20171130 Ver 1_Shoreline Stabilization_20170906

2 p 1 7 1 1 3 0 State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
ixvisioa of Water Resources FORM: SSCP 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
Applicant Information
1. Owner 1
Name:
Mailing
2
Telephone Number: rax vuEnoer:
E-mail Address:
Agent/ Contact Person nformati n
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
) must be attached if the Agent has signed this application form.
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Person to receive the Certification Approval:
II. Project Information
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 yardstick, shovel handle, etc.)
4. Location of the grope (where work is to be conducted)
County: �� — Nearest Town:
Subd'nri ion name or site add ss (include phas t nu er
IJO
Directions to site - please include narpes art' numbers, landmarks, etc.:
JC le
77
Latitude (in dedmaidegrees;,'L&� !SL&"7 Longrkude (dedmaidegrees)i���'
S. Describe the existing land use or condition of t sat-the time of this application
(residential, undeveloped, etc.):
6. Property size (acres): • �-r /��/'�s
7. Lake/ river/ ocean adjacent to property:
8. Describe proposed work (include discu ion ass how hard r of shor line has been
r why it is necessary):
,� /off
avoided, o y rY
9. Will work be conducted from land? 9K"- From water? ❑
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining wails, etc.)
below the normal pool lake level/ Normal Wa r 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 Lev I and 50 feet land -ward in
square feet or acres: S a
12. Please describe the vegetation above the normal poo lake level/ Normal Water Level and
50 feet lan and to be impacted (number of trees, for insta ce):
Owner/Agent's Signature Printed Name Date
Agent's signature is valid only yon authanzation leiter from the owner is provided
Page 2 of 3
FORM: SSGP 10-2013

Full Pond/
(Norma} ;water Level
Shoreline
� t
Le ke
jA—Fui4 Pondf Mornal IMater
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.
S. 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

NOTES:
9 GRAPHIC SCALE 1. TRAVERSE ADJUSTED BY THE COMPASS RULE
PNCY "AT RD j I ADJUSTMENT METHOD.
m o n m Na Im
2AREAS DETERMINED 8V COORDINATE COMPUTATION
3. ALL DISTANCE ARE HORIZONTAL GROUND DISTANCESI -NEW .
4, NO GEODETIC MONUMENTS FOUND WTNIN 2000'.
( 1N FEET) S. AN 8' UTILITY EASEMENT FOR THE
$ 1 InchDO f4 & MAINTENANCE WILL PURPOSES 13F T RUN ALONG INTERIOR
NRT Tdi SITE CURVE TABLE PROPERTY LINES OF NEW TRACTS.
L2 6. ALL SIP'S ARE /4 REBAR UNLESS OTHERWISE
- - CURVE LENGTH RADIUS CHORD CHORD BEARING NOTED.
C11 284.421 207,52262.67 N26'2T47'E REFERENCES:
VICINITY MAP (n . t, $,) C2 37,99 50.00 37.08 N8T29.43'E OG; c 1. DEEDS AND TAX MAPS SHOWN HEREON
C31 77,35 50.00 69.86 S6S'00'49'W Lc�2
CSI 53.69 252.50 53.59 N07.12'01'E O C 4
• This PNeM of land doe[ rat Ile within a Rater supply Watershed OAwrloy Caning district CS 79.89 25250 79,56 N22121'23'E
-1111ld Enmpt
Date
mz�
atenn Administrator
i>�,roos, y nw not seen ---by me 11-11 County Hearn LINE TABLE
LINE LENGTH BEARING S12'46'46'E
nvaonm I*l Health SpecmR4t Goa LI 88.45 S65'43'47'w 22'
L2 92.34 N65.43'47'E 1�
L3 83.22 S65.43'47'w
L4 67,53 S85.37'20'W :J:R
State of North Corolmc L5 20,53 N72.OD'53'WIP� 1 ' REMAINDER LOT B
c-Tty of Mainly L6 20.02 S74'56'45'W / G' _ EIP/ 0.21 ACRES
I, Rerlew Office of Stanly County, aertlly that the mop of plot, to L7 SL63 S73.0T11'W / 'I ' 79 0 22�E 9,058 SF
nnkn InM eertllkau N ameee, msec al CtetutN requirements for reaaMn L8 A.
N71.59'02'W
ro
v/
aew er o • j ®IP._
,,�V I A ur.v Tert. CAlCCIvllBos SOI'
QF1?ItC B 9bse
Plot approved by the Steely County PlonninR Board �. CL Elpl�l SIP .95'
aU d elan Admrls rota E1P4S �6 REBAR
�2,�/" r� S01'14'02'W
�i 3 5p� 16 aHs� �� / �� EREC RECOMBINE LOT H! REBAR j �8 IP 003DACRES
S 0.71'
SIP % / AeGDbCury Y IN TAKEN
44 RE BAR f FROM LOT B
Certificate of Ownership and Dedication !), .� REMAINDER LOT J / h�
S01.14'0 '
N60'41'97'E �2�r= v 0.87 ACRES / dd 42,53'
I herby certify that am the owner of the Property shown and described hereon, 5. Or X 37,779 SF EIP
whkh U located M the subdivision jurisdiction of the County of the Stanly and EIP �y0 EIP
that hereby adopt this plan of subElMsion with my Ire* consent. 9 J - , i
E]
oLD H
p(lpPERTY
-'/ LINE fV, �\. j�i1 f 1V 1
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�� sa SIH sees ' P
;o
\64REBAR
SIP
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6 SF �l /"� ' 4L� ,��4• / /J' G�
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RECOMBINE LOT I G tse S' u; % W
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39,000 SF `/ ,:1tPDIN W 045 Q,9 Q
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137 2L'•I✓ i
THE �PUBTHE OT FOULINGTHIOT I R 7LOT 3
0 RCIOCATC THE COYWN PROPERTY LINE ^ / 08229ESACRES TO BE TAKENTMIN LOT l AND BECOME= W71TI LOT I FOR A
/OAACRCAOH Orwo.90 ACRES
�E1P� TTL I
11 RELOCATE TIR CANYON PROPERTY WIC
BETWEEN / AND LOT 5
0.03 ACRES BE TTAIRNFOUDMTPROY IAT J AND RECOMBINE WrTH tA'T 1 TOB A
TOTAL ACREAGE OFAMAIG ACRES
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ACTIAL OML'LY YADC Ne1G LRE
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MM[O MT NAND AND anWL K.1 Mf Nn DAY ar WAY, =1 TIE
Ai RM WI) 0 OsssM cavi M Iu DualWm) ! 20016 SILVER RD. OAKBORO, NORTH CAROLINA 26129
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(B) SANITARY RKA IWPfOL[ PHONE:[phone]
• Ap,wDOJr Lw F a® pR NAr
Tor OF WARM low") X NO POINTS FOUND OR SET DATE: MAY 9th 2017
LAOS War NRnC1(a i SCALE: 1'-SD'
POWER MES
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