20170671 Ver 1_Shoreline Stabilization_20170530

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
Three copies of the application (including attachments) and the application fee should be sent
to:Q V I
Division of Water Resources D D
401 & Buffer Permitting Unit
1617 Mail Service Center roti t- MAY
Raleigh, NC 27699-1617 WA RE S
_., ��au�i►41bS
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: Scott A & Maria Lynn Sherrill
Mailing Address: 1360 Winged Foot Drive 2 0 7 0 6 7
Denver, NC 28037
Telephone Number: 704-677-8473 Fax Number:
E-mail Address: [e-mail]
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:
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Person to receive the Certification Approval:
Fax Number:
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 3

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: Stanly Nearest Town: Norwood
Subdivision name or site address (include phase/lot number):
Edgewater on Lake Tillery — Phase 1— Lot 58
Directions to site - please include road names and numbers, landmarks, etc.:
From Highway 52 in Albemarle — Head to Norwood on Hwy 52. Turn Right onto
Bowers Road. Go to SS. Turn left onto Indian Mound Road. Then in app 1 mile turn right
onto Randalls Church Road. Then turn left into the Edgewater Development. Turn at the
3!" road on the right then left onto Timber Way. Property is the first on the right.
Latitude (in decimal degrees) 35.278643 Longitude (decimal degrees) -80.096903
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): developing residential
6. Property size (acres): .78 acres
7. Lake/ river/ ocean adjacent to property: Lake Tillery
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary: Proposing to build sea wall and new boathouse and pier
9. Will work be conducted from land? M 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:
222' of shoreline x 10' below full pond is 2220 sq. 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: 222' of shoreline x 12' above full pond is 2664 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): Normal
A L4� al
A��V . 5-
Owner/Agent's Signature' [ 1_`)A NCAC 0,21-1 .05C2101 Date
bY4444 Z&
Owner/Agent's Signature' [1'DA_NCAC 02H .0502(f� Date
FORM: SSGP 10-2013 Page 2 of 3

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BOOK 25PAGE72(1) 385891
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Plat of Property Surveyed For.
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Edge Water Developers, Inc.
P.O. Boz 4127 / WilmhWton, NC 28406
a trwaao E Center Twsp., Stanly County, N.C.
r�iaswr 7ra.aae.r.rtreb. For Reference See:
a y'�t�1DQ
Ctsttasat D.B. 1225, PG. 102 /PIN: 6575-01-17-8235
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roes 1r62 -4T 6 asr- 11 s D.tr. 11/16/26 - Dew. Dr. Kid . Pao a: 17616

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SHERRILL RESIDENCE S.J.SMITI-I
LOT 58 — EDGEWATER ON LAKE TILLERY NRWOOD, NORTH CAROLINA
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