20191219 Ver 1_Shoreline Stabilization_20190913

Stat&f North Carolina
Department of Environment anqatt sI Resources
Division o ater i3sq +c-
f.
Water Resout c t ISA NCAC 02H .0500 -Water Quality Certification, Shoreline S abi4ation
LNVIH4NMI:NI h,L 7V ^
FORM: SSGP 02-2i 7
Shoreline Stabilization Application Form 2 0 1 9 1 2 1 9
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: 0 .i i
Mailing Address: zc)S �i K
iI Vi C%(?
Telephone Number: g- qff'
SZ TZ' Fax Number:
E-mail Address:
2. Agent/ Contact Person Information
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/regulatoryZregdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM pdf)
Name: 3,,7Z �
Company Affiliation:
Mailing Address:
Telephone Number: \�" �`���— Fax Number:
E-mail Address:.�L�( c� ��� ��c�r;�S�c�L •yam
B. P sect Information [15A NCAC 02H .0502(a) & (b))
Attach a vicinity map (i.e. street map) clearly showing the location of the property with
"4/respect to local landmarks such as towns, rivers, and roads.
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

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 pr p (where work is to be conducted)
County: te�4 Neares Town: _ 16V��
p
Lake/ river/ ocean adjacent to property: Ornlgn
Property size (acres): 0.64
Subdivision nam A sits addreys (include phase/lot number):
landmarks, etc.:
Latitude (in decimal degrees)_3L_ SOYyqL Longitude (decimal degrees) J0.9 S_MZ
S. Describe the existing land use or condition of the site at the time of this appli ation
(residential, undeveloped, etc.): f 4aN 1ta I �101�� S F({ Q� d pNyq P oc("
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): j
l�M-►- t� i� f� ��c✓�L�k ' r1,�/rL l`G� l�.t-r�(L ) ��,SiAk aJyr`c 1,�.+`-f_L e-1Sss
`3 '12 -if IZA-1
7. Will work be conducted from land? From water? ❑
8. Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent impacts (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
91
Temporary impacts in square feet:
CJ
9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet
land -ward
Permanent `n pac is (including back fill, excavation, rip rap, retaining walls, etc.) in square feet:
Temporary impacts (temporary clearing, construction corridor) in square feet:
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): _0"tt_ 7T- ,s
Gvie, LVC4 i1Z�c� OI { 7Iev � 'f-iPrr
11. Signature
Own Agent's Signature' (15A NCAC 02H 05021f11 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 r4rAri0irin hcl.,... 4-t ,. c..0 r ___ _
- - a — L,— 1 un rullu/ rvurmal Water Level elevation
Lake
(At Full Pond/ Normal Water Level)
i�
IM IM
W4��—
i9 Q� 3 I
Full Pond/ Normal Water Level - -
Shoreline
Plan View
Full Pond/ Normal Water
• ` n oreone
7 h . 150 ft.
iA,ticnN dcar:n
''f MYCYsnry
Lake
im roll Pony Harrod W ter leMN
Existing Dock
3R.ISoh
edow NO POW NWL
ah.150h
Ab— hili rymd/ N Wi
I
I
E
AMPLE
Plan View
FORM: SSGP 02-2017
Page 3 of 4

C
Side View
I ft. below fall pond water level 4 ft. above foil pond water level
2 ft. additional clearing
•if necessary
Existing bank
10 ft. bank a
height yQ
QO
QUO
Side Vi MPLE
FORM: SSGP 02-2017
Page 4 of 4

9/4/2019 205 Sunstede Dr - Google Maps
Go,',gle Maps 205 Sunstede Dr
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1205 Sunsletle Drive
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205 Sunstede Dr
Mooresville, NC 28117
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Directions Save Nearby
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Map data @2019 2000 ft
https://www.google.com/maps/piace/2O5+Sunstede+Dr,+Mooresville,+NC+28117/@35.5l41366,-80.9545948,14zldata=!4m5!3m4! IsOx8856adc42244aebf:OxI4acI... 1/2

9/4/2019
Photos
205 Sunstede Dr - Google Maps
At this location
Dem Electric
Electrician - 205 Sunstede Dr
https://www.google.comlmaps/place/205+Sunstede+Dr,+Mooresville,+NC+28117/ C-@35.5141366,-80.9545948,14zldata=!4m5!3m4! 1 sOx8856adc42244aebf:Ox 14ac 1... 2/2

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