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Home My WebLink About20190598 Ver 1_Shoreline Stabilization_20190502State 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 2 0 1 90 5 98 Three copies of the application (including attachments) and the application fee should be sent to: 1 Division of Water Resources 401 & Buffer Permitting Unit �\ n , 1617 Mail Service Center Raleigh,PAID NC 27699-1617 / I -.1 Applicant Information [15A NCAC 02H .0502(a)] Owner'~F. Name: Mailing Telephone Number: 7py Q%S- X37 f Fax Number: 9/9.287 ;Z9S-S— E-mail Address: Ko^(_*Qer;41cQyiip/Yen�ScryiCeS.eowj 2. Agent/ Contact Person Information A signed and dated copy of the Agent Authorization letter (a form can be downloaded here: ht_tp,/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:�f� Company Affiliation: Mailing Address: Telephone Number: E-mail Address: Fax Number: Person to receive the Certification Approval: n n4 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 propert(where work is to be conducted) County: Q (.v ; ok Nearest Town: ben aey— A je— Subdivision name or site address (include phase/lot number): MAI 'n"S A iA t"xo� 4 1 Directions to site - please include road names and numbers, landmarks, etc.: 'T -m ,,e. (; A 4 cie41 0 t-, V is -a 's',.m rr& ""; l le T'- 7,1 /,.c s� Latitude (in decimal degrees) 3Longitude (decimal degrees) —036. 17717,57 5. Describe the existing land use or condition of the site at the time of this application (residential, undeveloped, etc.): ae5iAe41a i 6. Property size (acres): r I & S Acct 5 7. Lake/ river/ ocean adjacent to property: L .A )&c AJQ Ma4 8. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, orwhyit is necessary): A84 1-2 l9Y of 4P 4-0t— �OA 0V CX6 4I /l4 12 io gA A 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: AJON 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: JOVE 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): AJOAv6 ner/Agent's Signature* [15A NCAC 02H .0502(f)l Date 'Agent's signature is valid only if an authorization letter from the owner is provided. FORM: SSGP 10-2013 Page 2 of 3 La ke (At Full Pond/ Normal Water Level) Full Pond/ Normal Water Level Shoreline,;o rz Y.2 7-a 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 NOTES: • PROPERTY MAY BE SUBJECT TO RECORDED OR UNRECORDED RIGHTS OF WAYS OR EASEMENTS NOT OBSERVED • OWNER TO VERIFY ALL SETBACKS AND ZONING REGULATIONS PRIOR TO ANY PLANNING OR CONSTRUCTION. • DIMENSIONS OF ALL IMPROVEMENTS SHOWN ON THIS PLAT SHOULD NOT BE SCALED OR REUED UPON FOR DESIGN OR CONSTRUCTION WITHOUT A FIELD VERIFICATION OF ALL DIMENSIONS. • DIGITAL COPIES OF THIS FILE ARE FOR REFERENCE ONLY AND MAY NOT BE USED FOR DESIGN WORK. • A PORTION OF THIS PROPERTY IS LOCATED IN A 100 YEAR FLOOD PLAIN. • NO PORTION OF THE RESIDENTIAL STRUCTURE IS LOCATED IN THE 100 YEAR FLOOD PLAIN. Course Bearing Distance L1 S 48°53'00° E 71.97' L2 N 89°12'42' E 41.14' 1/2° PIN )I, o h/ tir / / 2 / 7g2g / / 'OO / Rcy �e #2 REBAR 40 d9 40 0 40 80 120 \ \ GRAPHIC SCALE — FEET ` DOCK APPROXIMATE 760' CONTOUR LINE 9 � i \\`rB L2 j)4 REBAR o, 0.368 AC +- ^y� \APB 16-132 `S�BUfF _-7 / A 114, OFC ^�. lb I O /. EDGE OF DRIVEWAY Q. ENCROACHES 0.6' PIPE CHUCK POOVEY, PLS #3762 ROBERT DEDMON, PLS #3899 3704 INC HIGHWAY#16 NORTH P.O. BOX 494 - DENVER, NC 28037 PHONE: 704/48314908 FAX: 704/48312170 SEAL L-3899 I, ROBERT J. DEDMON, CERTIFY THAT THIS PLAT WAS DRAWN FROM AN ACTUAL SURVEY MADE UNDER MY SUPERVISION (DB 3471, PG 3)(PB 16, PG 132); THAT THE RATIO OF PRECISION AS CALCULATED EXCEEDS 1:10,000'; THAT THIS PLAT WAS PREPARED IN ACCORDANCE WITH GS 47-30 AS AMENDED. WITNESS MY ORIGINAL SIGNATURE. DECEMBER 20, 2018. Y 0 m �,� � 3899 5 PROFES510 LAND 5URVEYOR LICENSE NO. a SU.. BY: MP DRAWN: RD JOBS MPMSD9 VICINITY MAP 4rA,, SHORE OP SITE 0 PENINSULA LN U LEGEND PHYSICAL SURVEY FOR \P C\ / EDGE OF PAVEMENT RONALD CHAMBERS, JR CHNTERUNEWAY PDE PERMANENT DRAINAGE EASEMENT )K UTILITY POLE LAKE - A UGHr POLE 8172 MOUNTAIN SHORE DR - SHERRILLS FORD, NC ==NORMAN 0 swrrARrSEWER MANHOLE LOT#9, MOUNTAIN CREEK SHORES SUBDIV. ALL DOCKS. PERS OR OMER. �INPROVENENfS. M/yW.:OVERHEAD UTILITY UNE B01LT 1) UNE, -ARE NOT S.011 OOWWNN ON THIS MOUNTAIN CREEK TOWNSHIP, CATAW BA COUNTY, NC SCALE: V=40' DEDMON SURVEYS ` DOCK APPROXIMATE 760' CONTOUR LINE 9 � i \\`rB L2 j)4 REBAR o, 0.368 AC +- ^y� \APB 16-132 `S�BUfF _-7 / A 114, OFC ^�. lb I O /. EDGE OF DRIVEWAY Q. ENCROACHES 0.6' PIPE CHUCK POOVEY, PLS #3762 ROBERT DEDMON, PLS #3899 3704 INC HIGHWAY#16 NORTH P.O. BOX 494 - DENVER, NC 28037 PHONE: 704/48314908 FAX: 704/48312170 SEAL L-3899 I, ROBERT J. DEDMON, CERTIFY THAT THIS PLAT WAS DRAWN FROM AN ACTUAL SURVEY MADE UNDER MY SUPERVISION (DB 3471, PG 3)(PB 16, PG 132); THAT THE RATIO OF PRECISION AS CALCULATED EXCEEDS 1:10,000'; THAT THIS PLAT WAS PREPARED IN ACCORDANCE WITH GS 47-30 AS AMENDED. WITNESS MY ORIGINAL SIGNATURE. DECEMBER 20, 2018. Y 0 m �,� � 3899 5 PROFES510 LAND 5URVEYOR LICENSE NO. a SU.. BY: MP DRAWN: RD JOBS MPMSD9 VICINITY MAP 4rA,, SHORE OP SITE 0 PENINSULA LN U 10 16 Lv Bing Data from: Zillow - GreatSchools 9 8172 Mountain Shore Sherrills Ford, NC 286' a. + o f s , '' Pry it t YG '; tt.. -' l �• Sp 5 -. ��""Viii ! e"t. ,,,�C' . .'x 1 .,..'•' �=.� Yds .'Tii t', � 1��-� {..' -`L f -�. - fi IVY y' INS apt--. s