20190161 Ver 1_Shoreline Stabilization_20190205

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SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. � \ PLAN NO. PARCEL ID:
STREET ADDRESS:
Please print:'(��
Property Owneer. ` ��5
Property Owner:��" --1
The undersigned, registered property owners of the above noted property, do hereby authorize
of
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
2p1901a
Telephone: 0,�—��^ — lz�"—aA,
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Date: t / �212 > r 9
—�.�....-,-----
Authorized Signature
Date:

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State of North Carolina
INC- Department of Environment and Natural Resources
Division of Water Resources
WaterResourc-es 15A NCAC 02H .0500 - Water Quality Certification, Shoreline Stabilization
l NVIRONMIrN IAL GUALIIT
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 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)J
1. Owner Information _
NameSc��.s
Mailing Address:
Ic- \\tel
Telephone Number: Fax Number:
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.army.mil/PortaIs/­59/docs/­`rep,ulator re docs/PPrmift/qAftA__ - AGENT AUTHORIZ
ATI/l\1 raw.. •r\
Name:
Company Affiliation: ,�—y'�� \�\�r���e, ,7�0�\C_
Mailing Address: \ " I-!
Telephone Number:t\�� aC\c\- � Fax Number:
E-mail Address:
B. Project Information [15A NCAC 02H .0502(a) & (b))
,X 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.
,Z. 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

a
"'- Attach a photograph of the shoreline/ bufferro 0
p p sed to be stabilized. (Include a scale of
some sort- a yard stick, shovel handle, etc.)
4. Location of the property (wh. re work is to be conducted)
County: ���� Near st Town:�����5����
Lake/ river/ ocean adjacent to property:��`�����
Property size (acres): 1
Subdivision name or site address (include phase/lot number):
Directions to site - lease include road names and numbers landmarks etc.:
VZ,
Latitude (in decimal Longitude (decimal degrees) -
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): 1q cc; T Lz, 7-
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
G� 1 I �� �i�,¢—f' r -L �•�./'!�-._ I-� CU � v L� �i _ �`(;!i •. �^'� e
,/� I� P1� L � / �-C� S ,;,.-, c% S�-� C b✓�s c�c � l '�1 i f --¢-Cr 6 � •- �Cc1� T�� C/.t-.J1" i� ���'�,
7. Will work be conducted from land? From water? g1te1Zzl
8. Total amount of impacts below the normal pool lake level/ Normal Water Level
Permanent impactsincluding all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
G�
Temporary impacts in square feet:
e
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:
Z Z�
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): ,54A
sU I (ie,"/ics
11. Signature
Owner Agent s gnature' [15M�C��� 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 anV — .1..,.1..— V_i_.. _
- ��b•
Full Pond/ Normal Water
Shoreline
Plan
IF, -�IWW LlM rull runup wormai Water Level elevation
Lake
(At Full Pond/ Normal Water Level)
C-� C�)
Lake
01 FLA POW NWMW %W L..Q EWsft Dock
Full Pond/ Noynal Wow Lems:ssss•�ts•ss• ,
�iSY�•�Z• ...:
iprap
if
E AMP E
Plan View
FORM: SSGP 02-2017
Page 3 of 4

9i
Lake �z
(at FWi �� voter �++�)
Lm
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C
Side View
ILL.
3 ft. below full pond water level
Existing bank
10 ft. bank
4 ft, above full pond water level Z ft• additional clearing
'if necessary
FORM: SSGP 02-2017
Page 4 of 4

2/1/2019 335 Agnew Rd - Google Maps
Go gle MapS 335 Agnew Rd
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Map data ©2019 Google 500 ft
335 Agnew Rd
Mooresville, NC 28117
https://www.google.com/maps/place/335+Agnew+Rd,+Mooresvi IIe,+NC+28117/@35.5625886,-80.9365559,16z/data=!4m5!3m4! 1 sOx8856acda9e3c7... 1 /1

NOTES:
• YRgflislw\YgOR EASEMENTS
Curve Radius Length Chord
• OWNER To
Chord Bear.
VERIFY ALL SETBACKS AND ZONING
TO ANPLANNING ORc
C7 224. 1 117.91 116.6 N 58'120 E
• DIMENSIONS OF ALL IMPROVEMENTS SHOWN ON
THIS PUT "" NOT BE SCALED OR RELIED
UPON FOR DESgN OR CONSTRUCTION WITHOW
/
A FED VfRFrAT0N OF ALL DROMAIN IL
.
• DIORAL COPIES OF THIS FEE ARE FOR REFLROICE
/
ONLY AND MAY NOT BE USED FOR DESON WORK
• NO PORTION OF THE RESIDENTIAL STRUCTURE
/
/
• BEM �4 RFDAR
�.
S LOCATED N THE 100 YFM FLOOD KM
•
RIW
50
A PORTION OF THIS PROPERRY IS LOCATED IN A
100 YEAR FLOOD PLML
AGNEW ROAD
J. SANCHEZ
Cor PvW
��g��' , 1808-2137
15-35
/
CONCRETE MONUMENT "� ®WELL "am y
/ •:.�`\�qS�,,�
�''Ja', � IV COUNTY SB
IRALDING
/ ®
Yom' / ��;'.• "g 50' SO PER PUT
\\
0.607 AC
15-35
REBAR
A7\ \CAR PORE :;'?i:�•. % �'/
\ 51
APPROXIMATE 100 YEAR FLOOD LINE
/ / APPROXIMATE 760' CONTOUR
SIMPSONS INVESTMENTS �V
2386-1754
\ , ' alA FRAME BUII.CNri �
15-36
- I %:
40 0 40 80 120
GRAPHIC SCALE - FEET 05
PHYSICAL SURVEY
FOR
NANCY CRAFTON
LOT /51 OF CRESCENT LAND A, TROM RED. LATS
355 AGNEW ROAD. MOORESVI L.E NC 25117
DAMDSON TOWSHP, StEDE1L COUNLY. NC
SCALE: 1' — 40'
DEDMON SURVEYS
CHUCK POOVEY, PLS #3761
ROBERT DEDMON, PLS #3899
3704 NC HIGHWAY #16 NORTH
P.O. BOX 494 - DENVER, NC 28037
PHONE: [phone]
FAX: [phone]
SIAL
L -3M
1, ROBERT J. DEDMON. CERTIFY THAT THIS PUT WAS
DRAM FROM AN ACTUAL SURVEY MADE UNDER AIY
SUPERVISION (OB 615. PC 451 )(PB 15 PC 3S);
THAT THE RATIO OF PRECISION AS CMOIRAT5
EXCEEDS 1:10.000'; TINT TNS PUT WAS PREPARED
IN AOCOROARCE WRH CS 47-30 AS AMENDED.
WITNESS MY ORIGINAL SIGNATURE. (11-30-2015).
ISDN. BY: Wr I DRAWN: JR I x" WOLT51
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