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Home My WebLink About20181105 Ver 1_Shoreline Stabilization_201808072 0 1 8 1 1 05 State of North Carolina -� - &y, �+;� vcNa. uncna v. a.n�n vnu.cna c....... .................... ...... a Division of Water Resources 15A NCAC 02H .0500 —Water Quality Certification, Shoreline Stabilization Division of Water Resources FORM: SSGP 10-2013 Shoreline Stabilization Application Form w -kA a P. 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 PAUG Raleigh, NC 27699-1617 d 7 2018 1. Applicant Information [15A NCAC 02H .0502(a)] 1. Owner Information 2. Mailing Address: �601 • Telephone Number: 7-23' Jie3- &CXR Fax Number: XIXG E-mail Address: ZI25/l. <n in 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/regdocs/Permits/SAMPLE AGENT AUTH ORIZATION FORM.pdf) must be attached if the Agent has signed this application form. Name: ef 111109 Company Affiliation: Mailing Address: �.r�rGL O Gf/1 /Z,% 2 --,?723 Telephone Number: 6&K -7GI E-mail Address: rC�'1' Person to receive the Certification Fax Number: ZZ19 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 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: JCfG�,D✓1 Nearest Town: AGlr�SE�E Subdivision name or site address (include phase/lot number): Directions to site - please include road names and numbers, landmarks, etc.: Latitude (in decimal degrees) _ ��L l G Longitude (decimal degrees) �O 3. U 70 6- 5. Describe the existing land use or condition of the site at the time of this application (residential, undeveloped, etc.): ?gf]5ZV l 6. Property size (acres): 6.,'— 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? P_ 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: �Z,5 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: lis5 12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and 50 feet landward to be impa+/cited (number of trees, for instance): 61/ J Owner/Agent'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 SAMPLE AGENT AUTHORIZATION FORM PROPERTY LEGAL DESCRIPTION: 7 PARCEL ID: LOT NO. PLAN N0. I � t�C �� - �blY� STREET ADDRESS: Please print: Properly Owner: Property Owner: The undersigned, regMered property owners of the above noted property, do hereby authorize (Contractor / Agent) (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: We hereby certify the above information submitted in this application is true and accurate to the best of our knowledge. 'l Authorized Signature Authorized Signature Date: %j` / Date: 1S��l� l X Full Pond/ NormamZ��I Shoreline agAr� Lake (At Full Pond/ Normal Water Level) s` C01 .51r- l67,7D1V �QCC�SS Please approximately sketch the following information on this plan (provide dimensions for each item, such os 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`�i� ` !i ;;�/; _ :'f �' �-i Lit^1--- a,- �.Y _,�._ �. ; _ _. �. t � / ` 7 ��;/ ,� s � �., , � �, w. � � 0 I °� ' �i' F., _ � , c��i�'�.f l %I �s # % yam;.: f ' ,r v. x LEGEND These standard symbols will be found in the drawing. 0 Reber Found S 14 Rebar Sot O Utilities 6 Point Not Set 0 Nail Found v Magnail Set E Pipe Found a Concrete Monument Found d Crimped Pipe Found - Tree (Diameter in inches) 0 Aluminum Monument Found P Angle Iron Found - Night of way line — Creek - - -- - - Utility Lines -..__.... ,-_.._._. Fence W� Gravel Road Paved Road Jones 1132/152 'v `' CAE f7 S cP SEAL =r L-41266 LI f Z W 21 State of North Carolina, County of Jackson. Notes: ,. 1�41mr_IR�J[I' 1. This survey creates n subdivision of land within an Ite::Cc: Lff:CCr Wt uI Uao Cuuuty LhaL l:as all ordiueuce ilei rtif of �ac$:.un Coun!y, cey that 11, plaL Lu regulates parcels of lend. which this certification is affixed meets all 2. There are no recoverable horizontal control st ry requlrn eats for recording, monuments within 2000 feet of this properly. The owner at the time of survey is Rudman. o p Review Officer Date C' n` L7 U A m A us'' Lft 6 127 i � 4Z0 awe deaf � 4� 1� op �o v° �e yS 0 Cop ytiR 44 th`o� 50.0'' L9. IAo / Z' Qua Ro, h nope/ i roe 0 W V. nt a 0.63 ACRES moi rma o ` O 2. O / m �iP. °)~ ,oy 13ti' e• 9 u1 oa io m A •_, m cliN 10 o;16 0 166 ACRES %m 6 N , \ va 0 59 ACRES 0.55 ACRES 0.5 C - f. 0.63 C S v amu'. Nps , o p The Remainder o1 ;N 03'11'37' RN 03'54'43' E Rudman 1174/433 I {y0 00 112.40' N 02'20'30" E 4 95.62' 114.94, N 03.11'29' E �p 13 4.73 D e Plat for Keith Rudman Date f0 Lots on Bear Lake Drawing # Surveyed to 590 A 0.62 ACRES c River evis.ion Date r �f Township -- �o � None Clark Lipkin, PLS North Carolina Lipkin Land Survey�ny, I . P.O. Box 368 Tuckaae lee, NC 28783 (828293-3030 Scale Sheet �� 1 of 1 W� oState o 0.67 ACRES Certificate of Approval for Recording Clark Lipkin, certify that t , arpn, cery ahis plot was drawn of North Carolina, County of Jackson. The foregoing certificates of Clark Lipkin, lv n I certify that the plat shown hereon complies with under my supervision from an actual survey made under my supervision (deed description recorded Professional Land Surveyor L-4288, are certified tobecorrect. This instrument 0.53 ACRES a th^ 7atcrsh^_d Protection Ordin=" and is rp rcrcd for recording In the Register of Deeds office. in boot 117.1, pdga 433) and that the error of closure as calculated b coordinate computation is leas than 1:5000 that ^ce r 0 511 ACRES This day of J2LL-•_,at o"clock 20 e as amended. Witness my original signature, licence Imo• �' and seal tbts 19th day of December, 2005. Date WiteNhed Administrator - Z' Qua Ro, h nope/ i roe 0 W V. nt a 0.63 ACRES moi rma o ` O 2. O / m �iP. °)~ ,oy 13ti' e• 9 u1 oa io m A •_, m cliN 10 o;16 0 166 ACRES %m 6 N , \ va 0 59 ACRES 0.55 ACRES 0.5 C - f. 0.63 C S v amu'. Nps , o p The Remainder o1 ;N 03'11'37' RN 03'54'43' E Rudman 1174/433 I {y0 00 112.40' N 02'20'30" E 4 95.62' 114.94, N 03.11'29' E �p 13 0 7 SL. Nr 2?J! Site Vicinity Map (not to scale) _ \ Centex Homes 1184/478 The Remainder of Rudman 1174/433 alis along 2b00' contour F__ 4.73 D e Plat for Keith Rudman Date f0 Lots on Bear Lake Drawing # Surveyed to 590 A 12/15/05 c River evis.ion Date 0' 60' 120' 180' Township o � None Clark Lipkin, PLS North Carolina Lipkin Land Survey�ny, I . P.O. Box 368 Tuckaae lee, NC 28783 (828293-3030 Scale Sheet �� 1 of 1 W� oState o F1 Certificate of Approval for Recording Clark Lipkin, certify that t , arpn, cery ahis plot was drawn of North Carolina, County of Jackson. The foregoing certificates of Clark Lipkin, lv n I certify that the plat shown hereon complies with under my supervision from an actual survey made under my supervision (deed description recorded Professional Land Surveyor L-4288, are certified tobecorrect. This instrument % a th^ 7atcrsh^_d Protection Ordin=" and is rp rcrcd for recording In the Register of Deeds office. in boot 117.1, pdga 433) and that the error of closure as calculated b coordinate computation is leas than 1:5000 that was presented for registration recd de in this office in 1 cabinet s'de ._ - r and this map was prepared in accordance with G.S. 47-30 This day of J2LL-•_,at o"clock 20 e as amended. Witness my original signature, licence ►a-a�-o�J641Mnumber and seal tbts 19th day of December, 2005. Date WiteNhed Administrator - ,QR NOTICE: This properly is located within a Public — o v Rater Supply Watershed -development restrictions may apply. Professional Land Surveyor L-4288 Regisyr oN Deeds 0 7 SL. Nr 2?J! Site Vicinity Map (not to scale) _ \ Centex Homes 1184/478 The Remainder of Rudman 1174/433 alis along 2b00' contour F__ Plat for Keith Rudman Date f0 Lots on Bear Lake Drawing # Surveyed 590 A 12/15/05 River evis.ion Date Township Jackson County None Clark Lipkin, PLS North Carolina Lipkin Land Survey�ny, I . P.O. Box 368 Tuckaae lee, NC 28783 (828293-3030 Scale Sheet 1"=60' 1 of 1