20190036 Ver 1_Shoreline Stabilization_20190104

State of North Carolina
Department of Environment and Natural Resources
WR Division of Water Resources
�°°� 15A NCAC 02H.0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources
FORM: SSGP 30-2013
Shoreline Stabilization Application Form PAID
1�
Three copies of the application (including attachments) and the application fee shoulder -
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 InformatZ"'-/
Name:
Mailing Address: 3 ��
G.1 v.,. 4v,
2 0 1 90 0 3 6
Telephone Number: Fax Number:
E-mail Address: 1/1 C' �i' / �►� ,-.� �� c�rv�
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.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:
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)]
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: Nearest Town:
Subdivision name or site address (include phase/lot number):
Directions to site - please include road names and numbers, landmarks, etc.:
11 5rAA-h e)6A- DS r-ICht on NC -13 rlgbt no Ra N,rS
J t/
Latitude (in decimal degrees) �, Longitude (decimal degrees) ' � . q J 53�
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.):P��IC�PYIT 1 �I
6. Property size (acres):
7. Lake/ river/ ocean adjacent to property: LOkP NOCrY<_�,1
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Mnl ,L1 Lao a l e O�- exc,4kf1rR�
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:
no GC'16LCT-' -A 10 X 1 sc)/
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: N-�ccui ti'..cA�si�ucbo vxa_ -C x Ovt1 yvckp�' X ( 5a,
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): O1A��}licvyAnee,
Owner/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

Full Pond/
Normal Water Level
Shoreline
s'X iw,
T CGC L �Cc
Lkfxt avec�,
La ke
(At Full Pond/ Normal Water Level)
1p' X 150,
tXSh#N
2;Q love
ut1 pond
— _ter
at X ISO
�x►5h� t��p�c�
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

Bing maps
A Mooresville
B 13807 Hagers Ferry Rd, Huntersville, NC 28078
A Mooresville
36 min ,15.3 mi
Heavy traffic (15 min delay)
Via NC -115, 1-77 S
B 13807 Hagers Ferry Rd, Huntersville, NC 28078
1
Depart W McLelland Ave toward S Broad St
246 ft
2
Keep straight onto NC -11 S / W McLelland Ave
82 ft
Turn right to stay on NC -11 S / S Main St
3•
Pass Exxon in 0.4 mi
3.6 mi
4
Turn right onto Langtree Rd
1.1 mi
Take ramp left and follow signs for 1-77 South / US -21 South
S.
♦ Serious Congestion
5.9 mi
6
At exit 2S, take ramp right for NC -73 toward Concord / Huntersville
0.3 mi
Turn right onto NC -73 W / Sam Furr Rd
7'
Pass Shell/Circle K in 0.1 mi
4.1 mi
8
Bear right onto Hagers Ferry Rd
0.2 mi
Arrive at Hagers Ferry Rd
9•
If you reach Clarendon Pointe Ct, you've gone too far
B 13807 Hagers Ferry Rd, Huntersville, NC 28078

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These directions are subject to the Microsoft® Service Agreement and are for informational purposes only. No guarantee is made regarding their completeness or accuracy.
Construction projects, traffic, or other events may cause actual conditions to differ from these results. Map and traffic data 0 2018 HERE'".

Polaris 3G Map — Mecklenburg County, North Carolina
Date Printed: 12/28/2018 3:04:50 PM
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This map or report is prepared for the inventory of real property within Mecklenburg County and is compiled from recorded deeds plats, tax maps, surveys, planimetnc 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. Mecdenburg County and its mapping contractors assume no legal
responsibility for the information contained herein.

TIFICATION
AT THIS MAP WAS DRAWN
:N ACTUAL SURVEY MADE
ESCRIPTION RECORDED
HAT THE RATIO OF
.ATITUDES AND
r THE BOUNDARIES NOT
:EN LINES PLOTTED FROM
PAGE
IN ACCORDANCE WITH
SSOC. INC.
IS
REA
IMPERVIOUS CALCULATION
HOUSE/PORCHES= 4637 SF
DRIVEWAY = 8157 SF
BRICK SIDEWALK 737 SF
STONE PATIO = 811 SF
RETAINING WALLS = 67 SF
A\C PADS — 27 SF
TATAL IMPERVIOUS = 14,436 SF
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2.42 AC. TOTAL
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NOTES
1) THIS PROPERTY MAY BE SUBJECT
TO ANY EASEMENTS AND/OR
RIGHTS OF WAY OF RECORD.
2) ACREAGE COMPUTED BY THE
COORDINATE METHOD.
3) UNDERGROUND POWER
4 NO GRID MONUMENT FOUND WITHIN
2000 FEET.
5) PARCEL # 00101413
6) DEED REF. BOOK 14934 PAGE 635
7) ADDRESS 13807 HAGERS FERRY RD
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LOT 2
BEN THANKACHAN
31594\808

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