20181422 Ver 1_Shoreline Stabilization_20181017

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
ENVIRONMENTAL QUALITY FORM: SSGP 02-2017
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee shouldebe t
If sending via US Postal Service If sending via delivery service (UPS,$;Exre )
Karen Higgins Karen Higgins
DWR — 401 & Buffer Permitting Branch DWR — 401 & Buffer Permitting Branch
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC 27699-1617 Raleigh, NC 27604
A. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner
Name:
Mailing
2 0 1 8 1 4 2 2
Telephone Number: Fax Number: *
E-mail Address:
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter must b at che>ld/Af)hg
signed this application form. (Aform can be downloaded here: 4o,Fo qT
htt www.saw.usace.arm .mil Portals 59 docs re ulator re docs Permi A
ATION FORM.pdf) AF
Name: Nk.cc,
Company Affiliation:
Mailing Address:�(� Chc�.�-,O�k. !•�wa
Telephone Number: `�J�'J ��\ \l,,',� Fax Number:
E-mail Address: Y\\X-r\ A!_� ,rvNpr �rSer��rc .0 D�tY1
B. 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, buildings, retaining walls, docks, impervious surfaces, 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.
FORM: SSGP02-2017 Page 1 of 3

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: Nearest Town:
Lake/ river/ ocean adjacent to property:
Property size (acres):
Subdivision name or site add res (include phase/lot number): VU
���c�0 �.Ye_���a.�-'re. c C_..`c�ca�-\mac : ��`f � e�►�c��1�
Direct ons to site -please include road names and numbers, ndmarks, etc.:
o \
Latitude (in decimal degrees)Longitude (decimal degrees)'%1.0`��dlo5l�
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): \\ - '%Aa_r V c>`
6. Describe proposed work (includ discussion as o how hardening of shoreline has
avoided, or why it is necessary):
7. Will work be conducted from land?❑ From water?v
8. Total amount of impacts below the normal pool lake level/ Normal Water Level
Permanent impacts (including all excavation, Backfill, rip rap, retaining walls, etc.) in square feet:
Tqmporary impactsin square feet:
9. Total amount of impactsabove the normal pool lake level/ Normal Water Level and 50 feet
land -ward
Permanent impacts (including back fill, exc vation, rip rap, retaining walls, etc.) in square feet:
-,l n I�s% X — \ IYV0--V
porary impacts (temporary clearing, construction corridor) in square feet:
10. 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):
11. Signa ure
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: SSGP02-2017
Page 2 of 4

12. Please approximately sketch the following information on this plan and provide dimensions for
each item:
a. All proposed vegetation clearing
b. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
c. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
d. Location of any proposed structures such as buildings, retaining walls, docks, etc.
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
La ke
(At Full Pond/ Normal Water Level)
Full Pond/ Normal Water Level
Shoreline
\o�p sol, V-,
Plan View
Lake
(At Full Pond/ Normal Water Lever
Existing Dock
/30h.7h
FORM: SSGP02-2017 E AMP E
Plan View
Page 3 of 4
•����rr��rro�row•
1. �r�o
additional clearing
FORM: SSGP02-2017 E AMP E
Plan View
Page 3 of 4

> `
La keo�,
(At Full Pond/ Normal Water Level)
3 C
M —
EWE
i O O
C
Side View
3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing
if necessary
Existing bank
10 ft. bank a
height �yQ'
I
FORM: SSGP02-2017 Page 4 of 4

AGENT AUTHORIZATION FORM
Property legal description
Lot No. 'SG Plan No. Parcel ID: jjj 4 -k4.�,
Street Address
awaal%
Property Owner: __ & rji j Sw i ck Aqu feeyl %AA J
The undersigned, registered property owner of the above noted property, do
hereby authorize
1671
1 1 i 1 1 1
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 from above):
Telephone: 0% 3q(6jj
We hereby certify the above information submitted in this application is true
and accurate to the best of our knowledge.
`~. uthorize Sign e
Date:
eow
Auth rued Signature
Date: 9 :).Cf)

912.5/201 e 5850 Charlotte Hwy, Clover, SC 29710 to 15900 Riverpointe Dr, Charlotte, NC 28278 - Google Maps
Go gle Maps 5850 Charlotte Hwy, Clover, SC 29710 to 15900 Drive 6.3 miles, 11 min
Riverpointe Dr, Charlotte, NC 28278
Go gle
5850 Charlotte Hwy
15850
SC 29710
cmd'fte Highway
Go gle
5850 Charlotte Hwy
Clover,
SC 29710
t
1.
Head northeast on SC -274 N/SC-49 N toward Catamount Dr
r►
2.
Turn right onto SC -49 N
8 Entering North Carolina
t
3.
Continue onto NC -49 N
4,
4.
Turn left onto Riverpointe Dr
ro
5.
Turn right onto Eagleview Dr
4,
6.
Turn left onto Riverpointe Dr
15900 Riverpointe Dr
Charlotte, NC 28278
Rivevpoi,rte Dare
Map data @2018 Google 2000 ft
01.3::11
3.0 mi
0.8 mi
0.3 mi
16ft
0.3 mi
These directions are for planning purposes only. You may find that construction projects,
traffic, weather, or other events may cause conditions to differ from the map results, and you
should plan your route accordingly. You must obey all signs or notices regarding your route.
https://www.google.com/maps/dir/5850+Charlotte+Hwy,+Clover,+SC+29710/15900+Riverpointe+Dr,+Charlotte,+NC+28278/@35.1066564,-81.080791... 1/2

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