20171141 Ver 1_Shoreline Stabilization_20170907

State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
Division of Water Resources ISA NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 30-2013
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 Mail Service Center
Raleigh, NC 27699-1650
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Infnrmatinn
Name:
Mailing
Telephone Number:` UA -34\ $y`\-� Fax Number:
E-mail Address: n A.1'(
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/reeulatory/reedocs/Permits/SAMPLE AGENT AUTH
ORIZATION FOR�M.0df) must be attached if the Agent has signed this application form.
Name:K
Company Affiliation:
Mailing Address:
Telephone Number: `'S \A\ 67_� Fax Number:
E-mail Address: Vx-<NV. - e�5 p�Xv m
Person to receive the Certification Approval: ' r7Nyre__�
II. Project Information [15A NCAC 02H .0502(a) & (b)1
I. 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 Pagel 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 sort- a yard stick, shovel handle, etc.)
4. Location of the property (where work is to be conducted)
County: �a-5r Nearest Town:
Subdivision name or site address (include phase/lot number): �\
rctca©-\\-- (ti1k-� -M
Directions to site - please include road names and numbers, landmarks etc.:
5. Describe the existing land ue or condition of the site at the time of this application
(residential, undeveloped, etc.): '
6. Property size (acres): \ "_-� p r!,-4,
7. Lake/ river/ ocean adjacent to property: \►�C'rc.
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary),\
9. Will work be conducted from land? ❑ 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:
-o
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: �U� X 'A _ 1-\b<\ % .3Q •fir
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):
QCX'\u o� \e-�'S 1��1\yerc,E,v+e ri
Owner gent's Signature. [15A NCAC 02H .0502(f)] Date
Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013
Page 2 of 3

F
Norm
E
Lake
(At Full Pond/ Normal Water level)
Please approximately sketch the following information on this plan (Provide dimensions for each
item, such as 10 ftx 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.
5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
FORM: SSG 10-2013
Svc. '�V'c..,K•c�, W�� = �tc� `J���
Page 3 of 3
9

VICINITY MAP (NOT TO SCALE)
F#F JACIOE WILSON
REESE TAXMAP#1084IX3-02
WILSON 06:2319. PG: 0098
ROAD FOUND
RR 8P�
FOUND
ssRH�AR ��
IiR EBAR
94 FOUND
FORMERLY 05 REBAR
JOHN W. GOINS—
TAX MAP 1 FOUFO •S�
0108008-00 16A®Mt '�
DB: 1276, PG., 0250
SET
e A5 REEW
zR
DISTANCE
J/
NIF BRIAN 6 TRACEY BUZZED
N 10'10'30• E
TAX MAP #108014-03
L2
DB: 4070, PG. 1834 1
42.46'
w
N 55.14'53' E
19.82'
L4
LOT 43 q
30.22'
1.42 ACRES Ff- CROS. Fa'
S 28'4658' W
A PORTION OF
b
L6
TAX MAP #108008-00
9.61 '
08:1276. PG: 0250.
N 39'55'30' W
TAX MAP 0108414-M
L8
DB: 2928. PG: 0040, d
4
TAX MAP 010800804
n
0 '
D8: 2066, PG: 0930
7
N 01'39"" E
53.04'
PPE
N 01.45'53' W
9.84'
L12
\
52.97'
NIF BRIAN 6 TRACEY BUZZEO
L°
_
TAX MAP 0108-010-00
Ji
L14
DB: 4070. PG: 1834
�\
44.25'
L15
N 36'55'38' W
10.59'
L16
$'
\ \ zl
FOUND
05 REBAR
L17
N 66.4220• W
21.63'
L18
POT
677REBAR \POINT POWT
v,
e
4i
SET
a
rsARNT'a
• W ■ 1 1 • •. FORMERLY JOHN F. GOMS 6 PONT
• i7'1 C4p�� •• BEVERLY W. GOOVS 7 `
• ./ • TAX MAP #108-01400 FO#tf
40•* ESS '• ;SOF (0, DB: 2928. PG: 0040 I�
L-3341 ► H.
✓E7TER p
�•118�
GENERAL NOTES:
1. IIEiSURBIENTS ON THIS WP ARE IN FEES AND OE=Lgs 7HEREOF.
2 ALL SET CORNERS ARE 5/8' REHAR UILM MERWISE NOTED.
3. THIS 5 A PIAT OF AN CORM PARCEL OF LAND.
4. THIS PUT 6 SUBJECT TO ANY EASOAEP(M K6E DM'I M OR R GHM-OF-WAY
OF RECORD PIHIOR TO DATE OF 7HIS PUT. WHICH WAS NOT VISIBLE AT THE
TOE OF OUR SURVEY.
5. NO NODS MOfAA1pR WHIN 20DO FEET.
REFERENCES
1. AS SHOWN
NOTE
7HIS SURVEY NOT AMENDED TD
MEET 6547-30 REOUHNNIEJTS.
THIS SURVEY WAS PERFORMED PER
THE STANDARDS OF PRACDCE FOR
LAID SURVE'YM IN NORTH
CAROLINA WITH AN ERROR OF
CLOSURE IN EXCESS OF 1:10,000.
REVISED 2
SURVEYED 1)5 19 09 SCALE 1' n 100'
100' 00 100 200'
NUMBER DIRECTION
DISTANCE
L7
N 10'10'30• E
11.24'
L2
S 36'2515 E
42.46'
L3
N 55.14'53' E
19.82'
L4
S61'1345'E
30.22'
L5
S 28'4658' W
69.93'
L6
S 42'114T W
9.61 '
L7
N 39'55'30' W
69.86'
L8
S 61'37'33• W
82.64'
L9
N 89'29'16' W
34.40'
1-10
N 01'39"" E
53.04'
L11
N 01.45'53' W
9.84'
L12
N 23'4473' E
52.97'
L13
S 74.5758' W
24.54'
L14
N 72'0372' W
44.25'
L15
N 36'55'38' W
10.59'
L16
S 89.03'43' W
38.66'
L17
N 66.4220• W
21.63'
L18
N 13'50119' W
10.12'
L19
N 79'2715' W
22-11'
L20
N 70'1T45' W
50.52'
L22
N28'38'51'E
39.99'
L23
N28'5T49'E
29.94'
NIF ANDREW 6 BETH HORSLEY
FORMERLY TAX MAP #108408-05
JOHN W. GOINS DB: 4268, PG: 0823
TAX MAP 0108408-04
DB: 2866. PG: 0930
LOT #2
1.13 ACRES r]_ CRDS.
F A PORTION OF
TAX MAP #108-00802
FOUND DB: 1782, PG: 0308,
/. PPE TAX MAP #108-01400
y FOUND 06: 2928, PG: 0040, &
94 R3M TAX MAP #10840604
\ D8: 2056, PG: 0980
o \
umx
aF+� jm l�RtCpytiDp�
«�
'@� V: LarrBlbw�
�t! Pope
BET
sir °d a t15RE8
RmAR OT #/
1.1� N-CRDSx
A PORTION OF •8a`o 0• 1
TAX MAR #106006-02
D@ 177i2,'RG: 03058
TAX MAPA"a"14.00 UOWyPds �
DB: 2928, FO. $)DAO
tTr FORMERLY JOHN F. GOI1,
... \ �'/Y W. GOINS
#5R®IW/ TAX MAP NIOSO0602
F D6: 1782. PG: 0306
SUBDIVISION SURVEY FOR
GOINS PROPERTY
REESE WILSON ROAD
GASTON COUNTY \ CITY OF BELMONT \ NORTH CAROLINA
PROFfssi
DPOGRAPHIC MAPS A.
OUTS SURVEYS PHOTO CONTROL SURVEYS
UBOIVISNS �� CONSTRUCTION SURVEYS
TE PLANS BOUNDARY SURVEYS
v PHYSICAL SURVEYS
'y0 SU RV
P.D. BOX 1512. FORT MLI- Sc 29716 [phone] FAX (B03) 547-07M
P-VC01E131K0E13. DWG JCB

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8/15/2017 500 Reese Wilson Rd - Google Maps
Go gle Maps 500 Reese Wilson Rd
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Map data @2017 Google United States 500 ft - I
500 Reese Wilson Rd
Belmont, NC 28012
https://www.google.com/maps/place/500+Reese+Wilson+Rd,+Belmont,+NC+28012/@35.163013,-81.0090264,16zldata=!4m5!3m4! 1 sOx8856973f9f53... 1/1