20181305 Ver 1_Shoreline Stabilization_20180925

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
_DWR
Division 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:
1
2.
Division of Water Resources PAI'
401 & Buffer Permitting Unit
1617 Mail Service Center 2 0 1 8 1 3 05
Raleigh, NC 27699-1617
Applicant Information [15A NCAC 02H .0502(a)]
Owner Information
Name:
Mailing Address:
/2,)77
Ai V f-vQST f, IJC Z Y39�D
EI
SEP 2 5 2018
Telephone Number: qlo 6 o 2243& Fax Number: "Ilq 77,q 743C-)
E-mail Address: ,eeL)I.#1 A l sekg d yp Cam
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 FORM.pdf) must be attached if the Agent has signed this application form.
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Person to receive the Certification Approval:
II. 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.
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
00(Ct,

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: .7ri"(_F_4 Nearest Town: Ife)Pcc9 o c -) 1 --)
Subdivision name or site address (include phase/lot number):
1491 1�1�Yna�c� ���1��� . I)v?_W60o jJCzStZK
Directions to site - please include road names and numbers, landmarks, etc.:
Latitude (in decimal degrees) 3S ,ZZI 1-4-1 Longitude (decimal degrees) -50. 01 81-F
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): 'Ps i D£PT(A-L-
6. Property size (acres): .2-58
7. Lake/ river/ ocean adjacent to property: L",V _ ✓'`�
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): PnatW i VIA Ai►h SU -5 4l+En 6 0i t- )
M A-Tn vi ,ii "b 212 EAP Poe -v. ro PW7T�CT 5146 Z
9. Will work be conducted from land? ❑ From water? X W I+f Q L,4IL4_- IS
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:
PP Wx I m A-
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake level/ Normal WaterLeveland 50 feet land -ward in
square feet or acres: 40290Xi owetTE,ci(J-500 } f sa.
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): BAU— 0 -WI FOVM N0PVh4—
X
LL I_/ g/5' ho / b
er/Agent's Signatur/ Printed Name D
e,�ate
[15A NCAC 02H .0502(f)l "
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

La ke
(At Full Pond/ Normal Water Level)
kAe
�IGwe,cL�`J 1�1w1--�1r1Lt `�
I Zklp rL�
dr
Full Po -�-. �.r- --- ---
Norm
we
i . • f . • • • 0 40 • • • 030
f '
�—
I
1
e4mcc� em"
Please approximate) s etcF t Aolowing information on this plan (provide dimensions for each
item, such as 10 ft 100 ft)*:
1.4" All proposed vegetation clearing
2Y✓ 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 NJ� 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

V
�s
,.► t
E21
481 Tranquil Bay Circle
Piney Paint Golf Club 10
C
1768

s. snw+o
1RANOWL eAY CfRr1E
NANg°R Ra.
s�
VICINTY MAP
not to scale
IRON PIPE N
REMAINDER OF LOT 18
BARRY JAMES d
\ DB 815/PG 176 0
\ o� re•S.
\ ryry
\ r�
VC/ETP DECK
NOTESI
1 BOUNDARY PREDICATED ON EXISTING
MONUMENTATION FOUND IN THE FIELD.
2 AREA COMPUTED BY COORDINATE COMPUTATION.
3 PROPERTY IS NOT LOCATED IN A FLOOD
HAZARD AREA.
4 THIS PROPERTY IS IN A COUNTY WHICH
REGULATES THE SUBDIVIDING OF LAND,
5 THIS IS A SURVEY OF AN EXISTING PARCEL
OF LAND,
NOTE
SUBJECT PROPERTY BEING ALL
OF LOT 17 AND A PORTION OF
p _ LOT 18 OF THE TRANQUIL BAY SUBDIVISION .
r
ey
ao.
i��
ONE 1�
STORY
SHORFS�S9F .258 ACRES
UNE
SOS,
ALLOCATION
IRON ROD
LOT 16
JERRY ROGERS
DB 689/PG 675
IRON ROD
11-1
W
U
�0.
�m
o�
0
F
UNE / BOAT -HOUSE
DUAT E'NE'RGY I \
LAKE TILLERY1 SCI / 5 HO 12 j VA FI L 17 -4Tn o--�_
S ORE jQT�1e' Lu I n+ al,I,4rn r16 �
13jo 44,-a. 'P_I p iL4P (2�)&k_
►3��=0�-
(oir4L S�tOILcrY11� �. I�uX$` SHO/L.E 5T-Pe,rL 1 P
170 , 4 POST `lri20 f YSQ LEGEND:
1 T • EIP - EXISTING IRON PIN (Av D'bed
0 SIP - SET IRON PIN ft/2` IRONeacnREBAR�
CM - CONCRETE MONUMENT
NPS - NO POINT SET
PROPERTY UNE
- — — — ADJACENT PROPERTY UNE (NOT SURVEYED)
-- RIGHT OF WAY
— POWER UNE
I, George W. Simpson, certify that this
map was drawn from an actual survey
under my Supervision, that the
C O N V E Y A N C E P L A T�myEY OF
pROppm. OF : J O H N Sc TA RA H 1 LL
n
��AC'""T` It,
of lnd re arturesulsti�10000+,
� IN NORWOOD 1w ,, STANLY co NO
s`q�smade
latitu es aerror
d d��aa �`
that the boundoHes not aurveyad are4`c QFESSIO '
'�s';
IN THE CITY OF NORWOOD ON TRANQUIL BAY
4 TRANQUIL BAY
shown as bra�Ines, and tfie angular. Q, .y,': 6'
error was �7' tum. 9f
HOUSE N0. —�� IN BtDCX No, ON MAP OF
seconds per _�
r
yAp mmm IN aw 6 pO 76 pip R=ROEO IN
`C SEAL
• IT? :
BOOK 1325• pG 980 � oFFlCE of 111E REgSIFR OF DEEDS
Q'; L -349T
suRvtY rnR: BERT $S _ CAROL KELLY
SCALL 1" 60' DATE AUG. 16. 2018
r�/�•. S`URv�i.•�`. tom;
90" IN FW
60 30 0 So
20
lljo�t_ ""
C.1i 4_1P.
SIMPSON SURVEYING
CD :B �>G 1413
L-3491
Pr�0 Lard �^°y°f
MT. GTL.EAD, NC 27306
C910> 2a0-4000
F ILL 1 4131 TRANU,DWG

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