20171327 Ver 1_Shoreline Stabilization_20171016

Friday, August 18, 2017
Division of Water Quality
Wetlands Unit
Parkview Bldg., 2321 Crabtree Blvd.
Raleigh, NC 27604
To whom it may concern:
2p�?,3
2T
OCT
162017
Kim Broome of Dock Masters Marine Construction of Lake Wylie, LLC, Is acting on my
behalf and has full signatory authorization for the purposes of obtaining the necessary
permits for shoreline stabilization.
Mi ael Boughman

State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
Shoreline Stabilization Application Form
Four copies of the application (including attachments) and the application fee should be sent to:
1
Division of Water Resources
401 & Buffer Permitting Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Applicant Information [15A NCAC 02H .0502(a)]
Owner
Name:
Mailing
Oct
Telephone Number:�-11��j-u�'�D Fax Number:
E-mail Address:,CY�cx_�
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.miI/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION F RM. df) must be attached if the Agent has signed this application form.
Name:
Company Affiliation: -4s MCI,�--�
Mailing Address: Z .
Telephone Number:`Fax Number:
E-mail Address:
Person to receive the Certification Approval:C
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 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 cond euc�t d)
County: Nearest Town: r
Subdivision name or site address (include phase/lot number):"� �tee_Zetyc
5
Directions to site - please include road names and numbers, landmarks, etc.:��
`aC-�►1� \f Ertl�K Ca,�1 X10 )Aerr ,4 hciyc\
Describe the existing land us or condition of the site at the time of this application
(residential, undeveloped, etc.):�C�er►ta\
6. Property size (acres): cel. XUe1. SAC`r�'`
7. Lake/ river/ ocean adjacent to property: L--'Cx�.
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): pp
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:
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: ZAP X. ; 3
12. Please describe the vegetation above the normal pool lake level4 NJgr nal Water Level and
50 feet landward to be impacted (number of trees, for instance)e;,>
�rrvv est, v .Z
g-
Owner/ ent's Signature* [15A NCAC 02H .0502(f)l Date
Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

FI
Normi
5
Lake
(At Full Pond/ Normal Water Level)
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10ftx 100ft)*:
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
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FORM: SSGP 10-2013 Page 3 of 3

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201 Meet Second Avenue Gastonia, NC 28032
Phone: [phone] a 704-884-9007 • Fax 70"54-9328
I.
BOUNDARY SURVEY
OF
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MICHAEL BOUGHMAN
SOUTH POINT TOWNSHIP
GASTON COUNTY, N.C.
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