20190678 Ver 1_Shoreline Stabilization_20190520

SAMPLE AGENT AU$RX FORM 2 j 9 0 6 7$
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO.�rS�( PARCEL ID:
STREET ADDRESS: 6 "1 ( C -r -Q t S
J' e O rec---' ✓ 10 C 23- l l
Please print://��
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Property Owner: C.0 l ` ►' t t`�!, -'j--
Property
'j--
Property Owner: J36,C
t�%L_f
The undersigned, registered property owners of the above noted property, do hereby authorize
�-�h Sc' Y-) of
(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):
7 crus t i �G IA010-?-?- S V/ /�e ""Vc 2-vi�
Telephone:
76)c 677- � �u
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
�-
Authoriz Signature Authorized Sig re
Date:�5 / % Date: -�

01 -
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
Three copies of the application (including attachments) and the application fee should be sent to:
If sending via US Postal Service If sending via delivery service (UPS, FedEx, etc.)
Karen Higgins Karen Higgins
DWR - 401 & Buffer Permitting Branch DWR - 401 & Buffer Permitting Branch
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC 27699-1617 Raleigh, NC 27604
A. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: G, I i P'P /) rT 4-- cz_ b cc., r -e'
Mailing Address: C,> ( g, 4 (a 9--K
%�,�(9ar�5lr r 1 til L `%`t�.
Telephone JkI5er: 1(9l1 t
p �Pti -1 �� _TOC
�$�-Number: �r _ 7041962 669if
E-mail Address: G2 u_ 6& 07 I -2, -67(D_ GLp ( . C 0—W1
- � J -1P 10 M c<- rvi e vi a f c -o �
2. Agent/ Contact Person Information J
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 army mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf) /
Name: a. s (i ,
Company Affiliation:
Mailing Address:
Telephone Number: Q"syl7� Fax Number:
E-mail Address: -50
B. 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, 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
0

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: 1 r --r- 'd—e- ( i Nearest Town: _ 626 T- e S V l ( Q
Lake/ river/ ocean adjacent to property: �--� �� ,/l� b fi M Ck V1
Property size (acres): � _S6j
Subdivision name or site address (include phase/lot number):
Directions to site - please include road ames and numbers, landmarks etc.: ,L7?
lqcke o( Z d �,OeEJ)(I e P v acs tzS
�
Latitude (in decimal degrees) Longitude (decimal degrees) f 5 �
5. Describe the existing land use or condition of the site at Jhe time of this application
(residential, undeveloped, etc.): 2o -S i � ✓���
6. Describe proposed work (include discussion as to how hardening of shoreline has been ,
avoided, or why it is necessary): AcJJ. ri (? Y'C-I- (�► �'v �ry" + 1s ^y ((
0h(� A'TO� 1�� ri d �✓(�arB.((,r, �,—}���+l�1-Ze , �v r rS rvnfrorJ U
7. Will work be conducted from land? Yr From water? ❑
8. Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent impacts (including all exyvation, backfill, rip,rap, retaining walls, etc.) in square feet:
t65-) �vL (--P rc- r •kga,e.,4­ 4,tke wix, tt
Temporrary�rnpaLts in square feet: /
C©% P -c r el (m n `� L� a,C ( G2.< < G� •� V C41 i[ C.)
9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet
land -ward
Permanent impaptts (includi
—
/DJ /
fill, xca ation, ri r p, ret ining walls etc.) in siquare feet:
L.. ��/� I ret
Pfdeep
Temporary impacts (temporary clearing, construction corridor) in square feet:
" , C55 l 5- �Lo he, re,ma-V e_ �Z4
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): e--�-
11. sigpatUrq
Gil' g- o
Owner/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 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)
:Ir'l _P°c,I�
para
Plan View
Full Pond/ Normal Water Level
2k x 150 fL
addftlonal cl—Ing
' If necesury
Kd0s� t---
Lake
(At Full Pond/ Normal Water Lewl) Existing Dock
/30ftx7ft
Riprap
3ftv150ft
.loW full pond/ N WL
rw
4ftx4ftX 1500
ft
Ab— full pond/ NWL
E,a ,Qw�CAMPLIE
FORM: SSGP 02-2017 Page 3 of 4
)3
`F

_ .t.=.. e -La
(At Full Pond/ No
E
C
Side View CL
ILL
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 a
height ge'
Q�
t�
Q
Side Vi.:
FORM: SSGP 02-2017 Page 4 of 4

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191 Crystal
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Mooresville, NC 28117
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5/8/2019
Google Maps 191 Crystal Cir
191 Crystal Cir - Google Maps
Imagery ©2019 Google, Map data @2019 Google 200 ft
191 Crystal Cir
Mooresville, NC 28117
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Directions Save Nearby Send to Share
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LEGEND
0 FOUND OR SET REBAR
UNESNO7 SURVEYED
UTILITY POLF
EDGE OF PAVEMENTIGRAVEL J
WELL
LANDMARK TIE;AS NOTED)
TELEPHONE PEDESTAL F
LOT 28
«•r.. w�cw
M 4P4 IY. SMO
PHYSICAL SURVEY
CRYSTAL BAY
PLAT BOOK 9, PAGE 9
LOT 29 &
ADJOINING TRACT
GRAPHIC SCALE
•ma-wrt
LIKE NORMAN
dna aemr;wwa
lM L/.liG I1M
VCINIITYMAP
.T
-`�'j• •^ A, ° �O 4 .w... _L18 547'64.42'E 10 29'
C1 -y^ •? A 5'L1g L19 S35'17JT'E _ 1371' {
L=427x• _ •., _ �7J� L20 S28'S8'20'E 18.99'
R
574 °e L21 S17 -01'02-F 10.64'
CH ARCH = 42 5IS 2520E�. i L22 + SO4-21-33-E 14.87• .
\� & w L23 ) St t'4743 -W - 1027
LOT 30 - VCNE M Nanah C,l _ - __..
GENERAL NOTES:
1 APPARENT SOURCE OF TITLES DEEDBOOK 1045. PAGE 48
DEED BOOK 1038. PAGE 1317
2 THE PROPERTIES SHOWN ARE E2USTINQ PARCELS OF LAND
3. LINEAR ERROR OF CLOSURE EXCEEDS 1 ,20,000.
4 AREA CALCULATED BY COORDINATE GEOMETRY METHOD.
5 N.0 -GA MONUMENT NOT LOCATED WITHIN 2007 OF THIS SITE.
6 THIS SURVEY WAS PREPARED WRNOUT THE BENEFIT OF A TITLE
REPORT AND IB SUBJECT TO FACTS THAT SUCH MAY REVEAL
7 UNLESS SIGNED AND SEALED THIS MAP IS PREJMKARY.
8. ZONING REQUIREMENTS SHOWN PER IREDELL COUNTY'R-20'.
I. JOFN W BA.LZER. CERTIFY THAT THIS PLAT
WAS DRAWN FROM AN ACTUAL FELD SURVEY
PERFDRMED UNDER MY DIRECT SUPERVISION,
IS CORRECT TO THE BEST OF MY KNOVI -E
n AL s
�L.4M •
C�lW BALZER
LS L-3868 p `'••...,.� �e
LINE TABLE
UNE
L2
BEARING DIST
1563'20'38'E 2.83' i
L3
1
578'4 tATE 5.58' J
U_SSB'S3'OB'E
784'
!_ L5
S40'S3'18-E 553'
LIS_
52Y03.14•E 11 77'
L7
S13.167WE 4541'
Le5063928-W
-417'
L9
S2Z'38'S6'W 4.87
110
LS50"2717'W S.BV_
• l71
! N05'3514'W { 5.88'
L12
S62 -2Y07 -W 1 `~1120
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f
l 4
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SIU 9•.'Ir �
FU
M1
LIS
N13473Z'L bA _
L16
l 30
ST6'4O"E 750
L17
S61'24'101E 803'
-`�'j• •^ A, ° �O 4 .w... _L18 547'64.42'E 10 29'
C1 -y^ •? A 5'L1g L19 S35'17JT'E _ 1371' {
L=427x• _ •., _ �7J� L20 S28'S8'20'E 18.99'
R
574 °e L21 S17 -01'02-F 10.64'
CH ARCH = 42 5IS 2520E�. i L22 + SO4-21-33-E 14.87• .
\� & w L23 ) St t'4743 -W - 1027
LOT 30 - VCNE M Nanah C,l _ - __..
GENERAL NOTES:
1 APPARENT SOURCE OF TITLES DEEDBOOK 1045. PAGE 48
DEED BOOK 1038. PAGE 1317
2 THE PROPERTIES SHOWN ARE E2USTINQ PARCELS OF LAND
3. LINEAR ERROR OF CLOSURE EXCEEDS 1 ,20,000.
4 AREA CALCULATED BY COORDINATE GEOMETRY METHOD.
5 N.0 -GA MONUMENT NOT LOCATED WITHIN 2007 OF THIS SITE.
6 THIS SURVEY WAS PREPARED WRNOUT THE BENEFIT OF A TITLE
REPORT AND IB SUBJECT TO FACTS THAT SUCH MAY REVEAL
7 UNLESS SIGNED AND SEALED THIS MAP IS PREJMKARY.
8. ZONING REQUIREMENTS SHOWN PER IREDELL COUNTY'R-20'.
I. JOFN W BA.LZER. CERTIFY THAT THIS PLAT
WAS DRAWN FROM AN ACTUAL FELD SURVEY
PERFDRMED UNDER MY DIRECT SUPERVISION,
IS CORRECT TO THE BEST OF MY KNOVI -E
n AL s
�L.4M •
C�lW BALZER
LS L-3868 p `'••...,.� �e

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