20190673 Ver 1_Shoreline Stabilization_20190520

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 2 0 1 9 0 6 7 3
One copy of the application (including aacl�ges� the application fee should be sent to:
Division of Water Resources P'` 1
LJ
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Applicant Information [15A NCAC 02H .0502(a)] h ��
1. Owner Information
Name: _Jason E kea.4)e.r (1r1Oc.k
Mailing Address: i usoo Crt ree_n 1�. o1pk-, n Ln,
Oorrntl ,05 tAc df3n3�
Telephone Number: 1o'4 - ql8 - 3l1 a. Fax Number:
E-mail Address: ason . h . CnrloCk nr)nma, l . rnm
2. Agent/ Contact Person Information LJ
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/regulatory/regdocs/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: 'l0u-(oU)-5111 Fax Number: -70(1- U6O- 5gloq
E-mail Address: _ 06eSPnuJl15a_N«;i0�S4-ream. n e-+
Person to receive the Certification Approval:
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,
etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
FORM: SSGP 10-2013 Page 1 of 3

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: �� Nearest Town: US
Subdivision name or site addressl(include phase/lot number): 11, 500 ,�re� Do ?b1 n
Ln . Co c ne i o, No—Lo
[ las
Directions to site - please include road names and numbers, landmarks, etc.:
See 00*a ilea
Latitude (in decimal degrees) a5 _ y (A 3 3y 8 Longitude (decimal degrees) — 0 . 431 SCJ 1
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): 1eniAe_n+►a N
6. Property size (acres): , 9q-1 aCtre.S
7. Lake/ river/ ocean adjacent to property: J*,Aa rrrmn nn
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):-��, i nJII nno}
T�
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:
31 6e.lato [ t.30 Sl� ay � +—f
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:_ l a� Qoy
-- e
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): Qr SS
Y10 -gees remnved rnc, d s}ter kcLnCQ -t)
Owner/Agent's Signature` [15A NCAC Qk6 . 502 f Date
`Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: 55GP 10-2013 Page 2 of 3

Full Pond/
Normal Water Level
Shoreline
Lake
(At Full Pond/Normal Water Level)
3 i L�doui
a 1 b' I ength
No tcee,5 jremo\red
iia d i s+L) s Uko'2 C
-t-o I�Jf�r
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
Jason and Heather Carlock
16500 Green Dolphin Ln.
Cornelius, NC 28031
FORM: SSGP 10-2013 Page 3 of 3

51132019 610 Fast CwW A1erxle, Mooresville, NC to 16500 Green Dclplin Ln- Google Maps
Go gle Maps 610 East Center Avenue, Mooresville, NC to 16500 Drive 12.7 miles, 24 min
Green Dolphin Ln
610 E Center Ave
le "i- -3116
t
1.
Head south on Evergreen St toward
E Center Ave
14 s (197 ft)
Take
S Main
St, NC -115 S, Langtree Rd, 1-77 S/US-21 S and
Jetton Rd to Harbor Light Blvd in Cornelius
22 min (12.1 mi)
r
2.
Turn right onto E Center Ave
0.s mi
41
3.
Turn left onto S Church St
0.5 mi
N
4.
Turn right onto College St
01 mi
41
5.
Turn left onto S Main St
1.2 mi
t
6.
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2.1 mi
r
7.
Turn right onto Langtree Rd
1.1 mi
8.
Use the left 2 lanes to turn left onto the Interstate
77 S/US 21 S ramp
02 mi
9.
Merge onto 1-77 S/US-21 S
29 mi
10
10.
Take exit 28 for US -21
02mi
11.
Merge onto W Catawba Ave
10m,
F*
12.
Turn right onto Jetton Rd
2.3 mi
Drive to Green Dolphin Ln
2 min (0.6 mi)
`1 13. Turn left onto Harbor Light Blvd
456 ft
41 14. Turn left onto Yawl Rd
407 ft
r' 15. Turn right onto Green Dolphin Ln
04m,
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5/132019 610 East Cenitw Aienlue, MoormiAlle, NC to 16500 Green Dolphin Ln- Google Mope
11 16. Turn left to stay on Green Dolphin Ln
8 be on the left
95 ft
16500 Green Dolphin Ln
Corneis NC:b�'
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.
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Professional
Property
Surveyors, Mc.
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Property o :
As Recorded in:
Site Address:
18335 Old Statesville Road Ste. A
Jason B. Carlock
Map Book 17. Pg 544
16500 Green Dolphin Lane
Cornelius, N.C. 28031
704-765-5134 Phone/Fax
Heather J. Carlock
Deed Book 30907, Pg 319
Comelius, NC' 28031
Fmn I u'rnx ('-3Md1
Mecklenburg County
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Polaris 3G Map — Mecklenburg County, North Carolina
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Date Printed: 5/13/2019 8:36:51 AM
in is map or report is prepared for the inventory of real property within Mecklenburg County and is compiled from recorded deeds, plats, tax maps, surveys, planimetric maps, and other public records and data.
Users of this map or report are hereby noted that the aforementioned public primary information sources should be consulted for verification. MecWenbu Count and its ma
responsibility for the information contained herein. r9 Y Aping contractors assume no legal

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Go gle Maps 16500 Green Dolphin Ln
16500 Green Dolphin Ln - Google Maps
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Map data ©2019Google 100fti I
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