SEE ATTACHED SITE PLAN AND DETAILS
1=1 IM i � MI
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

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
_DWR
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 115A NCAC 02H .0502(a)]
1. Owner Information
Name: Anthony T. Fertitta, Jr.
- Mailing Address: — -1200-Rembrandt-Circle--
Charlotte NC 28211
Telephone Number: 704/576-7957 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:
httD://wwwsaw.usace.armv.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.odf) must be attached if the Agent has signed this application form.
Name: N/A
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Person to receive the Certification Approval:
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 4

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: Montgomery Nearest Town: New London
Subdivision name or site address (include phase/lot number):
Lot 24, Porters Glen Section, Uwharrie Point
Directions to site - please include road names and numbers, landmarks, etc.:
NC Hwy 49 to Badin Lake Road (SR 1162), south to old North State Club entrance, see
gate attendant for directions to property.
Latitude (in decimal degrees) 35.27.56 Longitude (decimal degrees) 80.05.29
S. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): developed lot in existing subdivision
6. Property size (acres): 1.69 acres
7. Lake/ river/ ocean adjacent to property: Badin Lake
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): To stabilize and eroding shoreline and protect it from
further erosion.
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:
300 So. Ft.
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: 1470 Sq. Ft.
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): 6 to 10 trees of varied
species, size and condition will be removed in order to complete the stabilization proiect.
Own Agent's Signatur A NCAC 02H .0502(f)1 Date
Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSOP 10-2013 Page 2 of 3

Lake
(At Fut! Pond/ Normal Water Level)
Full Pond/
Normal Water Level
M rr .....
Shoreline
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

�1"aii�� '� y�• ) �. � I � � IY I " '
. t � � fib° f 'r� t. � �' � �! _t �,1� (�• � .. y..
rj � • � l
• ',1 C". ice',. ' .�� F ! t..
4
`y ' Y� �� d'rcw�� fi� �r'}'1SS3♦"',+ {.il �f I!' 1 �Y,1� h,�}�f 7+-4
�➢
af'
ti
i - �➢r ➢ 'fc t w'.
'. 1 ti r tl ..,.i`�Y � t'a fi�,a� it*'1 •t ,{?��';, ��,�
yi ifi

as,,', '
Lw
- - - - - _ - _ 1 � ' i.' •� ) `{�+ .- �� � it {}

GO gle u _ 293 Porter's Glen
nes Chapel „ 0
dist Church
Uwharrie Point
f2.93 Porter's Glen
G;R gk
Page 1 of 1
Map data 02017 Google 1000 ft
2/3/2017