20190685 Ver 1_Shoreline Stabilization_20190521

State of North Carolina
Department of Environment and Natural Resources
DWR — Division of Water Resources
Division of Dater Resources 15A NCAC 02H .0500—Water Quality Certification, Shoreline Stabilization
FORM: SSCP 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
1617 Mail Service Center
Raleigh, NC 27699-1617
t. Applicant Information (15A NCAC 02H .0502(al]
1. Owner Information
Name: Lee Bledsoe
Mailing Address: 156 Wades Way
Mooresville, NC 28117
Telephone Number: 7046041098 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:
http://www. saw.usace.army.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.odf) must be attached if the Agent has signed this application form.
Name: Dean Fisher
Company Affiliation: President, Lake Norman Custom Dock & Pile Driving, Inc.
Mailing Address: P.O. Box 1439
Denver NC 28037
Telephone Number: 7044832144 Fax Number:
E-mail Address: [e-mail]
Person to receive the Certification Approval: Dean Fisher
H'. Project Information [15A NCAC 02H .0502(x) &Lb)]
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: Iredell
Nearest Town: Mooresville
Subdivision name or site address (include phase/lot number): 156 Wades Way
Mooresville, NC 28117 (lot 5)
Directions to site - please include road names and numbers, landmarks, etc.:
Head northwest on NC -16 Business N toward Denver Dr. Tum right onto Campground Rd. Continue onto Slanting Bridge Rd.
Turn, right onto NG -950 E_ Turn right onto Morrison Plantation Pkwy -Tum left onto Plantation Ridge Dr. At the traffic circle; take the 2nd exit
and stay on Plantation Ridge Dr. Turn right onto Williamson Rd. Tum right onto Alcove Rd. Turn right onto Wades Way.
Latitude (in decimal degrees) 35.535117 Longitude (decimal degrees) -80.8681393
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):0.93 acres
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 along existing
wall
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:
750 sa 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: 1.875 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): grass, shrubs
! ° -1
i
6yf Ker/Agent's Signature* [15A NCAC 02H .0502(f)j Date
'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. 5 PLAN NO.
PARCEL ID: 4645-44-9806
STREET ADDRESS: 956 Wades Way, Mooresville, NC 28197
Please print:
Property Owner: Lee Bledsoe
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Dean Fisher of Lake Norman Custom Dock & Pile Driving, Inc
(Contractor / Agent) (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 application is true and accurate to the
best of our knowledge.
;.s
Aut,. rized Signature 2
Date: C _g_L ��,,
Authorized Signature
Date:

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