20181045 Ver 1_Shoreline Stabilization_20180730

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources
FORM: SSGP 10-2013
Shoreline Stabilization Application �Fo�' I
110 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 2 0 1 8 1 0 4'5
Raleigh, NC 27699-1617 D
JUL 3 0 2018
I. Applicant Information [`5A NCAC 02H .0502(a)f
� �. ��rrtK h'tKMITTINC
1. Owner Information I
Name:
Mailing Address: 1i

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 properly (where work is to be conducted) ,
County: p A4 !A 114 6" Nearest Town:
Subdivision name or site address (include phase/lot number):
' n r
Directions to site - please include road names and numbers, landmarks, etc.:
q.
61
Latitude (indedmaiLongitude (dedmaidegrm).:A0. l���3PJSS�
5. Describe the existing land use or condition of they sItie atthe time of this application
(residential, undeveloped, etc.): a A%tot
6. Property size (acres):
7. Lake/ river/ ocean adjacent to property:
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): b�r1;
-- i 1 ?. - Q-- L- •-- I D
9. Will work be conducted from land? §er From water? ❑
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normalpool 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 I ke level/ Normal Water Level and 50 feet land -ward in
square feet or acres: • 03 (`lite°..
12. Please describe the vegetation above the normal pool lake level/ Normal W r Level and
50 feet landward to be impacted (number of trees, for instance):
WINAOr
Owner/Agent's Signature Printed Name Date
11Jt P A CAC 1."21.1
i": :SI.Y.L V.:_f 1
Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013
Page 2 of 3

Full Pond/
Norrnal Water Level
Shoreline
PC
a
CD3 �x 6'
La ke
(At Full Pond/ Normai Water Level)
--7 �p3
,00$o QO�vo�
pp o m0V9v 0p0(0,0v
b o p o t? o 0 4 0 a tgDtqe� D
0 00 VVIO to
p g p p O O D 0
o 0V 0.0
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

kan!v
Page 1 of 1
https://www.webgis.netlarcgislrest/directories/arcgisoutputfUtilitiesIPrintingTools_GPServerl ags_cfD7Ob00afa248ec95b52e85... 7/24/2018

Duke Energy
Progress, Inc.
Lake Tillery
NZ^ Lot 24
Plat Cabinet F
Slide 49—A
PIN 6575 14 42 2695
o;
D
ti� s • `�• Building
Pad
0.48 Acre* IQ/
10. &T/
Ns \O R/
•
Lot 22 NM
Plat Cabinet F
I Slide 49—A /
PIN 6575 18 42 1334
THIS DOCUMENT ORIGINALLY ISSUED AND SEALED By diARLES
R. STEPHENS, JR., NCPLS L-5143, ON JANUARY 167H, 2018.
7M ENEVRONIC MEDIA SHALL NOT BE CONSIDERED A
CERVIED OOCU MENt SEE THE PLAT FOR CER7NFICA7E AND
SEAL
I certify that this map was drawn by me from an actual
survey made by me (deed description recorded in Book 796.
page 321); that the boundaries not surveyed are indicated
by •, and drawn from information in Plat Cabinet F 49—A;
that the ratio of precision or positional accuracy is
1:10,000'+; and that this map meets the requirements of
The Standards of Practice for Land Surveying in North
Carolina (21 NCAC 56.1600). This 16th day of January, 2018.
C" 1e //,b -�!d
Charles R. Stephens, 111 N L -5143A i�������'',,,•''
ESS,,77QZ-
SEAL r
z� L-5143 0
s )!%in /A 7 �V
NOTES:
'
c°J
v
OWNERS
Pail T. Childress d: Wife,
Brooke Y. Childress
D8 796; PG 321
Lot 23
Plat Cabinet F
Slide 49—A
PIN 6575 18 42 1486
1. A North Carolina Geodetic Monument was not found within
2000'.
2. Property shown hereon is subject to all Rights—of—Way,
Easements, and Restrictions of Record.
3. This Survey does not represent a Title Search by this Firm.
Boundary information is based on deeds. maps of record.
and a field survey by this firm.
4. This map is NOT FOR RECORDATION.
5. Underground 01111:16% % talks. and or lines not surveyed
unless noted otherwise.
6. All distances shown an this survey are horizontal ground
distances, unless shown otherwise.
7. All areas computed by coordinate method.
GRAPHIC SCALE
6o 0 30 60 120
.( IN FEET )
1 inch =60 ft.

' r��. ; �� � �` � f+,� t�� it`s ., �"�fl�i�f �• / `�+�j-r+� •rr;w ''.
Ar
of
tjEf Y 4
ap
r
�+�ft. �,, 1�: Ir F�� h1��S19Qn'�1 f.� {� ��r,.�j`'x"�D�, •.a'.. ' -`^� ---�..
j y "'� Qtr,

W�W