20181673 Ver 1_Shoreline Stabilization_20181206

' State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 02-2017
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the _application fee should be sent to:
If sending via US Postal Service If sending via delivery service (UPS, FedEx, etc.)
Karen Higgins Karen Higgins
DWR - 401 & Buffer Permitting Branch DWR - 401 & Buffer Per tir
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC 27699-1617 Raleigh, NC 27604 ll ---
A. Applicant Information [15A NCAC 02H .0502(a)] 2 0 1 8 1 6 7 3
1. Owner Informatio
Name: Curc i(�u (f-
Mailing Address: f .giffa 19 �Z AM
15
Telephone Number: c� Jq- (� 3(G - I I k Fax Number: 1:jF '+
E-mail Address:
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter must be attached if the Agent has
signed this application form. (A form can be downloaded here:
http://www.saw.usace-armv.mil/Portals/59/docs/regulatory/repdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf)
Name: r71 r)4 Cca) i
Company Affiliation: rly-W n1t)fej- f 5cn &rlS 1. L LC'
Mailing Address: C e I I,(- (t0 y)C) I rrr L /I 1
Telephone Number:
E-mail Address:
n c' r CA N -7'3 4_3
3_3 '_L;03 _3c�_ Fax Number:
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: SSGP 02-2017 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 tie property (where work is to be conducted)
County: -)( 4' `_.>CV,1 Nearest Town:
Lake/ river/ ocean adjacent to property: L] (I(c L CL_ Y,
Property size (acres): i. 1), g 0_ C rr C
Subdivision name or site address (include phase/lot number): Th e RC.5e_►' V't
3C.;y �-S+ct4c Rd., ���r�c� cr, N(- ,Q'73 `-3 Lc f �5
Directions to sitet/- please include road names and numbers, landmarks, etc.: rcn�c;Xiw
Z"Ci i J'I C�1(cY(�lkcl --ft C
1 t' 1 fZf^!1�' � f — 1� Ie E-+ Oil
-j(Ly 1144 vyl I rtk,riI Ief1 cnrz fs'tCti+e Rcl. yc ro zI�Gf
Latitude (in decimal degrees) 3 (c.5 I L Longitude (decimal degrees) - 7g. CG:3
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Y`10'�; d eki,+1 C�_p
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):���.�
ala ,ft A')
7. Will work be conducted from land? M From water?
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:
Temporary impacts in square feet: alt 5C{. f t c f c(iYJC l`4 r) b.i) 4 -cc -,-F
9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet
land -ward
Permanent impacts (including back fill, excavation, rip rap, retaining walls, etc.) in square feet:
Pin r ,4
Temporary 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): l
lt>1A
11. Signature
C c�L
Owner/Age 's Signature+ [15A NCAC 02H .0502(f)l
/ i, 1 ~ /Y
Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 02-2017 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 I PvPI elevation
La ke
(At Full Pond/ Normal Water Level)
Full Pond/ Wat r
'��T 4 O 4
5 Or, re
Plan View
Full Pond/ Normal Water
-� ore7ine `r
2 ft.x 150 ft.
addldonal clearin
' N necessary
Lake
(At Full Pond/ Normal Watef L�p Existing Dock
3 ft x 150 ft
&low full pond/ NWL
4 ft x 150 ft
Above NA pond/ NWL
EXAMP(E
Plan View
FORM: SSGP 02-2017
Page 3 of 4

Lake
(At Full Pond/ Normal Water �eVelbicy©
t�
0
Side Vied/
C "Cap C�On(UX. 3- qA�if o n� y c
0
U-
3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing
*if necessary
FORM: SSGP 02-2017 Page 4 of 4

C3u� cL ku 4. rlp V'CW1)e d
PHYSICAL SURVEY FOR
AARON RUDOLF hf�CICS� 4U 6t c-eef&
CUNNINGHAM TWP., PERSON CO., NORTH CAROLINA %
FIELD WORK PERFORMED MAY 2017 \
PROPERTY AS DESCRIBED IN DB 763-74 /
PROPERTY STANDING IN THE NAME OF \
BM DEEPWATER DEVELOPMENT
Elp
CONTROL
CORNE
VICINITY MAP
NOT TO SCALE
I HEREBY CERTIFY THAT THIS PLAT IS OF THE FOLLOWING TYPE:
G.S.47-30 (FX11XCx1). THIS SURVEY IS OF AN EXISTING PARCEL OR
PARCELS OF LAND AND DOES NOT CREATE A NEW STREET OR
CHANGE AN EXISTING STREET.
-AND-
-, MICHAEL T BRANDON. CERTIFY THAT TINS PUT WAS DRAWN
UNDER MY SUPERVISION FROM AN ACTUAL SURVEY U40E UNDER
MY SUPERVISION (DEED DESCRIPTION RECORDED IN BOOK 763,
PAGE 74, ETC.); THAT THE BOUNDARIES NOT SURVEYED ARE
CLEARLY INDICATED AS DRAWN FROM INFORM4TXM FOUND IN
(SEE -REFERENCES-): INA T THE RATIO OF PRECISION AS CALCULATED
NS 1: 10,01OD: THAT THIS PUT WAS PREPARED IN ACCORDANCE WTH
G.S. 47.10 AS AMENDED. WITNESS MY ORIGINAL SIGNATURE,
REGISTRATION NUMBER AND SEAL THIS
6TH DAYOF M4AY, AD.. 2017....................CA "
SEAL
L-4922
PROFESSIONAL (AND SURVEYOR REG. NUMBER L-4=
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EXISTING MONUMENT FOUND
TIM POINT
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PROFESSIONAL LAND SURVEYOR L4922
1437 BROOKS DAIRY RD.
PNiCEL DATA.
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PHONE: 911F358-6432
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DEVELOPMENT
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DUKE ENERGY
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RECN 27469
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VICINITY MAP
NOT TO SCALE
I HEREBY CERTIFY THAT THIS PLAT IS OF THE FOLLOWING TYPE:
G.S.47-30 (FX11XCx1). THIS SURVEY IS OF AN EXISTING PARCEL OR
PARCELS OF LAND AND DOES NOT CREATE A NEW STREET OR
CHANGE AN EXISTING STREET.
-AND-
-, MICHAEL T BRANDON. CERTIFY THAT TINS PUT WAS DRAWN
UNDER MY SUPERVISION FROM AN ACTUAL SURVEY U40E UNDER
MY SUPERVISION (DEED DESCRIPTION RECORDED IN BOOK 763,
PAGE 74, ETC.); THAT THE BOUNDARIES NOT SURVEYED ARE
CLEARLY INDICATED AS DRAWN FROM INFORM4TXM FOUND IN
(SEE -REFERENCES-): INA T THE RATIO OF PRECISION AS CALCULATED
NS 1: 10,01OD: THAT THIS PUT WAS PREPARED IN ACCORDANCE WTH
G.S. 47.10 AS AMENDED. WITNESS MY ORIGINAL SIGNATURE,
REGISTRATION NUMBER AND SEAL THIS
6TH DAYOF M4AY, AD.. 2017....................CA "
SEAL
L-4922
PROFESSIONAL (AND SURVEYOR REG. NUMBER L-4=
1'7747-3
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26.57 725.00 706 00
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5 60'20 28 W 63.43
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11 1017
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N 7651 28 W 46.56GISTTp
N OT 18'35" E 37.84
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d [E@WAmbE11B0ABif RON ROD OR PIE SET
O 40 80 120
i
MICHAEL T. BRANDON
EXISTING MONUMENT FOUND
TIM POINT
1" INCH = 40' r:.
0_arta
PROFESSIONAL LAND SURVEYOR L4922
1437 BROOKS DAIRY RD.
PNiCEL DATA.
27eeM TIE LINE
ROXBORO, N.C. 27574
AX MM AN 2m — — EASEMENT LINE
B0°5�14
PHONE: 911F358-6432
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Cf: ]0110086
WNBY:MTB
-NES FROM REFERENCE
1'7747-3

�y�.`... J'•., r� nom- Q, ,,,� ,� � _ j� � (�
�r-- 1ned, � -ed ;ropert; e:;rers c` the at,:)ve rc`ed prlpertl, da �e °eb,r authorize
Ca,it�c�'aF
��� r� ccyvs'7rwcZ: t1CL
• i jG3 .ticTe Of Cc-tSLltrg ftr'[r!;
Znd take ati a:-t*rs lecessary for the p-ocessing, issuance ar;d acceptance of
�TMt c: and a-7 and a;,, star. a -d anc special corditia;s attach.
e ; by t�e:vy tiv ab ve information sutm;itted III this application is true and am4rate to the
_!!V- of our know ems.
-lkUhor,zed Signature
Date:

RUDOLF AARON )( CZ
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