20181072 Ver 1_Shoreline Stabilization_20180801

State of North Carolina
Department of Environment and Natural Resources
DW.R Division of Water Resources
Dlvlslon of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 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
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
2
Name:
Mailing
PAIL
20181072
Telephone Number: Fax Number:
E-mail Address: �C',wU Gt I�Y15u1brWl @ ciulce
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/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION-FFORM.0 ) must be attached if the Agent has signed this application form.
Name: ,) I�(YImu A AvI�( bn car -
Company Affiliation: SK/ Lli:? Gi(� . _TJ)G�
Mailing Address: 113 - I If- &e,231A SE
Telephone Number: M -3)2 -)q -5q Fax Number:
E-mail Address: �IIYY) YY A lA) o04fe Si 1
Person to receive the Certification Approval:
01.2418
Project Information [15A NCAC 02H .0502(a) & (b)] 401
B
Attach a vicinity map (i.e. street map) clearly showing the location of the property P R UR E
respect to local landmarks such as towns, rivers, and roads.
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 yard stick, shovel handle, etc.)
4. Location of the property (where work is to be conducted)
County: 1 _0ayol Nearest Town: GYA,f k;T• A1S
Subdivision name or site address (include phase/lot number):"em-li `DYl - Imo_
t,Y1 j1'1sW Q .'l` Ve,
Directions to site - please include road names and numbers, landmarks, etc.:
Latitude (in decimal degreesi35, o b 2- Longitude (decimal degrees) `9 1 1 332869
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): J2,, it P.bFW(
6. Property size (acres): l r 0 (e It 115L0,9
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):
9. Will work be conducted from land? X 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: _132-3-7F 54E (flag e 5-00 SE
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):
00-mtt c -fvtr-s oaotvx-qua G�j �i ✓w.�� i 15�,l;1 5�►^�c S�titr, it �%(v L
r_&V1SLNcIf P LS
(AAA,,t�wa_ q i21
Owner/Agent's Sin uret [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

`'sem
6x
IL&
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

YOUR TRIP TO:
Granite Falls, NC
13 MIN 1 7.1 MI >�
Est. fuel cost: $0.75
Trip time based on traffic conditions as of 9:06 AM on July Print a full health report of your car with
30, 2018. Current Traffic: Light �9 HUM vehicle diagnostics (800) go6-2501
O1. Start outgoing north on Peninsula Dr toward Plantation Pointe Dr.
Then 0.02 miles
2. Take the 1st left onto Plantation Pointe Dr.
If you reach the end of Peninsula Dr you've gone a little too far.
Then 1.27 miles
3. Turn left onto Lovelady Dr.
Lovelady Dr is 0.6 miles past Pier Point Dr.
Then 0.14 miles
4. Turn right onto Rocky Mount Rd.
Then 0.71 miles
r+ 5. Turn right onto Grace Chapel Rd.
Then 1.32 miles
6. Turn left onto Falls Ave.
Falls Ave is 0.1 miles past Hurricane Hill Rd.
Grace Chapel United Mthdst Chr is on the corner.
If you are on Grace Chapel Rd and reach Ike Starnes Rd you've gone about 0.5
miles too far.
Then 3.58 miles
4 7. Granite Falls, NC, Welcome to GRANITE FALLS, NC.
W. Your destination is just past Dudley Aly.
If you are on Madison Ave and reach Midway St you've gone a little too far.
0.02 total miles
1.29 total miles
1.44 total miles
2.15 total miles
3.47 total miles
7.05 total miles
Use of directions and maps is subject to our Terms of Use. We don't guarantee accuracy, route conditions or usability. You assume all risk
of use.

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vim HICKORY
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BOOK 19 PAGE 415
LOT 38 PLANTATION POINTE
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TERRY LYNN AINSWORTH
LAM "ExcIft
LOVELADY TOWNSHIP CALDWELL COUNTY, N.C.
VICINITY MAP
DATE: AUGUST 12, 2016 SCALE: 1' - 30'
TAX MAP: 08 147 1 38
PIN Al 3705842399
DEED REFERENCE: BOOK 1835 PAGE 1019
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REFERENCE: LOT 38 'PLANTATION POINTE'
PLAT BOOK 19 PAGE 416
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