20181239 Ver 1_Shoreline Stabilization_20180907

201 81239
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee'LS�d f'
should be sent to:
Division of Water Resources
401 & Buffer Permitting Unit I%
1617 Mail Service Center
Raleigh, NC 27699-1617 p �,�,A��/
• Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: ej 17. £ V,6 57 tiv
Mailing Address: C-7-
6gi5,, n/5 oyeo NC- P-7Ya7
Telephone Number: &3&. 3(0: • & -7:5_1 Fax Number: 3-34,-,57q7 - 4, 7Vn
E-mail Address: /mr%d k o vvi — O;i- r✓i cA. os,
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be
downloaded here:
htto://www.saw.usace.armv.mil/Portals/59/docs/reeulatory/reEdocs/Permits/SAMPLE
AGENT AUTHORIZATION FORM.pdf) must be attached if the Agent has signed
this application form.
Name: NN 4 57
Company Affiliation
Mailing Address:
aQE F NS B e2X o N C P--7 540 7
Telephone Number: 334- 3&�X -6i 75-/ Fax Number: 3.3 (o - 5-Y 7- w 7 8'0
E-mail Address: /�r1 d 61�rn�0�- P41roet
Person to receive the Certification Approval: �H/✓ FIS T
• Project Information [15A NCAC 02H .0502(a) & (b)]
• 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.
• 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.
• Attach a photograph of the shoreline/ buffer proposed to be stabilized.
(Include a scale of some sort- a yard stick, shovel handle, etc.)
• Location of the property (where work is to be conducted)
County: McAl7_(i v o4Z RNearest Town: A4 7-
g, L t5_,4,0
Subdivision name or site address (include phase/lot number): RwA5t4V eeS 50 -, 7/4
R w4 Y' R -P 447- 4/ e-44-4 We— X7304,
Directions to site - please include road names and numbers, landmarks, etc.:
(R) a�/ ��,ici.vA�l S/foeEs %�� �Sa � Tib) To �i,) o .J �A i R w .Q ✓
Latitude (in decimal degrees) .J A • A.1 y (o Longitude (decimal degrees) Oro, e77;?—
Describe
7;?—Describe the existing land use or condition of the site at the time of this
application (residential, undeveloped, etc.): f—g- !�i D eAlri A i--
Property
—
Property size (acres): 0 Z 9 • /40 4 I8 A
• Lake/ river/ ocean adjacent to property:
• Describe proposed work (include discussion as to how hardening of shoreline
has been avoided, or why it is necessary): SrAFi_1'ZAr1eN
W 4t� P D4>,5 Tn 4 4K L W A r,E2 ERV 5/ C',✓
• Will work be conducted from land?rom water
• 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: < :510 a S F
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: t /VC70 st-
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):
OSI&Y TtE rR ES I-Ac,,_1,y(, iwry Ttt)s L-AxE lviz_L 6,e
Mvv i7 �3 - y r,REc y
ow't_ .4 9 O -t
Owner gent's Signature' (15A NCAC 02H .0502(f)l
2
Date
q_y-/ff

*Agent's signature is valid only if an authorization letter from the owner is provided.
A.)- sj
Mame Insert D—s 4n,ms—, SW, Shoe: Renew View
mp
J
vme-
..,.�.1
r_
e � 1
Lake
(At Full Pond/ Normal Water Level)
Full Pond/
Normal Water Level`
Shoreline
1 1� rrA-e,✓E �
i
j
SW 4 W 4
Please approximately sketch the following information on this plan (provide dimensions
for each item, such as 10 ft x 100 ft) *:
• All proposed vegetation clearing
• Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level
elevation
• Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level
elevation
• Location of any proposed structures such as buildings, retaining walls, docks, etc.
• Location of any excavation or dredging below the Full Pond/ Normal Water Level
elevation
• Location of construction access corridors
3

It A
I, Robert K. Russell, PLS, certify that this map was drawn from ,�4 CA/�Q #0 oj�t d
an actual field survey, and that the area shown was calculated from �� 00
coordinate geometry, error of closure < 1:10,000.
I also certify that this is a survey of an existing parcel of land. 40"00••
Witness y hand and seal 18th day of3uly, 2018.SEAL • ?S Site • P
1 q'
'.00s L-33" s
Robert K. Russell, PLS 7 ; per• —J�
PIN 6574 20 90 8373, 6574 20 90 92090� ~ O%, yt
Referred to as Lots 28 & 29 w!r Tj .
Fairway Shores Subdivision 4a r 0 0 K 111M �• ;v
Map Book A431 vicinity Map a
EIR °
�f
6574 20 90 9416 `''_
Linda M. Cagle Blakely s d
DB 442 PG 877 Fc�o
s ;oys�
ti� Lot 28 `�° '�L �p
8012.9 Sq. Feet d0,
0.18 Acres
84.56' EIR
Lot 29 F
11.72' 7273.6 Sq. Feet
oS<' � ti �a�° 0.17 Acres
ipSo�F poi
y 6584 17 00 9246 EIR
bhp✓le I��e- J 0 8.22' �. Ernest R. Chilton
S4at �,� Billie Chilton
d Existing ° DB 159 PG 336
�t Fram
14.02'
21.74's� °
.3�.u• ��� � �y 17.84'
Existing
legend:
O Existing Iron Pipe
* New Iron Pipe
O Computed Point
p Power Pole
Existing Boat House
to be replaced
*** This map does not comply with N.C.G.S. 47-30 ***
Associated Surveying &
Engineering, P.C.
C-1430
P.O. Box 7576
Greensboro, NC 27417
336-323-8308
[e-mail]
Survey For
Chilton Group, LLC
468 Fairway Shores Road Peed Dee Township
Mt. Gilead, NC Montgomery County
25 0 50 100
Drawn By:WTR
Scale 1"=50' Job No. 18084

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