20190128 Ver 1_Shoreline Stabilization_20190125

DWR
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Division of Water 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 PA
401 & Buffer Permitting Unit
1617 Mail Service Center �,�� 2
0190)28
Raleigh, NC 27699-1617 (�
I�
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information 1 I
Name:
Mailing Address: �AoT/ I e'l I` Y-
S2rr\lkS Fn rd , aS(,)'`13
Telephone Number: 3LL31 Fax Number:
E-mail Address: rn 1A e..l kyA L ('1)ar-4e_r . n e+
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: `1bLl - Utjp(� -51 l 1 Fax Number: _'1044- LaUO - 59Log
E-mail Address: CbcSeawa.11sCD ne--
Person to receive the Certification Approval: _:an ice_ ESJL
11. 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: 00yiy r i
Subdivision name or site address (include phase/lot number): o>ouey tlr-1-'hV ievo
I4a.r\ooyr-br, cSker6l�6 Vord . NC a 2)6.7 L of # 5U
Directions to site -please include road names and1 numbers, landmarks, etc.: -F IR
AD ey.iT 7L]_ ,,e. l2i+ )LI An
De -S h -U +urCPT onin KC -15-0 U). I or'n
r i jAh-- �n+n S6_rr 111-3 turd Ra , -�-4, ext r % o►hL o No Tsl &nel P61 Ti i' B&
A he -n f P_E- -- ci n4t,�, L10- 600 r- ck . //��
Latitude (in decimal degrees) 35. La'A5 I I R Longitude (decimal degrees) —SO. q Li 5"S
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.):e3i es i dere+%a-1
6. Property size (acres): .950
7. Lake river/ ocean adjacent to property: (VOrrrVnr)
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): ShcuQe r sin,-_w� l h5-l-CLA YY1�1-�-�i ►�,
I n S -�O_ l( hr,i -)1 A 2r r ,7 r—1D
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:
L4 V_ -,e " � �
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: l I cave.
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):
'Agent's signature is
i [15A N CAC 02
/(i shy
Date
only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

Full Pond/
Normal Water Level
MmM7 �rM:.
Shoreline
La ke
(At Full Pond/ Normal Water Level)
No +ree5 rernoveJ
I move, (\� o d; 5-�uv-6o-nG2
+o 6j ��c
IUI' Ie-n�{h
I?LW' vle- l I e
a065 1AortKvIe.w IAG'rbour 1%r
'5herr l�S Ford, t1C x 66 13
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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0 ^ catawba county Geospatial Real Estate Search
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MAKING. LIVING. RErrER. Information services
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Parcel: 462903118769, 2065 NORTHVIEW HARBOUR DR SHERRILLS FORD, 28673
Owners: KELLEY PERRY MICHAEL, KELLEY PATTI A
Owner Address: 2065 NORTHVIEW HARBOUR DR
Values - Building(s): $807,400, Land: $343,400, Total: $1,150,800
This map/report product was prepared from the Catawba County, NC Geospatial Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling information contained on this map or data on this report. Catawba County promotes and recommends
the independent verification of any data contained on this map/report product by the user. The County of Catawba, its employees, agents, and
personnel, disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect or consequential which arises or may
arise from this map/report product or the use thereof by any person or entity.
Copyright 2014 Catawba County NC
01/21/2019

10/17/2018
Go gle Maps 2065 Northview Harbour Dr
2065 NortNew Harbour or - Google Maps
Imagery 02018 Google, Map data 02018 Google 50 ft
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1/21/2019
Glcr glry= Maps 2065 Northview Harbour Dr
2065 North\iew Harbour Dr - Google Maps
Map data 02019 Google 100 ftt
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