20190003 Ver 1_Shoreline Stabilization_20181221

State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources FORM: SSGP 10-2013
Shoreline Stabilization Application Form
PAID
Three copies of the application (including attachments and the application feeSuld a sent
p pp ( g ) pp _a
to:
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center 2 t 9 0 Q
Raleigh, NC 27699-1617 V —
g
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: krin keel
Mailing Address: I to q I S Sin', osU.XL4c-h�( .
rne1'us, Ae_ 20031
Telephone Number: Loa(. - 676 - d141 Fax Number:
E-mail Address: 1Amke.e1e._1 I oahoo.Gom
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
httP:/Iwww.saw.usace.army.miI/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name:
Compar
Mailing
Telephone Number: 7041 - LoU6 -5111 Fax Number: 70y- (clod - 5q Uq
E-mail Address: o7 w',ndSfream. ne✓+
Person to receive the Certification Approval: Tanlce E_aAf=1:)
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 property (where work is to be conducted)
County: MP'C_k1e_n koro Nearest Town: _ Oo rne.hoS
Subdivision name or site address (include phase/lot number): 1 olq h'�� �=1,c hl,
_D
Directions to site - please include road names and numbers, landmarks, etc.:
lk-LAwr L►ahk Bluff ,+hen rlohk oto b6-,n61L�eyl Pk,
Latitude (in decimal degrees) 3 Sou{ t.3 el4' J Longitude (decimal degrees) - go. 4w) alp,
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.):
6. Property size (acres): b. r l0 a
7. Lake river/ ocean adjacent to property: _10 rvw.+n
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): �'� Q�e S �o i n5:4a rfv-(+'i n_
9. Will work be conducted from land?
From water? Q`
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:
I//
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: ( + above_
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): Q rAbS 66-er'
oo-1-rees rtn-nvcd , no Hi -5+u r Iia nce- +o in i 1� Fe.r-
0 n /Agent' igna ore [15A NCAC 02H .0502(f)] Date
Agent's signature is va i ly if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

GGe55
�y
Full Pond/
Normal Water Level
E AM � � � �
Shoreline
La ke
(At Full Pond/ Normal Water Level)
L r Cho ve_
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CorrNcl ivS, Nc a8031
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No -%sees rermvecL
tVo d � S�vrl�a.nce
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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Polaris 3G Map — Mecklenburg County, North Carolina
Date Printed: 12/13/2018 3:32:31 PM
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This map or report is prepared for the inventory of real propertywithin Mecklenburg County and is compiled from recorded deeds, plats, tax maps, surveys, planimetric maps, and other public records and data.
Users of this map or report are hereby notified that the aforementioned public primary information sources should be consulted for verification. Mecklenburg County and its mapping contractors assume no legal
responsibility for the information contained herein.

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