20170486 Ver 1_Shoreline Stabilization_20170419

State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources FORM: SSGP 10-2013
Shoreline Stabilization Application Form
Four copies of the application (including attachments) and the application fee should be sent to:
Division of Water Resources
401 & Buffer Permitting Unit
1650 Mall Service Center LD
���
Raleigh, NC 27699-1650 2 j 7® 4 8 6
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name:
Mailing Address:
Telephone Number- J� �`��- ���� 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:
http://www.saw.usace.army.mil/Portals/59/docs/regulatory/"regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.Pdf) must be attached if the Agent has signed this application form.
Name:P(r-3r-,=-?nMfa
Company A";iilazion:
Mailing Address:
Telephone Number:
�V\
Fax Number:
E-mail AGuress: _
Person to receive the Certification Approval:��-<-
II. roject Infoi•iriadon [15A NCAC 02H .0502(a) & (b)y
Attach a vicinity map (i.e. street map) clearly showing the location of the property with
re ect to local landmarks such as towns, rivers, and roads.
2 rovide 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 scc-t- a yard stick, shovel handle, etc.)
4. Location
\oft -he propert (where work is to be conducted)
County: \\\��p-\��V- Nearest Town:
����\��
Subdivision name or site address (i clude phase/lot number): c
Directions to site - please include road names and numbers, landmarks, etc.:
5. Describe the existing land use condition of the site at the time of this ap lication
(residentia,, undeveloped, etc.
6. Property size (acres):
7. Lake/ river/ ocean adjacent to property
8. Describe proposed work (includdiscussion as to how hardec ing of shoreline has been
avoided, r why it i$ necessary):
9. Will work be conducted from land?
From water? ❑
10. Total arnQunt 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:
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 feet lar:dward to be impacted (nu ber of trees for instance): C�'\ ��E-� ��,� Q: `1_
201
Owner/Agent"s Signature* [15A 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

Full Pond/
Normal Water Level
Shoreline
La ke
(At Full Pond/ Normal Water Level)
D)
t
Q
Try -f5
<�::D iL'P Ito -D
pt-,q(e, tteL
ox I J ✓t.4ci-'
Please appir , U«:y sketch t'r,e following information o�-. -,'I-lis plan (provide dimensions for each
item, such as 10 ft x 100 jt) *:
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 ria 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

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Map data ©2017 Google 1000 ft
21209 Island Forest Dr
Cornelius, NC 28031

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Graphic Scale
20 10 0 20
Scale of Drawing 1 Inch - 20 Feet
CURVE TABLE
CURVE LENGTH RADIUS CHORD CHORD BRG
C7 23.02 111.36 22.98 N84'38'31'W
760' LAKE CONTOUR
FOLLOWS ADJOINER'S SEA WALL
(TIE ONLY)
—
O' SV� ADJOINER'S CONC.
PATIO CROSSES LINE /
4.3'X4.8'
1. NO NCGS MONUMENT FOUND
WITHIN 2000'
2. PROPERTY MAY BE SUBJECT TO
OTHER COVENANTS, RESTRICTIONS,
EASEMENTS OR RIGHTS-OF-WAY
THAT MAY BE OF RECORD.
3. THE PROPERTY IS SUBJECT TO THE
"CCR" AS RECORDED IN DB 2706, PG
171 IN THE MECKLENBURG COUNTY
THE PROPERTY IS CURRENTLY
)NED "G -R" WITH THE TOWN OF
)RNELIUS PLANNING
WARTMENT. THE SETBACKS ARE
:R THE TOWN OF CORNELIUS
.ANTBNG DEPT.
LAKE 2VORMAX
ZONA
ZONE "W'
15 Pip pEP� U/ \
F P/
LOT 57
10,329. SQ.FT
0.237 ACRES
(VACANT) I
,I
760' LAKE CONTOUR
FOLLOWS ADJOINER'S SEA WALL
1 (TIE ONLY)
SI 2-06'17"1
PQ' O`c
Oaf riot• 4SO�F'
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DAVID A. TEIFER
JENNIFER L TEIFER
DB. 30289, PG.688
FRONT -50'
4,
7I
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14.0'
dL FP
° a.o ,o F'eea0
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SAM YOL SUNG
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LINE OR 30' OF 760' CONTOUR LINE
WHICHEVER IS GREATER.
ULSOOK SUNG
MITSUO IWASAKI
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5. THE PROPERTY IS SUBJECT TO A
PERPETUAL EASEMENT FOR RAISING
JUNG IA S. IWASAKI
DB. 13909, PG. 578
113710463400K, DATED 03/022009, AND
50' FRONT SETBACK _
THE WATERS OF CATAWBA RIVER TO
Q
PROVIDED BY MECKLENBURG
PROPOSED/ \
QOJQ QO
Q
S89.26'27"W 29.HH' Ct 40J l
PIER AND
DOCK
/
DESCRIBED IN DB 2391, PG 535.
1"=20'
Drawing Scale
N79.56'04'E
x
CONSOVP
ZONA
ZONE "W'
15 Pip pEP� U/ \
F P/
LOT 57
10,329. SQ.FT
0.237 ACRES
(VACANT) I
,I
760' LAKE CONTOUR
FOLLOWS ADJOINER'S SEA WALL
1 (TIE ONLY)
SI 2-06'17"1
PQ' O`c
Oaf riot• 4SO�F'
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DAVID A. TEIFER
JENNIFER L TEIFER
DB. 30289, PG.688
FRONT -50'
4,
7I
I
SIDE - 8'
001-111-16
FLOOD INSURANCE RATE MAP -
PANEL #3710463400K; EFFECTIVE
I
REAR: 25' FROM REAR PROPERTY
SAM YOL SUNG
23
r
c'
LINE OR 30' OF 760' CONTOUR LINE
WHICHEVER IS GREATER.
ULSOOK SUNG
MITSUO IWASAKI
AND ARE SHOWN USING
a0
N
5. THE PROPERTY IS SUBJECT TO A
PERPETUAL EASEMENT FOR RAISING
JUNG IA S. IWASAKI
DB. 13909, PG. 578
113710463400K, DATED 03/022009, AND
50' FRONT SETBACK _
THE WATERS OF CATAWBA RIVER TO
Q
PROVIDED BY MECKLENBURG
H
THE LEVELTO THE 770', AS
S89.26'27"W 29.HH' Ct 40J l
8 173E FLOOD MAPS ARE SUBJECT TO
RS
DESCRIBED IN DB 2391, PG 535.
1"=20'
Drawing Scale
001-111-17
x
6. PORTION OF SUBJECT PROPERTY IS
4,
LOCATED WITHIN A SPECIAL FLOOD
=
HAZARD AREA ACCORDING TO FEMA
•
FLOOD INSURANCE RATE MAP -
PANEL #3710463400K; EFFECTIVE
2
-
DATE: 03/022009.
2
SUPERCEDE THE RECORDED PLAT.
r
c'
7. FLOOD ZONES DEPICTED HEREIN
WERE NOT FIELD LOCATED BY PPS
xN
AND ARE SHOWN USING
W
INFORMATION FROM FEMA PANEL
?
113710463400K, DATED 03/022009, AND
0
ALSO USING INFORMATION
Q
PROVIDED BY MECKLENBURG
COUNTY FLOODZONE MAPPING.
S89.26'27"W 29.HH' Ct 40J l
8 173E FLOOD MAPS ARE SUBJECT TO
RS
CHANGE WHEN FLOOD INSURANCE
�
RATE MAPS (FIRM'a) ARE UPDATED
AL
AND ADOPTED BY THE FEDERAL
•
EMERGENCY MANAGEMENT
lop
AGENCY (FEMA). THESE CHANGES — — — _ — —
_ _ EDGE O_F
SUPERCEDE THE RECORDED PLAT.
/,,C _ PAVEMENT
9. CONSULT WITH GOVERNINGU
/
ISLAND FOREST
AGENCY FOR PREVAILING LAND /
DRIVE
DEVELOPMENT AND ZONING
REQUIREMENTS PRIOR TO DESIGN OR60'
Public R/W
CONSTRUCTION OF ANY �V
(MB 12, PG 341)
tPROVEMENTS. /
l
Road Width Varies
LEGEND
//4 REBAR FOUND
O
MAG NAIL SET
AL
COMPUTED POINT
•
UTILITY POLE
0
UTILITY PEDESTAL
p
SUBJECT PROPERTY LINE
Request of:
ADJOINER PROPERTY LINE
— —
BUILDING SETBACK —
— — —
760' CONTOUR UNE
— — —
FENCE LINE
—X—
OVERHEAD UTILITIES
ou
� �S9>s�nFo
Pier &
LOCK bite rlan ror Lot J of Island rorest, Jneet L
Professional
ProSurveyors, Inc.
Map Made at the
As Recorded in
Site Address:
18335 Old Statesville Road Ste. A
Request of:
Deed Book 2907, Pg 159
21209 Island Forest Drive
Cornelius, N.C. 28031
Jeremy Koster
Map Book 12, Pg 341
Cornelius, NC 28031
704-765-5134 Phone/Fax
Mecklenburg County
Firm License: C-3666
Rev: 03/232017
082616-OIA
JEC
21:10,000
1"=20'
Drawing Scale
001-111-17
21209 ISLAND
1 Ofl
11/022016
Date
Job No.
Prepared By
Error of Closure
Tax Parcel Number
Drawing File Name
Sheet Number
-L.

Jeremy Koster
21209 Island Forest Dr.
Cornelius, NC 28031

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