20190636 Ver 2_Shoreline Stabilization_20190613

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State of North Carolina
DWR Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500—Water Quality Certification,Shoreline Stabilization
Division of Water Resources
FORM: SSGP 10-2013
Shoreline Stabilization Application Form
One copy 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 PP '
Raleigh, NC 27699-1617
Applicant Information [15A NCAC 02H .0502(a)] 7V;�\\t 1
1. Owner Information
Name: ll rtan acne-
Mailing Address: co.014 Cleanourin Ln.
��err�1�S Vord c�8(nr13
Telephone Number: 1 O'd- 2.01- aLickp Fax Number:
E-mail Address: C .. t .je 4-cr c� rmu:►�. Garr
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/reRdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name:
Company Affiliation: Ci?C '34one. f.�ec C\►ncA 1�LL.G
Mailing Address: (v 38 nak r i dye rC:i.rm f4usr .
(rlooresv,ll� Nc aeils
Telephone Number: 1W-k- ( LBO - Slit Fax Number: 10'-4- (alse) - 5cth9
E-mail Address: CAD c Seawalls c�ua ndS+ream.Person to to receive the Certification Approval: 3a.cc c.e E,549)
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: Lincoln Nearest Town: ----)eyive.x
Subdivision name or site address(include phase/lot number): 4b8eji',verde.l1 .
Ienver,NC a8o3r1 Ls+44 3 E. u,i%nY Co.1e, so .,.ilsian
Directions to site- please include,road names and numbers, landmarks, etc.:
See o.clr\e d.
Latitude(in decimal degrees) 35. 5 a.(.o 3 I.cl Longitude{decimal degrees) — 8o,q q a 5 1 3
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): "Ply s td,e,Y1A'k0..1
6. Property size (acres): . 5
7. Lake/river/ocean adjacent to property: T4.or Arladl
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): —0ce.(13e.171, bone_ r ryj. haul rr%+eria.l
out \ \name_ ,
9. Will work be conducted from land? -1 From water? ir
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:
. It
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: 0'
12. Please describe the vegetation above the normal pool lake level/Normal Water Levei and
50 feet landward to be impacted (number of trees,for instance): c�roSS \o 'er
d �r 4-) hay-9 e. 1 no s�A i urbo.lnce +oOF�'e r-
�
I), , v—i___-______-
C,.,,,, ../„..;,......,,...-- ,v_ S'" ,) .-/q ,
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.
i
FORM:SSGP 10-2013 Page 2 of 3

\coS/
,) Lake
(At Full Pond/Normal Water Level)
50 3e5cuf
//,30'
Full Pond/ •
Normal Water Level
� NMI NM INN - .swim - - -
Shoreline ir10 -h-eeS removed
No diS4ofdance
boccer.
N-ew dock perm'►+
0+0 ved co 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
Brian and Carrie Ivester
4085 Rivendell Rd.
Denver, NC 28037
FORM:SSGP 10-2013 Page 3 of 3

1311=19 610 East Center/Venue,Mooresalle,NC to4065 Rhendell Rd,Darner,NC 28037-Google Maps
Google Maps 610 East Center Avenue,Mooresville,NC to 4085 Rivendell Rd,Denver,NC 28037 Drive 20.1 miles,39 min
610 E Center Ave
Mooresville,NC 28115
t 1. Head south on Evergreen St toward E Center Ave
14s(197 ft)
Take NC-150 W to Webbs Rd in Catawba Springs
34 min(18.9 mi)
I. 2. Turn right onto E Center Ave
0.2 mi
f' 3. Turn right onto N Maple St
0.2 mi
41 4. Turn left onto E Iredell Ave
1.1 mi
41 5. Turn left onto NC-150 W/E Plaza Dr
•Continue to follow NC-150 W
•Pass by Zaxbys Chicken Fingers&Buffalo Wings
(on the right in 2.1 mi)
10.7 mi
'1 6. Turn left onto Slanting Bridge Rd
2.3 mi
t 7. Continue onto Campground Rd
2.1 mi
'1 8. Turn left onto Will Proctor St
0.5 mi
'1 9. Turn left onto NC-16 Business S
1.7 mi
Continue on Webbs Rd.Drive to Rivendell Rd
3 min(1.1 mi)
MtpsAwev.google.caNneps/dir/610+Easl+Center+Ai.erxie,+MooresNlle,+NC/4085+Ri l+Rd.+Daman+NC+28037/@35.5164389,80.9860251,12z/arrFt/dat !4m14!4m13!1n611m1!1s0>8653ffe41c43234f.0... 1/2
6/10/2019 610 East Center Avenue,Mooresulle,NC to 4085 Risendell Rd,Denier,NC 28037-Google Maps
41 10. Turn left onto Webbs Rd
0.7 mi
'1 11. Turn left onto Eastwind Cove Rd
0.1 mi
ir' 12. Turn right onto Rivendell Rd
is Destination will be on the left
0.3 mi
4085 Rivendell Rd
Denver,NC 28037
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 alt signs or
notices regarding your route.
hitpsJ/wnw.google.corNmaps/dr/610+East+Carter+Aerue,+Mooresville,+NC/4085+Rhergdl+Rd,+Darner,+NC+28037/@35.5164389;80.9B60251,12r/aims/data=14m14!4m13!1m5!1m1!1s0r8853ffe41c43234f0... 2/2

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EXEMPT CERTIFICATION STATEMENT CERTIFICATE OF OWNERSHIP AND DEDICATIOII
Watershed I hereby earth that b the biot of rd Y obllltY e! Certificate
abdlyblcn CinWetrotar that 1 frees aetmnU.<b tMl I hereby certify that I cm the Olo of the t'operLY.ton All Iota Within the EwV1o•ab/nYG
the*u istan plot*haul herrm le rot abject to the ad described hereon,which is located In the aubdireim So6:Sdsen,to the best 0t
Lhuaet County Lklool sbo County
Saba to subdivision
d taxa Canty old that I hereby adopt this plan d o I knowledge,lie Wail the WS IV CRITICAL uutaeMd of
adopted
I=of tldiroln Cwmty SubdoNam Ordnance of akdMam with my free salaam,establish mk:Mrn building Lake Noma,m designated by the Moth Carolina Carleton of IU I
adapted August 7,IRBR ad amended Jauoy 1 Io1M. eetbikk linen,old declare all street., lke,Parks•od dher Embammtal Mare�rtmt ad Rakers en the bkterehed d
This detamirolbn I.based a,.idmnmb mode by the sites ad easements b wblk or prF ot<tx as noted. 4^clop of Llreoln feed la) 7,
oppNraa as to the mbhxtbl a rerenbitatim of Furthermore,I hereby dedicate all public amlby eaters b RLD �� ICWI.•• g
remod=hats,the status of road*ced the=aeration __�,all loam sewer a Qt A
1I had subsequent to August 31,1RS9 ad Jarwy I. ------- yeteme to --' 'r'L
R94resu1t F thoexaltatione of List i certificate. t Would -_-_ _--__—ad all wales IMs b Date 9ubdlrielm etratar O „•,
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Oar I0?Aar DATE �OWNERO
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Mon Aam etmdar Dote I�i¢Ao ArSR Review,Ranu arks'of Lincoln Canty,artily em F.
t�q that the nap or plat to which this certificationla affixed meet.all statutory 4 N
V'16 r� CERTIFICATE OF SURVEY AND ACCURACT �Qbe��b�IQ��• 'C e7
to-it
a� STATE OF NORTH CAROLINA,LINCOLN COUNTY -{�-✓ - VICINITY MAP Ms� .,., : e
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13.387 t,Frederick Ira Gore,certify that the plat was drool ceder Reyl.w Officer/ Dote •~^t c CO
nor=paklm front an actual s.rrey node order may ,'i u
•r.,/1� eupervlelm(lot dencrlptlm recorded in Beek �o—�'� LINETTPE LEGEND - ~ •4 x
OD e aRr )that the bandaks not swayed arc dearly indicated V 712
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a'- drool from pooiotie fond in Hope___-,plops__I PUBLIC RAd ----
ithee,ratio of preclalm as wlcylaled Is h_—tint 4.d ADJOINER
plot tun prepared In=cordara with G.S.47-30 ea amended.
Piled for registration and recorded Wily_ my aly a epe4dlan,umber ad seal this .0.0. Yfo PROPERTY LINE
thin the ll1:b day of October, 2005, ?. "d%°f A.D.2005. 1,:.:1 GAR,7l�'�r4• EASEMENT
6 at 11t57 A.H. in Plat Book 13, Page i I' t I.•3a.�3 fc, 'y REBAR
327. 9ornoya• Reyetrdkn 1,n,b ,l M1'•" ._-__
I■t ELAINE N. RAEMON SEAL
■ y� EegieetterdoffeOceean for Lincoln
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THE PURPOSE OF ilIE PLAT IS TO ADD BEENLOT IA AND REVISE LOTS fir: 'aa24•E Me to'It►' s 4SpTli9s•E \ S .g
I,2,MD e.NO DINER CHANGES RAVE MADE TO THE PLAT P �'�-E �'' Co ^�9 L \ S
PREVIOUSLY RECORDED IN MH 13 PG 2aa. o:. i \\ i
APPROAMATE 5.peo•
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DREDGE SPOIL DISPOSAL FORM
Project Name/address: 4o85 endell Rd. Denier. 11C a8031 County: Lancoln
Location Address: D tsosal Sv-ke (038 Ca.1sr,c 1e. 5..rm t c i . (`Coores ),IC a 115
Parcel#: 9(JAD q( Q Lt
Parcel/lot size Zs ,ti q
Disposal area required (sq ft and/or acreage) IOO' X 1001
Acknowledgement of Notification
I, e�ereRe�r,d9e5 Tr . , am aware that the site must adhere to all state regulations
and rules regarding sediment and erosion control and water quality. And give permission for
"Br ‘a.n aonci CoLr Zv es-E-e r
Name of Individual and Company
to dispose of their dredge material at the above stated location
Owner: P.�r
Print Signature V CI
Date: (/p
Along with form, please provide:
Aerial of parcel/lot (County GIS)
Photo of proposed spoil site
Identified proposed spoil site

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