20170562 Ver 1_Shoreline Stabilization_20170508

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 s=pies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resources 2 1 T 0 5 6 2
401 & Buffer Permitting Unit
1617 Mail Service Center @
----
Raleigh, NC 27699-1617 � � v
MAY 2017 �.
Applicant Information [15A NCAC 02H .0502(a)]
8
1. Owner Information L40h_13 A ER R oU,RName: UFF R PERMITTI�
Mailing Address:c)e`c`� L
1n)"W!r Var { 1V o3
Z�L �C�b-C�7y7 iCrlii
Telephone Number: 331. 60;-- tb5_1S Fax Number:
E-mail Address: /r� J 5 RP4 C GtDc , C.a ire.
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorisation letter (a form can be downloaded here:
http.ljwww.saw.usace.army.mil/Portals/59/docs/regulatory/repdocs/PermitslS AMPLE AGENT AUT
HORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name:ia+r�e 0.S Aa`S2.
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Person to receive the Certification Approval: Y�ic9�cec�l
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, etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Level
FORM: SSGP 10-2013 Page 1 of 3

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: �wR.`4e_ Nearest Town: l �1►,W��L c�.ks
Subdivision name or site address (include phase/lot number):
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Directions to site -please include road names and numbers, landmarks,
etc.:
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Latitude (fn decimaldlegrees) _ 353' 4211 Longitude (decit wldegtees) =8t. 4'J t 9!Q
5. Describe the existing land use or condition of the site at the time of this
application (residential, undeveloped, etc.):'''t"or.,,,,.,
6. Property size (acres): S
7. Oriver/ ocean adjacent to property: l� OAA► %%4
8. Describe proposed work (include discussion as to how hardening of shoreline has
been avoided, or why it is necessary):b
9. Will work be conducted from land? From water? El
Ia. Total amount of disturbance (including aft 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:

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L4 N 10'00'1211W 43.89'
L5 N 56°37'113"E 10.60'
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POCAHONTAS
PLACE
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GRAPMC SCALE — FM
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1173 Shiloh Church Rd, Hickory, NC 28601-7855 to 2056 Pocahontas PI Directions - M... Page 1 of 3
YOUR TRIP TO: MC'JCJG�
2056 Pocahontas PI
37 MIN 1 19.2 MI
Est. fuel cost: $1.77
Trip time based on traffic conditions as of 11:01 AM on April 20, 2017. Current Traffic: Light
https://www.mapquest.com/directions/list/2/us/north-carolina/hickory/28601-7855/1173-s... 4/20/2017
Start of next leg of route
It
1. Start out going southwest on Shiloh Church Rd toward Rosenbalm Ln.
Then 0.05 miles
0.05 total miles
TI_
2. Stay straight to go onto Hubbard Rd.
Then 0.62 miles
0.67 total miles
3. Tum right to stay on Hubbard Rd.
Hubbard Rd is just past Cook Ln.
If you are on Cemetery Loop and reach Doberman Ln you've gone a little too far.
Then 1.38 miles
2.04 total miles
,r
4. Hubbard Rd becomes [card Dam Rd.
Then 1.38 miles
3.42 total miles
5. Turn left onto Petra Mill Rd.
Then 0.88 miles
4.30 total miles
a
1 -
6. Turn right onto Rocky Mount Rd.
Then 0.02 miles
4.32 total miles
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7. Turn right onto Grace Chapel Rd.
Then 1.32 miles
5.65 total miles
41
9. Tum left onto Falls Ave.
Falls Ave is 0.1 miles past Hurricane Hill Rd.
Grace Chapel United Mthdst Chr is on the comer.
If you are on Grace Chapel Rd and reach Ike Starnes Rd you've gone about 0.5
miles too far.
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Fkoloi Na I
Then 3.58 miles •
9.23 total miles
9. Tum left onto S Main S1/US-321 Alt S.
S Main St is just past Dudley Aly.
If you are on Madison Ave and reach Midway St you've gone a little too far.
Then 0.10 miles
9.33 total miles
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10. Take the 1st right onto Duke St.
If you reach Stirling St you've gone about 0.1 miles too far.
Then 1.20 miles
10.52 total miles
,r
11. Duke St becomes W Caldwell Dr.
Then 0.03 miles
10.55 total miles
12. Tum right to stay on W Caldwell Dr.
W Caldwell Or is just past Hickory St.
ff you are on Church St and reach Park Ave you've gone a little too far.
Then 0.58 miles
11.12 total miles
,r
13. W Caldwell Or becomes Burke St.
Then 1.20 miles
12.32 total miles
,r
14. Burke St becomes Rhodhiss Rd.
Then 2.29 miles
14.61 total miles
https://www.mapquest.com/directions/list/2/us/north-carolina/hickory/28601-7855/1173-s... 4/20/2017

1173 Shiloh Church Rd, Hickory, NC 28601-7855
to 2056 Pocahontas PI Directions - M... Page 2 of 3
15. Tum slight right onto Oak Ridge Church Rd.
Oak Ridge Church Rd is 0.3 miles past Monteith in.
If you reach Icard School Rd you've gone about 0.3 miles too far.
Then 1.34 miles
15.95 total miles
16. Turn right onto Tomlinson Loop Consp.
Tomlinson Loop Consp is 0.1 miles past Shuffler St.
Then 0.48 miles
16.42 total miles
T17.
Tomlinson Loop Consp becomes Tomlinson Loop.
Then 0.38 miles
16.80 total miles
r+
18. Tum right.
0.2 miles past Spann Ave.
If you reach Paradise Harbor Dr you've gone a little too far.
Then 0.03 miles
16.83 total miles
a
1 -
19. Turn right onto E Paradise Harbor Dr.
Then 2.20 miles
19.03 total miles
20. Turn left onto Pegasus Dr.
Pegasus Dr is 0.3 miles past Cordova Dr.
If you reach Paso Fino Ln you've gone a little too far.
Then 0.08 miles
19.11 total miles
1
21. Take the 1st left onto Pocahontas PI.
If you reach the end of Pegasus Or you've gone a little too far.
Then 0.10 miles
19.21 total miles
0*
22. 2056 Pocahontas PI, Connelly Springs, NC 28612-8609, 2056 POCAHONTAS
PL is on the right.
Your destination is at the end of Pocahontas PI.
Use of directions and maps is subject to our Term, of Use. We don't guarantee accuracy, route conditions or usability. You assume all risk of use.
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Mountain View
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https://www.mapquest.com/directions/listl2/us/north-carolinalhickory/28601-7855/1173-s... 4/20/2017

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): tlsfiuZloe� —
�s_o.�
Owner/Agent's Signature* [15A NCAC 02H .0502(f)] Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
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S�YvJ✓I�' Lake
(At full Pond/ Normal Water level)
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Fl I 1_dNo
Full Pond/
Normal Water Level - >
Shoreline
sua`�a are -orrNe Theme' .,�, I'7�o �j uzx
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 plac.c f -h vc- the Full Pori / ” Orrnal 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