20140042 Ver 2_Shoreline Stabilization_20190510

el qo41,� v x
a^w
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
ENVIRONMENTAL QUALITY FORM: SSGP 02-2017
Shoreline Stabilization Application Form PAID
W
Three copies of the application (including attachments) and the application fee should asen
If sending via US Postal Service
Karen Higgins
DWR-401 & Buffer Permitting Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
A. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name:
Mailing Address:
If sending via delivery service (UPS, FedEx, etc.)
Karen Higgins
DWR-401 & Buffer Permitting Branch
512 N. Salisbury Street
Raleigh, NC 27604
11----"% )0'�
� � GLi
diol
MDLR-eSy i L -L -e . W N I rl
Telephone Number: Fax Number:
E-mail Address: C�oV opvE4-)V' @ama"l.O-D(h
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.armv.mil/Portals/59/docs/reeulatory/reedocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf)
Name: P} -F 1 L�6T'-f' �
Company Affiliation:
Mailing Address:
Telephone Number
E-mail Address:
2412 UwQzve
l►►'*
t
DA ► 1:•Number:
B. Project Information [15A NCAC 02H .0502(a) & (b)]
f1. 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, 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

' ✓ 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: iR�DeL�- Nearest Town: M mg-2SV ic-L-e
Lake/ river/ ocean adjacent to property: Lai{ e NDS aW
Property size (acres): 0 814 S
Subdivision name or site address (include phase/lot number):
Directions to site - please include road names and numbers, landmarks, etc.:
0 DRaw/ �Y (C,+b-)� R
Latitude (in decimal degrees�,�aE _548 Longitude (decimal degrees)–Op- F33' J f) . L;14
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): �I D-e�l-aL.
6. Describe proposed work (include discussion as to how hardening off shoreline has been
avoided, or why it is necessary): �Qiw.JC h–Ile-1oG�T eaQ (
�x�s-r�NC-� �4ttr>,z-eu�'C-gar l�"�,�rT wasF+c-��ra�►
7. Will work be conducted from land? `4 From water? ❑
8. Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent impacts (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
Temporary impacts in square feet:
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:
32oS.�7•
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):
11. Signature
Owner/Agent's Signature' [15A NCAC 02H.0502(f)] 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 any excavation or dredging below the Full Pond/ Normal Water Level elevation
Lake
(At Full Pond/ Normal Water Level)
bO �1G
CXj
Full Pond Norma �xISTI uCT
Shoreline
Plan View
FORM: SSGP 02-2017 Page 3 of 4
Lake
(At Full Pad/ Normal Water
Level)
Existing Dock
30ftx7ft
3ftxiSOft
Full Pond/ Normal Water Level
&low full pond/ N WL
r aat reTne . .
aft.L50_ft
Riprap
Above full pond/ NWL
2 ft. x 150 ft -
.d ditional Bearing
' if necessary
EXAMPLE
Plan View
FORM: SSGP 02-2017 Page 3 of 4

a)
Lake
(At Full Pond/ Normal Water Level)
N
C
N
O
s
C
Side View CIL
Lj-
3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing
*if necessary
Existing bank
10 ft. bank
Side Vi
J he;
�o
Quo
FORM: SSGP 02-2017 Page 4 of 4

Wm. 40 0 40 80 120
IW al°Eo' Or . oa �►+an
•
NOT To VmFT A L SEmAm AND ZMM GRAPHIC SCALE — FEET
RECUTATNRNS PRIOR TO ANY PLATO G OR
C0ISTRNom.
' DYIENS7011S aF AL: WPRaYFYENI9 SRIOWN aI
a
THIS PIAT SNOUA NOT RII 50 oa RE
UPON FAR OEM OR CMWRUMW WITHOUT
1131
A PIETA iMITCU ON OF ALL CUMS10 6.
44 PPI
• 610OAL OF 7H6 RIE ARE FOR RffERENOE
oARY NIO YAY Nor RE 16[0 Fdl a& 07 WORK
J�
�L
• JW DRAW. a UMW R3RSEWW COW ALONG EACH UPI LOC
� _ '9
`
• NO UM NOMFLUD MW 2000 OF SUM" PR DPVM-
WEM
�v COILy
• A PORNON OF TNS PROF90 IS L=TW N A 100 YEAR FLOOD PLAN
AS OESWMIm & FM PAHA / 3110462400E
/'\!!�
'% �_(3.
CITEMNE CAM 3-11-2606
/'[ A
• NO FORRON OF THE RCS0001AL STRUM" RS LOCATED U INC 11000 PLAX
IsaeND:
1131
�•�-
WNANE
UNDEROR
�nnnnraW'm m "tE1E.N10N
IRIOiRWOlA01
• ` E
PB 41-60
P 04E Rmm)
1852/692
CP CmPureD . GOWAaO:O)
H/W raw -w -uv
E/P FDOE OF PAYEROR
C/L C WW
d . Uum POLE
14 PN
$
O
1p
11 , L�
DEDMON SURVEYS
JO• �
0.82 AC.+:�,
of 5 /�°
&ot
1129
PB 41-60
1699/2222
�a Irr-��Lina4sscx i�
w Kill tFJE2 =!Aus
tel• 0 a TK -D0 m" PIw S uP14■; &I:iI-9C!Yl "al
FOR
DAVID E. PYLIPOW
& MARY PYLIPOW
LOT J1130 OF INE PONT ON NORMAN
• 189 SHELBURNE PL. MOORESME NC
OATO 7-15-13 1653 PC, 1318
Pal
SO"- I' . 4V 41 PO: 10
DAVIOSON 7OWNSMP
IREDELL COUNTY. NC
CHUCK POOVEY. PLS 83762
ROBERT OEDMON, PLS #3800
3704 NC HIGHWAY #16 NORM
0.-80X-494---DENVE"C-26Q7�
PHONE: 7D414B3[ 908
fAX [phone]
111 !
i 4e
`�� /UO1111111�`
1 Calm THIS PLAT 118 ORIOTN FRDYAN ACRAL
SUM ANO 6 TRIS TO TNC BEST
3782
SUN. Ria HL I DRAIN CP JOW PO0R165

qk
t • ~"
JFWz '
t CPO Cod
of
It
1IL
e is
44
t
v
s,
� � � �1/ HYD°iy- � �,iy' .• � i`
A4c.
j•1 ' _ � t
` -• :. fir.. � �• :�
A�.
'VI -7 , : 4 g- /
um

J
N 10f,
'At

Disclaimer: While every effort is made to keep information provided over the internet accurate and up-to-date, the County does not certify
the authenticity or accuracy of such information. No warranties, express or implied, are provided for the records and/or mapping data
herein, or for their use or interpretation by the User.
Property Map
sq

Tax Account Number: 8omoe90
Old Parcel Number:
Owner Name: PYLIPOW DAVID E+MARY E
Mailing Address: 155 SHELBURNE PL MOORESVILLE NC 28117
Property Location: SHELBURNE PL
Lot Number: 1130
Legal Description: THE POINT P11 M1 PB41-60
Municipal Information
Township Code: 17
City Code: Null
Neighborhood Code: 17083
,Value Information - 7 or .. •
Building Value: 978750
Other Building Features: 127770
Land Value: 510000
Tax Assessed Value: 1616520
Deferred: o
DeedsLand Information - ,Ler of Online
Date Recorded Document Type Deed Book Deed Page Plat Book & Page Land Area Land Type Zoning
20130809 WD 2259 1069 41-60 0.818 AC Null
InformationTax
Exemption Tax Code 1 Tax Code 2 Tax Code 3 Tax Code 4 Tax Code 5
Null C ADVJAX Null FR04ADVLTAX Null Null
Iredell County
704.878.3118
Harmony
704.878.3118
Love Valley
704.878.3118
City of Statesville
704.878.3575
Town of Troutman
704.528.7600
Town of Mooresville
704.662.7040
Village of Davidson
704.892.7591

pleg!( )5XA5rcU1�d �� /-1/G 1f LlGA7�o
A /V,,q 0/' 5 4/0 /�L11v Jf-:� ©AvZ_ Y
• rAtr JIf 1NlOF m gCcimm OR 40 0 40 60 120
f•RW7ofn
jrtDor WAls o0 PSO EIFFS
• Zm m v Fv ALL SOBA AID ZOIIIaO GRAPHIC SCALE - FELT
JfolaJ IM P10011 TO AW wMOING of
tzFa�amlml.
A FUD tf3af1WAM Or JILL 011101134111. `.�
• °mllx�ilfo� Fa e�1ra1t a�aJ � �4 pw�r
H? Mft r UMW eAa�W 01101 AMID ECK WP UHL �.
NO tW UNIU9 Nf MW MM 1000' a SUa W PRDP ► !r/�/"�{... {�
• A Pl1FINN OF IM PItOFG" 6 1DD1m7 N A tDo VIM FLOOD PILAU � j •' "" � Av C
®FEURIE Q%Fa AS MEECHAMED a -IOC -M n0)F{l000c meq{ D7iC j Q
• ND ram" OF' m JtLSmum sOtlMitAfE 6 Lowe M = 1Lm N= "4 [� � v
uaalm:
�-�
�i.1D�avi
lot• IUMi
. IDIRII FM
DEDRON SURVEYS
test
PB 41-60
14 PN
4
50,
,
,
1
;LA10�
10
!moi V'E'.�Z. Rp rli
T
J4 �
- 7 #AO a
8
PB 41-60
1699/2222
�'� i-�li�S IL:Y4s SClC -5�
rtr ■>.111r-�-rsr� � s -x-
6F►.)l0 <,�Liz_.7C�4. � fes. !s:�
11c�>• Er;aIF_I7i 4f• 111t�CS_]r�
L�C1t�I=I..�itLS1FC7�fCr}f'e°li t: E?iiF-Y!i<>tl','J♦
PHYSICAL SURVEY
FOR
DAVID E. PYLIPOV
& MARY PYLIPOW
LOT J1130 OF IRE PONT ON NCWAAN
O 185 SHELBURME FL. NOORESAIM NC
DJM 7-10-43 oe 1353 P03 Ire
1t /Qt
8®I1C• 1' . 40'FM 41 f4 b
Mom TOWk06P
nam COUNTY. NO
CHUCK POovEY. PLS / 76z
ROBERT OEOMON, PLS %1!a
1704 NO M041 AY YtS NORTH
SIX
Lam
x fm 1J1
1 Waft p
'+aOtraFAls1
VTCHM 1e
10
�4
�° •
/ITE
X
s1IFaBlatNE :J.