20190987 Ver 1_Shoreline Stabilization_20190723

State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
15A NCAC 02H 300 PW ty Certification, Shoreline Stabilization
Division of Water Resources FORM: SSGP 10-2013
Shoreline Stabilization Application Form 2 0 1 9 0
987
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
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: `)off
Mailing Address:
ri vtC&
Aov<n-� ADI1.4 N -C-- 251/ 2x
Telephone Number: 704- SI©S-/[ems Fax Number:
E-mail Address: ialyinAbri-is 62 ntL . COA&
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http:Hwww saw usace.army.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: 1^,(uV'(So n
Company Affiliation:
Mailing Address: S�OK l=i es4" -RJ • u
Telephone Number: 7ol/-5ot, - -7WO Fax Number: SL3 - 931 - s bY5
E-mail Address: 55 a e_,,41 l ivxk • V1 c-+
Person to receive the Certification Approval: 12-a,el t� �IAwso•�
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: C-�us40n Nearest Town: 72.0 vu ►1
l a+
r
Subdivision name, or siteaddress (include phas-el/lot number):1&ozo HgE dIa xd,, C�
Directions to site - please include road names and numbers, landmarks, etc.:
a ,,
Latitude (in decimal degrees) 3S.- 1S Y,_K ,5 Longitude (decimal degrees) -94 y.? G6 13
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): /as 7 /_a --Li- - jytw 44o►wg_ �ons�ruc ion
6. Property size (acres): O. 35-4 cxc .
7. Lake/ river/ ocean adjacent to property: aka- Inlyl,`e,
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessa
9. Will work be conducted from la
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:
,, 2 q 9 s4 fir. sir.{fic-l`
0-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:
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): b rus
lnmd-r_ / - -� �" P" tr��s ��a7'_ 60-S �o �� r-e.>✓fov
�o � Cr9•r t S-tY'ccG�� �^'l� oT •S/7 d ✓'��i i1.� .
W
's Signature* [15A NCAC 02H .0502(f)]
(. A 11 Zo c
Date
signature is valid only if an authorization letter from the owner is provided.
FORM: SSCP 10-2013 Page 2 of 3

Full Pond/
Normal Water Level
SI
Lake
(At Full Pond/ Normal Water Level)
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
FORM: SSGP 10-2013 Page 3 of 3

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. ;Q Q PLAN NO. PARCEL ID:
I
STREET ADDRESS: e;0,20 Anda -ods Ct/
Please print:
Property Owner:
Property Owner:
/V//) -Z
G �
The undersigned, registered property owners of the above noted property, do hereby authorize
Of 6�S0115 04021 ` y fl uLro, q—_
(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:4/;i2
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized nature Authorized Signature
Date: A(A 0 / Date:

7/18/2019 906 S Point Rd, Belmont, NC 28012-9536 to 6020 Headlands Ct, Belmont, NC, 28012-6746 Directions - MapQuest
YOUR TRIP TO: MCDQJG LW
6020 Headlands Ct, Belmont, NC, 28012-6746
12 MIN I 5.7 MI R
Est. fuel cost: $0.56
Trip time based on traffic conditions as of 2:30 PM on July 18, Print a full health report of your car with HUM
2019. Current Traffic: Light vehicle diagnostics (800) go6-2501
1. Start out going northeast on Nixon Rd toward Southpoint Rd/NC-273.
------ Then 0.21 miles ------------------------------------------------------- .------------------------------ ...-______--- 0.21 total miles
2. Take the 1st right onto Southpoint Rd/NC-273. Continue to follow Southpoint
Rd.
If you are on RL Stowe Rd and reach Township Pkwy you've gone about 0.1 miles
too far.
- Then 4.58 miles------------------------------------_-_---_---_.._-_-------.--------_----__--------_-_-_-_---- 4.79 total miles
r+ 3. Turn right onto Reflection Pointe Blvd.
Reflection Pointe Blvd is 0.5 miles past Reese Wilson Rd.
If you reach Boat Launch Rd you've gone about 0.1 miles too far.
- Then 0.80 miles ---------------- ---_-_-_--_--__-e__-_-_-.___----_-_--..-_----_-__--_--__-_--__-.._____-_------ 5.59 total miles
4. Turn left onto Headlands Ct.
Headlands Ct is 0.1 miles past Hermitage Ct.
If you reach Ashwood Park Dr you've gone a little too far.
------ Then 0.10 miles ---------------------- .--------------------------- .----------------------------------------------- 5.68 total miles
5. 6020 Headlands Ct, Belmont, NC 28012-6746, 6020 HEADLANDS CT is on the
" right.
If you reach the end of Headlands Ct you've gone about 0.1 miles too far.
------------------------------------------------------ I ------------------- ------------
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7/18/2019
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STATE OF NORTH CAROLINA
GASTON COUNTY
' 09 a1F x
8 1 ce that this map h
mop .m oum on ocWa.sIMYyGn(ap(S.jl}Idtx+my
w
penislsion.
pH 6 The unadjusted error of closure as calculated is 1 1 00(i'F
Boundaries not surveyed If any, are noted. dill 4 RDIECT10N PT D!L
recorded in Book —_. Pape S�{ppp�.ee�e�WddN F
Witness my hand and sed this —day of ��r 7' `` X20 J r
o eswgna Ladd ('.
LAKE WYLIE
LOCATION MAP - NOT TO SCALE
q0 7'q
I.%N( `' r0)TAR RDW L►j
nEVATM - 571.00
aa.
'As
ftc
p -
0 O ftK
N . 1f ,po U
LOT'�3® +r LOT 231
P 67, P . 87 P8 67, PG. 87
.384 c.{
LOT 229
PB 67, PG. 87
STM
v
�- IRANS(OWIER � .
L%N ) S24'24'18"W *0.52'--
J
HEADLANDS COURT -- 40'M
LEGEND
LINES SURVEYED
LINES NOT SURWYED— --
ALL CORNERS ARE AS NOTED O
N.LS. NOT TO SCALE
C.P. CALCULATED POINT
OVERHEAD UTILITY LINES —
U'IUIY POLE
METAL FENCE •—.—.— —.
WOODEN FENCE -
SEriER MANHOLE
"BSL - MiNMUM CPJLDtNG SETBACK LINE
LPIN(S) - IRON PIN SET
I.P- IR -IRON %N FOUND. -IRNOTES: SURVEY MADE USING EXISTING PHYSICAL
1ON CMF -CONCRETE MONUMENT(F) F) Fd/N0 EVIOENCE FOUND AT TIME OF SURVEY.
S) SET SUBJECT PROPERTY MAY BE SUBJECT TO
RECORDED OR UNRECORDED EASEMENTS,
CAROLINAS ESSTTRICTIIVEECO ENANTSCNOT�SHOWWN
DESIGN HEREON.
�GROUP,PLLC 50 GRAPHIC SCALE
*LAND SLMVEYING-LAND PLANNING S O
2Cl West Second Avsrwe Gastonia. NC 28052
Phone. [phone] a 704-884-9OD7 a Fa, 704-1154-932e SCALE IN FEET
NC LICENSE /P-0188
BOUNDARY & TOPOGRAPHIC SUVEY
OF
6020 HEADLANDS COURT
SCALE: 1" = 50' SOUTH POINT TOWNSHIP - GASTON COUNTY, NC DATE: APRIL 4. 2018
PROPERTY TO BE ACQUIRED BY:
MAP RECORDED IN BOOK 67 AT PAGE 87 DEED RECORDED IN BOOK 3890 PAGE 989
CADD $ 8861MCSPADDEN WORK ORDER # 8861 DRAWN BY: MLC TAX ID NO. 203978

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