20190411 Ver 1_Shoreline Stabilization_20190401

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
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
401 & Buffer Permitting Unit IAJ`�
1617 Mail Service Center
Raleigh, NC 27699-1617 r f I l
Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: Imo,"',, --1
Mailing Address:
Telephone Number: "]0y - 5`1 J - '745'O Fax Number:
E-mail Address: r @ ao) Com
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/resulatory/reedocs/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: 'MLI -1.1,A-5111 Fax Number: 7()y- C4U0 - 5C4(9�
E-mail Address: 0 [' eo, wI is J,) t ,,, n(i 5-+rpa m. o p.±
Person to receive the Certification Approval: Janice-
�. n
Project Information [15A NCAC 02H .0502(a) & (b)]
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.
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: S,-erleJ J Nearest Town: I`Ylooresv_'► I Ie -
Subdivision name or site address (include phase/lot number): "135 ke-MD
iilrpor�S�i , e NG a�3113 Lo+ 441'l 30 re -5 e r -r Land 7, m 1ey- 6,"\1 I5�o�
Directions to site - please include road names and numbers, landmarks, etc.:
See -4 ,b e ci
Latitude (in decimal degrees),35. 510'1 C o O o^i Longitude (decimal degrees) — 80 1q3 (v 3
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): 0-t
6. Property size (acres): . I Lp acre S
7. Lake/ river/ ocean adjacent to property: Nor max,
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): CQ S4-„rx r,
In,A►It maAinn and r1n ra ±� re ice.',f-<?r-en 5sL-)here r��pderi
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:
yr
nu) ( 17o SV o� *trmnnknAl
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: [ ! 0.6vP
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): C rn_s5 6sye-'r
b
CE. W 0einlL,sno.. S1
Owner/Agent's Signaturef [15A NCAC 02H .0502(f)1 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/
La ke
(At Full Pond/ Normal Water Level)
L{ I �e-IC.3w
Normal Water Level
Shoreline
Robert Weisenberger Jr.
735 Kemp Rd.
Mooresville, NC 28117
No gees removed
No d; S}urbo.nce.
A -o 63 � P -r
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

3/26/2019 Mooresville, NC to 735 Kemp Rd, Mooresville, NC 28117- Google Maps
Mooresville, NC to 735 Kemp Rd, Mooresville, NC Drive 9.6 miles, 19 min
��.. gIv.:. Maps 28117
Mooresville
North Carolina
Take W Iredell Ave to N Academy St
1 min (0.3 mi)
t 1. Head southwest on N Main St
r' 2. Turn right onto W Iredell Ave
0.1 mi
0.1 mi
h 3. Turn left at the 2nd cross street onto N Academy St
2 min (0.6 mi)
Take NC-1100/Brawley School Rd to McKendree Rd in
Davidson
13 min (6.5 mi)
r' 4. Turn right onto W Wilson Ave
t 5. Continue onto NC-1100/Brawley School Rd
Follow McKendree Rd to Kemp Rd
r' 6. Turn right onto McKendree Rd
41 7. Turn left onto Kirkwall PI
r' 8. Turn right onto Kemp Rd
40 Destination will be on the left
735 Kemp Rd
Mooresville, NC 28117
These directions are for planning purposes only.
You may find that construction projects, traffic,
weather, or other events may cause conditions to
differ from the map results, and you should plan
your route accordingly. You must obey all signs or
notices regarding your route.
1.2 mi
5.2 mi
4 min (2.2 mi)
2.2 mi
92 ft
407 ft
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I, certify that this map was drawn under my supervision from an actual
survey made under my supervision recorded in deed b 873 1 page 429 and/or
plot book ---L5_ page 53 that the ratio of precision is 17:10.000, that this map
was prepared in accordance with the General. Statutes of North Carol' Chapter 89C.
my hand and seal on the 3 day of JUNE A.D.
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3/15/2019
735 Kemp Rd
735 Kemp Rd - Google Maps
imagery 02019 Google, Map data @2019 Google 50 ft
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3/26/2019
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