20190493 Ver 1_Shoreline Stabilization_20190415

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:
1.
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Applicant Information [15A NCAC 02H .0502(a
Owner Information
Name: George Fulford
Mailing Address: 14050 Clarendon Pointe Ct
Huntersville. NC 28078
20190493
Telephone Number: 7048759714 Fax Number:
E-mail Address: [e-mail]
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
httr)://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: Dean Fisher
Company Affiliation: Lake Norman Custom Dock & Pile Driving, Inc
Mailing Address: PO Box 1439
Denver NC 28037
Telephone Number: 7044832144 Fax Number:
E-mail Address: [e-mail]
Person to receive the Certification Approval: Dean Fisher and George Fulford
II. Project Information [15A NCAC 02H .0502(a) & (b)1
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: Mecklenburg Nearest Town: Huntersville
Subdivision name or site address (include phase/lot number):
14050 Clarendon Pointe_Ct, Huntersville, NC 28078 lot 10
Directions to site - please include road names and numbers, landmarks, etc.:
Take NC -73 E towards Huntersville. Turn left onto Hagers Ferry Rd.
Tum right onto Clarendon Pointe Ct. Property is 0.3 miles ahead.
Latitude (in decimal degrees) 35.4334233 Longitude (decimal degrees) -80.934000
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): 0.989
7. Lake/ river/ ocean adjacent to property: Lake Norman
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Refresh erroded areas of rip rap
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:
1000 sq ft
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 sq ft
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): dP rap with
shrubbery and grass
Owner/Agent's Signature* [15A (4CAC 02H .0502(f)]
Dat
Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 10 PLAN NO. PARCEL ID: 00101476
STREET ADDRESS: 14050 Clarendon Pointe Ct, Huntersville, NC 28078
Please print:
Property Owner: George Fulford
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Dean Fisher
(Contractor / Agent)
of Lake Norman Custom Dock & Pile Driving, Inc
(Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
Telephone. [phone]
We hereby certify the above information submitted in this appication is true and accurate to the
best of our knowledge.
Authorized Signatifre'
Date: —L 2 11131 Z o
Authorized Signature
Date:

Jul 12 04 04:25p DRUID J. DILLS, PLS 7048212099
p.1
SHOWN 01N -THIS PLAT AND THAT THE TITLE LINES AND THE WALLS OF THE BUILDINGS IF ANY ARE
SHOWN HEREON. THIS PROPERTY IS LOCATED IN ZONE X PER FEMA FLOOD INSURANCE RATE MAP
COMMUNITY PANEL NUMBER 370158-0030B DATED FEBRUARY 3. 1993 EXCEPT THAT PORTION THAT LIES
BELOW THE 761.00 ELEVATION WHICH IS IN ZONE A PER PANEL 370158-003013 DATED FEBRUARY 3.
1993 PER RECORED MAP
DISK 22 -
NOTE: TO THE BEST OF MY KNOWLEDGE SIGNED "' -- --- "
THE IMPERVIOUS AREA IS APPROXIMATELY DAVIO J. DILLS N.C.RJL- L-2503
19% OF THE LOT AREA,
A�w LAKE NORMAN PROPERTY LINE FOLLOWS
760' CONTOUR LINE IX CAA?
b;t, 49'02-E
S 20-49',30-E 5 \ 69.18. SEM.
IPF 63.49' S L-2503
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George Fulford

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