20181311 Ver 1_Shoreline Stabilization_20180927

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
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Division of Wafter 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
Name: -"_I � I c
Mailing Address:
ew L
ego�-Jil� Gj'(cc't�, -AJC-- `27'506 T
2018131'
Telephone Number: 336- q� 5 - lP4I-6- Fax Number:
E-mail Address: jlee., heu-kk e,,,, v,04 s-o44hOns
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http://www.saw.usace.armV.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: i �►ci Cn��
Company Affiliation:
Mailing Address:
Telephone Number: ; 0gGS' (A 15 Fax Number: ', ��
E-mail Address: -hl r (,eye � ctu�n's�,vl ��;�S.. C� w�,�i`,fe� ��wrnc�-+�c -'"�`.
Person to receive the Certification Approval: ` I of, 144. �t'
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 1property (where work is to be conducted)j(
County: /•�UI✓4T_,in a, Nearest Town: ,,n �C944 Gs61 a
Subdivision name or siteaddress (include phase/lot number):
(;w4f T_kfctn►` p1ci yi+g1rdy_ Lob W 3�
Directions to�site - please include road names and numbers, landmarks, etc.:
Ri jh} .1( 6? 214/.4'7 F 57L, Qy) t�o I4" 93
Latitude (in decimal
Longitude (decimal degrees)705'02.3" 05'02.3" W
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): QQ-5iJQv1'j1`'`�
6. Property size (acres): (9 • `iC 5 /cam
7. Lake/ river/ ocean adjacent to property: ct)eC, �r;_)B
8. Describe proposed work (include discussion as to how hardenVg of shoreline has been
avoided, or why it is necessary): CGVkS+^4r,+ 0aC,It- Gf�K� "PAoV-41C.-
GlP ,Jcl 4,N " (N %es rVV 5f'yh'-nk�
9. Will work be conducted from land? 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:
r3
11. Total amount o 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: /--yb)( 5U , X �o i --,>),�;0U f + Z
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):(e,L't/
16 5wnci ll
Ow6p(Agent's Signature* [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

{At Ful( Pond/ f oo
Full Pond/�
Normal Water Level
�-ilYl�!-i111111F,
Shoreline
so#
1296
uGd.
�iv11'1i1� d�
t�-ee5
50'
Ip �
1, oily- CA5
h ' La pfr/v\--
6al �b
b®a
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

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NOR H by
Plat Cabinet E
Slide 10—A
Boundary Survey for :
TYLER MADISON HEATH
Lot No. 38 on Sheet No. 2 of the Swift Island Plantation Subdivision
Pee Dee Township, Montgomery County, North Carolina
Deed Reference Book 747 Page 495; Plot Cabinet E Slide 10—A.
Surveyed by Thomas J. Fields, PLS -2906, on July 2, 2015.
TOTAL AREA = 0.85 Acre f
by coordinate.
30 0 30
ScIsis in Feet
1"= 30'
From the office of
WRIGHT k FIELDS LAND SURVEYING
1340 Albemarle Road, Suite C
Troy, N.C. 27371
Found: TI. Line _
1/2"Iron �,—._.—.—,— --'N 87'12'25' E 155.01 FT
Rebor `
-- — — -- — — — Found:
/2" Iron
Rebar
Lot No. 39
Found:
Found: 1/2" Iran
1-1/4" Iron B1— . Tie Line Rebar
Pipe N 86'44'58"W 94.42 Fi--'"
3/
vah~f4
Ofy
y/ "7
Found-
/2
ound:
/2" Iron
Rebar /
NORTH CAROLINA \ /
MONTGOMERY COUNTY
I, Thomas J. Fiddle, certify that this plat was
prepared ham on ctual eurvey done by me in
July 20,5 and is in oil respects correct
to the beat of my knowledge and belief. The
ratio of precision as calculated by latitudes and
departures is
1:15,000'f This plat ws
prepared In o cwdanc with Board Rule1600
Witness my original signature and official stamp
this the 20th day of July 2015
No horizontal control within 2000 feel.
Found:
1/2" Iran
Rebar
_.—.—.—.—.—. R1. 1
M£
Water Oak Way /
Foond: _ — —
1/2 Iron
Rebar See CURVE DATA Found:
'10'42" E 92.01 FT 1/2' Iron
Rebar
30 Fool Setback
I /
I /
I /
I /
I /
I /
/y 4
Y I Lot No. 38
h c
to
I /
I /
I /
I
I /
I /
S 63'35'27" W� /
L_-- 9.05F� /
10 Feet Setback /
Found:
N 86'49 50- W
68.66 FT/ / 1/2" Iron
Found: ' Rebar
1-1/4" Iron
Pipe
Duke Energy
P Foand:
Property /z" Iron
/ Rebar
Cove of
�gIGARpl%, Lake Tillery
3EAI. =
Hy
L-2806 ; O
O •., ; .
9 �0 suR�.'y4V
S�BFFR�.•
Lot No. 37
tt
+g SITE tw
ae„e,e
VICINITYuMAP
CURVE DATA
Rodius = 522.50 FT
Arc = 53.45 FT
Chwd 53.43 FT
Chord Bearing
N 84'22'07" E
Symbol Legend
o ...... denotes ExistNg 1/2" Iran Rebws
61 ...... denotes Ex(sthg 1-1/4" 1. Pipes
Symbol Legend
Boundary Linea
Tia Lines
Minimum Building Setback Lines
Extension of Leasetl Lines
Right—ol—Way Lines
Aapaeni eoaneoHoe (nal ear.Kyea)
Sob No. 2015-94