20171033 Ver 1_Shoreline Stabilization_20170817

State of North Carolina
Department of Environment and Natural Resources
N, C_ Division of Water Resources
Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
ENVIRONMENTAL QUALITY FORM: SSGP 02-2017
Shoreline Stabilization Application Form "171033
Three copies of the application (including attachments) and the application fee should be sent to:
If sending via US Postal Service If sending via delivery service (UPS, FedEx, etc.)
Karen Higgins Karen Higgins
DWR — 401 & Buffer Permitting Branch DWR — 401 & Buffer Permitting Branch
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC 27699-1617 Raleigh, NC 27604
A. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: BEATY KATHRYN W TRUST cS'J0
Mailing Address: Wells Fargo Bank, NA, Executer of Estate of Kathryn Bea�}t19'�
401 S. Tryon St., Charlotte NC 28202 2"d FI D1050-026
Susan W Causey, VP�li�
Telephone Number: 704-383-9077 Fax Number: Tic
E-mail Address: [e-mail]
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter must be attached if the Agent has
signed this application form. (A form can be downloaded here:
http•//www saw usace army.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf)
Name: Robert L. Morgan Jr
Company Affiliation:
Mailing Address:
Telephone Number
E-mail Address:
4110 Little Tree Ln
Denver NC 28037
704.607.4438 Fax Number:
rlmorgan*[e-mail]
B. 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. Vicinity map attached.
2. Provide a detailed site plan showing property boundaries and proposed locations of
vegetation clearing, buildings, retaining walls, docks, impervious surfaces, 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. Site plan
attached,
FORM: SSGP 02-2017 Page 1 of 7

3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale of
some sort- a yard stick, shovel handle, etc.) Picture attached
4. Location of the property (where work is to be conducted)
County: Lincoln Co. Nearest Town: Denver
Lake/ river/ ocean adjacent to property: Lake Norman
Property size (acres): .48 acres
Subdivision name or site address (include phase/lot number):
Westport - Lot 161 & PT 160 Island View Ct
Directions to site - please include road names and numbers, landmarks, etc.: NC -16 Business in
Denver NC; West on Lake Shore Rd S; .Smi turn left to stay on Lake Shore Rd S; .8 mi turn right
on Island View Ct; 4th lot on the right
Latitude (in decimal degrees) 35.496375259 Longitude (decimal degrees) -80.975844992
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): undeveloped vacant lot in residential neighborhood
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): lot has been undeveloped: a new residence is now planned
for the site; existing shoreline is showing signs of moderate to severe undercutting and
erosion; and, needs stabilization by applying fabric and rip -rap; see attached.
7. Will work be conducted from land? X & Frere+-wateF? 19
8. Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent Impacts (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
500 soft
Temporary impacts in square feet:
500 salt
9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet
land -ward
Permanent impacts (including back fill, excavation, rip rap, retaining walls, etc.) in square feet:
500 salt
Temporary impacts (temporary clearing, construction corridor) in square feet:
500 soft
10. 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): Treed with undergrowth...
Eleven pine trees and small vegetation will be removed to provide work access for
stabilization. Tree removal will be minimized and shoreline stabilization will be performed
in keeping with Shoreline Management Best Management Practices.
FORM: SSGP 02-2017 Page 2 of 7

11. Signature
s _%4 -z7
Owner/Agent's Signature' A AC 02H .0502(f)j Date
'Agent's signature is valid only if a uthorization lette rom the owner is provided.
cq44az, )A
12. Please approximately sketch the following information on this plan and Jrovide dimensions for
each item:
a. All proposed vegetation clearing
b. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
c. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
d. Location of any proposed structures such as buildings, retaining walls, docks, etc.
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
FORM: SSGP 02-2017 Page 3 of 7

Gtl
Island Vl6`� I
Farcel lID
4614119525
Site flan
Island view Gt
Denver, NG 28031
FORM: SSGP 02-2017 Page 4 of 7

4.i'
21
21
ark
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.dd I
width
,h
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below full
Fu"ems
m
Full. and Water Level
r 3 �► �a rip -rap
Section View
FORM: SSGP 02-2017 Page 5 of 7

Vicinity Map
Aerial View
FORM: SSGP 02-2017 Page 6 of 7

FORM: SSGP 02-2017 Page 7 of 7

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 161 & PT 160 PLAN NO. PARCEL ID:
STREET ADDRESS:
29552
Island View Ct. in Westport subdivision in Denver NC
Please pint W PAS, P
Property Owner . - ;
V.00 A kzt,, SA-ec %;�� aQ C A�&
.�..
The undersigned, registered property owners of the above noted property, do hereby authorize
Robert L. Morgan, Jr. of
(Contractor / Agent) ,
(Name of consulting firm)
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.
owner's, ddress (if rA15-1t ��G� property than � \0*- Q
., .1 �G , ndr,r _� n CO., - r', 'L In --
Telephone: 7 0 4- 3 'q,' 3 -9VU 71 S0-5 a+) (:pu�S.w�
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
jj�orized Signature Authorized Signature
Dane: � Z 0 7 Date: