20191223 Ver 1_Shoreline Stabilization_20190913

State of North Carolina
Department of Environment and Natural Resources
DWR 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 2 0 1 9 1 2 2 3
Three copies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resources $ P4 Ipj
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
I. Applicant Information [15A NCAC 02H .0502(a)] SEP 13 019
1. Owner Information Wafer R�ur,,ez
Name: Bikash Gupta ��rit��g Serer
Mailing Address: 20508 Deep Cove Ct
Cornelius, NC 28031
Telephone Number: Fax Number:
E-mail Address: poonambp .gmail.com
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/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: Dean Fisher
Company Affiliation: Lake Norman Custom Dock & Pile Driving, Inc
Mailing Address: PO Box 1439
Denver NC 28037
Telephone Number: 7044832144 Fax Number:
E-mail Address: Ikndock(aDgmail com
Person to receive the Certification Approval: Dean Fisher and Bikash Gupta
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: Mecklenburg Nearest Town: Cornelius
Subdivision name or site address (include phase/lot number):
Deep Cove lot #7
Directions to site - please include road names and numbers, landmarks, etc.:
Jake NC -73F towards Hunter villa Turn left onto W Catawba Ave.
Turn left onto Bethel Church Rd. Turn right onto Walter Henderson Rd.
Turn left onto Deep Cove Ct. Properly is on the right.
Latitude (in decimal degrees) 35.4890795 Longitude (decimal degrees) -80.9015087
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): residential
6. Property size (acres): 0.760 acres
7. Lake/ river/ ocean adjacent to property: Norman
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Grading, clearing and shrubbery removal to install
gravel footer, rip rap and block to level shoreline
9. Will work be conducted from land? ® 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:
450 sgft
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: 1200 sq ft
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): Existing landscaped
yard with grass
Wer/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 10-2013 Page 2 of 3

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 7
PLAN NO.
PARCEL ID: 00149181
STREET ADDRESS: 20508 Deep Cove Ct., Cornelius NC 28031
Please print:
Property Owner: Bikash Gupta
Property Owner: Poonam Gupta
The undersigned, registered property owners of the above noted property, do hereby authorize
Dean Fisher
(Contractor / Agent)
of Lake Norman Custom Dock & Pile Driving, Inc
(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: -6Y a - --7 A V
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
orized Signature
Date: 11 71
Authorized S nature
Date: <a- I M 1 / 9

NOTES:
PHYSICAL SURVEY
• PROPERTY MAY BE SUBJECT TO RECORDED OR
FOR
UNRECORDED RIGHTS OF WAYS OR EASEMENTS 50
NOT OBSERVED
0
50 100
150
BIKASH & POONAM
" OWNER TO VERIFY ALL SETBACKS AND ZONING Im ME
mmvm
REGULATIONS PRIOR TO ANY PLANNING OR
CONSTRUCTION. GRAPHIC SCALE - FEET
GUPTA
• DIMENSIONS OF ALL IMPROVEMENTS SHOWN ON
THIS PUT SHOULD NOT BE SCALED OR RELIED
UPON FOR DESIGN OR CONSTRUCTION WITHOUT
LOT /7 DEEP16Z0VE TRACT II, DB
A FIELD VERIFICATION OF ALL DIMENSIONS.
14_ 280
• DIGRAL COPIES OF THIS FILE ARE FOR REFERENCE
ONLY AND MAY NOT BE USED FOR DESIGN WORK.
LEMLEY TOWNSHIP, MECKLENBURG COUNTY, NC
• NO PMM OF THE R6LENIL•L STRucnm
6 LGGATW N TW 100 YEAR RCOD PIAN.
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SCALE: 1' - 50'
DEDMON SURVEYS
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LOT LINE
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ROBERT J. DEDMON, CERTIFY THAT THIS PLAT WAS
DRAWN FROM AN ACTUAL SURVEY MADE UNDER MY
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8/29/2019
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vicinity map
20508 Deep Cove Ct - Google Maps
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