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Home My WebLink About20180531 Ver 1_Shoreline Stabilization_20180413201 80 53 1 State of North Carolina Department of Environment and Natural 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: Division of Water Resources 401 & Buffer Permitting Unit 1650 Mail Service Center Raleigh, NC 27699-1650 RECEIVED Applicant Information [15A NCAC 02H .0502(a)] APR 13 2018 Owner Information R-j�((ry Name: � f 17"r!kdG Mailing Address: 0 L, 700" Telephone Number:-60)—l(r(6 ( Fax Number: E-mail Address: ��GLC „ q , ; I(. GO, 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/reRdocs/Permits/SAMPLE AGENT AUTH ORIZATION FORM.pdf) must be attached if the Agent has signed this application form. Name: _ 9!5 j 'r) Company Affiliation: Mailing Address: Telephone Number: E-mail Address: Person to receive the Certification Approval: Fax Number: Project Information [15A NCAC 02H .0502(a) & (b)] 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, 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) FORM: SSGP 10-2013 Page 1 of 4 County: _ i� 4 Sly Nearest Town: )*yr— 11 111 V Subdivision name or site address (include phase/lot number): 5. Describe the existing land use or condition of the site at the time of this application (residential, undeveloped, etc.): I'd ew�� 6. Property size (acres): %/ A.c.r'L 7. Lake/ river/ ocean adjacent to property:L4 8. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or why it is necessary): S a -t L 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: / 4 5,9.f4-. 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: = -a . P—? - 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): , J jv L Owner nt's Sign CAC 02H .0502 f Date 'Agent's signature i valid only if an authorization letter from the owner is provided. FORM: SSGP 10-2013 Page 2 of 3 oosoJL� _'fir �.•�- � � �y ^� , ! WF - +„, ;�...T t! �. 'rte �'"� •+'� "`�'”' ..r�� - }� yam. ,',_. eek ,� `� ""n '_. '4g, •a ': s a f� Wyp.Y.N� - ,.,iwr `, W-1 Mz-..n. illi' `� � • � < +< t '�� y �' 'i �,4 t :�, �^i. '�•. .:ice �"�"� r ■ .�� r. ^'� � �* � ��_ F .. }'./�•; " �'�. .:'i� �� e.) � _ �� K'.r r jj,j .iii ; '. � • � .+ � � { _ 4; s •`rva s'r i, f ¢ s- 'tic � G... � ,, � .t i, .. 4k � �t,� ti � . �' '!'- � •f,=i -+t >k.w.,t - _+ ♦A '�a lel 4%. l.r,� `• �, rj �ia MAH 4.� s 1- 1 y 4 rs �P �v I .0 Full Pond/ Normal Water Level _ _.�-'¢,�i�oh • Z� Shoreline i jrt.e— Iz-ee)'V'4( Ltf -q Si�' ......................................... . ....... . , 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. 5. 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 • • t � ,� t d` r�� ,r. �'i` t°. fir, 1• 5�.�'� �; of ,a d`r f j 1. � / - Lt '4 .• - �, ' t `� N.S • � ;€' }. f ' �'�l� � *,,, �. '.' '•{:� : ��ddd��""" ��Sw.�c � ` c ,�i; +• .` ry _ a i a s ' . Y _e .�. t' -sem �S : �, ♦ F` f _ l '`4 ' rli, •.�� --i7' ��+.' - � - 'cv1 .y �v.6 � ��.r'�, {.."tTa �a- � .eQfi" ; �,, 1 f ,t � � '� :v- ' t • f � o �r �SIEpT�! [ � /j• ��fy! r,•N $' 6...Gr i '�- ��,� `� " �ti� r � �-t,•.q�{� -,. � � ', �i �x' i '� .� �� Z. Bio s r °�o"�'�y;a.'G' f,g s� �� ry. p e ♦'"i - -''. .: .. � fpr .•}�'"% } '7G { � .0 . � { +�.'G .. i �� 'Sr,'' l � ,'[��, �'„�� . � � ��g a. �4A�i•1 ak - � �# 0 a r wj M :row-„ro�e.yme, x MMv-A+.a.e�c: x M�+4 Q).r etl9rx r•Gamn [ovqGi-u: x hv,uon Cony GSAIS d wr %AAADURC IIIA I MCG IJ MINIMUM STANDARD OF 1:10,000 �—N 112 SF — SQUARE FEET IAB g9 X MB — MAP BOOK R/W — RIGHT OF WAY D DEED BOOK PC — PAGE SSE— SANITARY SEWER EASEMENT AC — ACRE WM — WATER METER CW _CRETE WALKWAY SIDEWALKCSW — CONCRETE 97— REAR D SANITARY SEWER MANHOLE FY — FRONT YARD NB — WATER SHED BUFFER MB —TOP OF BANK Mer. ��.� ��IIIIIIIp11111 A"N O y, , J CURVE TABLE CURVE LENGTH RADIUS BEARING CHORD Cl 67.67 525.00 N17'11'18' 67.62 LAKE �LEEVEL-FFULL I POND ELEV.589.4 DOCKII FULL POND �FlELD LOCATED I I _ I _ _ LOT 158 I MB 89 PO 112 I 1 ,Vl 1 1 N LOT 159 9. MB 89 PO 112 LIGHTHOUSE ROAD •'' 50' PUBLIC R/W Rte' SCALE : 1` � BO' O �80 120' BOUNDARY AND PHYSICAL SURVEY OF: 104 UGHTHOWE ROAD LOT 106 RIVERFRONT PARKWAY SUBDIVISION MB 59 PG 112 CURRENT OWNER REF: DB 4816 PG 1862 CITY OF MOUNT HOLLY, GASTON COUNTY, NC 0 1 Scala: 1` - 80' Dots: JANUARY 10, 2018 A M E s = som caAlo e—nwr. L 8T1BaFIEi,.D sic ee7w Too: 0.484 AC --- 19 -?0.232 SF TAX ID 3895E MB 59 PO j1; ------I E''' ---- ------ I�I EXISTING 12.9 I HW�04 LOT 181 I MB 59 PO 112 — RF�IS cow DOCKII FULL POND �FlELD LOCATED I I _ I _ _ LOT 158 I MB 89 PO 112 I 1 ,Vl 1 1 N LOT 159 9. MB 89 PO 112 LIGHTHOUSE ROAD •'' 50' PUBLIC R/W Rte' SCALE : 1` � BO' O �80 120' BOUNDARY AND PHYSICAL SURVEY OF: 104 UGHTHOWE ROAD LOT 106 RIVERFRONT PARKWAY SUBDIVISION MB 59 PG 112 CURRENT OWNER REF: DB 4816 PG 1862 CITY OF MOUNT HOLLY, GASTON COUNTY, NC 0 1 Scala: 1` - 80' Dots: JANUARY 10, 2018 A M E s = som caAlo e—nwr. L 8T1BaFIEi,.D sic ee7w Too: SAMPLE AGENT AUTHORIZATION FORM PROPERTY LEGAL DESCRIPTION: LOT NO. PLAN NO. PARCEL ID: ,� / S �� 515,lf4p STREET ADDRESS: '9(n,( howL I2�- Please print: �21--e0cl,Property Owner: Property Owner: The undersigned, registered property owners of the above noted property, do hereby authorize of 6 (Contracto�/Ag �nt) (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. Property Owner's Address (if different than property above): Telephone: 31 7 Z60 7- z/27 S We hereby certify the above information submitted in this application is true and accurate to the best of our knowledge. ::-- Authoriz gnature Date: o2,1—,C Authorized Signature Date: