20190775 Ver 1_Shoreline Stabilization_20190611

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
_DWR
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources FORM: SSGP 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 g. v$ N
v-1 ,�
Raleigh, NC 27699-1617 & ®®
2
I. Applicant Information [15A NCAC 02H .0502(a)] 0 1 9 0 J
1. Owner Information I i I. i I 11, % 5
Name:
Mailing Address:
Telephone Number
E-mail Address:
ID1.�- `i-75;Fax Number: IJ
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
htto://www.saw.usace.armv.mil/Portals/59/docs/repulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf)fimust be attached if the Agent has signed this application form.
Name: lyaA lrl
Company Affiliation: /V& -L-
Mailing Address: 0, � b✓ /V
2-15l z S_
Telephone Number: 1452 Fax Number:
E-mail Address: ,,aLLC�cv�s%`
b
Person to receive the Certification Approval: , Lp e cCJ A -s—
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 property (where work is to be conducted)
County: Mi204Q0(V1e*4 Nearest Town: M-�-, = j
Subdivision name or site address (include phase/lot number):
Loi l
Directions to site - please include road names and numbers, landmarks, etc.: V
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): 4�trid%eve-lc e-<
6. Property size (acres): S
7. Lake/ river/ ocean adjacent to property: L LI 2.�►a
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Z L-6 U1 nt� cl o cJt�-
9. Will work be conducted from land? V 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:
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: IOX I05 - JC> C�,� 5 a�.
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 feet landward to beimpacted (number of trees, for instance): e' �r� c
/0 - /_!5 ,S° cna /-r G r5 0-f vaL,.- cxr vv�
Owner/Agent's Signature' [15A NCAC 02H .0502(f)]
///Y//
Date
`Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

12. Please approximately sketch the following information on this pian 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
Full Pond/ Normal Fater Le
IMI ■rw r �
Shoreline
Plan View
O5,
take
(At hof! P—d/ Norma' M,a r level)
Existing Dock
�efax78
s £
r L_ � Ittx 156P
Se r�44 ;,era31 NVA
F u I I Fondl 09rmat Water Level x'
• �• ]ha elln�err
R6pr8p .f Abow,'O pord/ NWL
2 ft x 150 ft.
add�Nona3 dean^g
if necessary
y
iIRLaY3 ME
/,amu%6�� / /�y�%/ �a�xex
Plan View
6' b clove(
ow no =16 am am MW
I D' Above
FORM: SSGP 02-2017 Page 3 of 4

jv
>
Laki
lv
P�J!�! Pond/ N,,D Iqlal ater Level)
u -
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Side View
U -
10 ft. bank
Side Vie W'
i
3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing
V necessary
Existing bank
FORM: SSGP 02-2017 Page 4 of 4
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FORM: SSGP 02-2017 Page 4 of 4

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 1W PLAN NO. PARCEL ID: CQ
STREET ADDRESS: 23 3 C -4L' -k- �%
MA- e lLe� gG 2?30c.o
Please print:
Property Owner: �' ^tel .���—�
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
of N<T C
(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):
Albu Owl
Telephone:
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature
Date: A) /
Authorized Signature
Date:

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Charlotte, North Carolina to Landing Trail, Pee Dee, NC 27306 - ... https://www.google.com/maps/dir/Charlotte,+North+Carolina/Lan...
Google Maps Charlotte, North Carolina to Landing Trail, Drive 53.5 miles, 1 h 15 min
Pee Dee, NC 27306
Imagery ©2019 Landsat / Copernicus, Map data ©2019 Google 5 mi
Charlotte
Get on US -74 E
5 min (1.1 mi)
t 1. Head northeast on S Tryon St toward W Trade St
482 ft
f* 2. Turn right at the 2nd cross street onto E 5th St
0.7 mi
3. Use the middle 2 lanes to merge onto US -74 E via
the ramp to NC -27 E
0.3 mi
Follow NC -27 E to NC -73 E in Pee Dee
1 h 4 min (47.7 mi)
A 4. Merge onto US -74 E
2. % fry,
' 5. Keep left to continue on E independence Blvd/E
Independence Expy
i )1 2 5/23/19, 10:54 AM

Charlotte, North Carolina to Landing Trail, Pee Dee, NC 27306 - ... https://www.google.com/maps/dir/Charlotte,+North+Carolina/Lan...
'*1 6. Use the left 2 lanes to turn slightly left onto NC -27
E/Albemarle Rd
40 Continue to follow NC -27 E
0 Pass by Pizza Hut (on the right in 2.0 mi)
38.0 mi
f* 7. Turn right onto NC -24 E/NC-27 W/NC-73 WE Main
St
0 Continue to follow NC -24 E/NC-27 W/NC-73 W
6.2 mi
Take Lillys Bridge Rd to Landing Trail
r' 8. Turn right onto NC -73 E
f* 9. Turn right onto Lillys Bridge Rd
N 10. Turn right onto Livingston Point
r* 11. Turn right onto Landing Trail
A Restricted :sage road
Landing Trail
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.
8 min (4.7 mi)
1.1 mi
2.2 mi
1.0 mi
0.4 mi
2 of 2 5/23/19, 10:54 AM

-�-*-- LOT LINE
A5
&,61e, R04-
►
►
►
i
+
►
►
SHORELINE ' (FULL POND�
PROPERT'f UNE
Jos
' TOTAL SQ FT BELOW FULL POND: I.ZODA4
LOT #1 (.0

PROdjERT
i
Il
- 1-1%""11 11" -------
--
(FULL POND) -
LAKE BOTTOM
(EXISTING GRADE)

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