20190380 Ver 1_Shoreline Stabilization_20190325

State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
, rFORM: SSGP 10-2013
Shoreline Stabilization Applicatian Form----'-'
Three copies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resources 2 0 1 9 0 3 8 0
401 & Buffer Permitting Unit
1617 Mail Service Center — t\ '
Raleigh, NC 27699-1617
1. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: Tyler Barrett
Mailing Address: 224 Riverside Dr
Mount Hollv, NC, 28120
2.
Telephone Number: 704-430-7739 Fax Number:
E-mail Address: [e-mail]
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.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: Tyler Barrett
Company Affiliation:
Mailing Address: 224 Riverside Dr, Mount Holly NC 28120
Telephone Number: 704-430-7739 Fax Number:
E-mail Address: [e-mail]
Person to receive the Certification Approval: Tyler Barrett
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: Gaston Nearest Town: Mount Holly
Subdivision name or site address (include phase/lot number): 224 Riverside DR
Mount Holly, NC, 28120
Directions to site - please include road names and numbers, landmarks, etc.:
Hwy 16 N; Right on Horseshoe Bend Beach; Left on Horseshoe Lake; end at 224
Latitude (in decimal degrees) 35.3528230 Longitude (decimal degrees) -80.9419590
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Residential
6. Property size (acres): .2
7. Lake/ river/ ocean adjacent to property: Mountain Island Lake
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Place rip rap to prevent erosion
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:
Now s—v
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: 600 Lf'�
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): Spotty brush
with erosion spots beneath
6a_�
Owne gent's Signature' [15A NCAC 02H .0502(f)l Da e
`Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

Lake
(At Full Pond/Normal Watertevel)
New PWA
Full Pond/
Normal Water Level
Shoreline
f' X50 rf'
g yaw ftU�
8�p0ty n
X �Uf�
PtAI-L C,15,4ItEb
Rr P RAP P44666
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ftx 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

Go gle MapS 224 Riverside Dr
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224 Riverside Dr
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ADDRESS 224 RIVERSIDE DRIVE, MT HOLLY, NC 28120
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boundary lines which may - may no be upheld by a court
of law and, (2) the general survedoes not include the
No part of this drawing may be reproduced by photocopying, recording
or by any other means, or stored. processed or transmitted
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location of all easements end, (:,y In ser,. rel.Ung to
boundary w,rvey., the consultant limits the liability to the
slectronkally without the prior written p""Ission of the a yor. This
survey I. -lid only for the parties Indicated in the title block.
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professional fee charged to the silent
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This property is not located 'n a 100 year flood zone per
VICINITY MAP
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PROPERTY OWNER: SYBIL & TOMMY ELMORE
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BOUNDARY/LOCATION/CONVEYANCE SURVEY
546 Newell Street NW
PROPERTY OWNER: SYBIL & TOMMY ELMORE
Concord, NC 28025
RIVER BEND GASTON
[phone]
Type„ Co., NC
ADDRESS 224 RIVERSIDE DRIVE, MT HOLLY, NC 28120
Firm License No.: F-0759 Qj&o
PID , 176361
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DEED BOOK 2150 PAGE 529
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LEGAL REF:
1, o rIC u On a certify, that this map was drawn from an
actual .urv.y made urd., my .up.rvisbn (deed d. ... iptian —.,d.d in
D8. 2150, PG. 529; that the ratio of precision as calculated by btitudew
and departure. ... 1:87,424+; the bounl.des not surveyed o shown
e broken linew plotted from Informvtbn found in M9 09 PG 33;
and that the angular f n was 02' per m.
Witness my hp �ffbia( 1 th th dayy Ju ,
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Registered Land Surveyor License No. L-3228
C:\Dar=ns and SeWnp\RodACCUTECH{ED366\Dalmp\13115\13115.dwg
SURVEY FOR: TYLER BARRETT
SCALE 1" = 30' DATE; JUNE 26, 2013
SCALE IN FEET
30 0 30 60