HomeMy WebLinkAbout20200844 Ver 1_Shoreline Stabilization_20200624State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Oiv6ion 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
Raleigh, NC 27699-1617 d
D
Applicant Information [15A NCAC 02H .0502(a)] JUN 2 4 2020
1. Owner Information TRANSPORTATION PERMITTING UNIT02NR - WATER RESOURCES
Name: PAW[ % r� ti Ja�•-c s s
Mailing Address: ( rc 1(.
A (_4e AA o� �r , /1lG 28pC> !
Telephone Number?D'-/429 - g,? 84 Fax Numk�er: 4 l0 ' �D
E-mail Address: ,0 G�i �� � cl vet S @ e�u� `KS °` �� °`iCe
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 mii/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name:
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Person to receive the Certification Approval:
Fax Number:
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: Nearest Town:�f
Subdivision name site address (include phase/lot number):
Directions to site - please include road naa s numbers, landmarks, etc.:
� rs'`/� s� /C�I�C✓'K
Latitude (in decimal degrees) G) Longitude (decimal degrees)
5. Describe the existing land use or condition :ofr th site at the time of this application
(residential, undeveloped, etc.): i ¢ /
6. Property size (acres):
7. Lake/ river/ ocean adjacent to property:
8. Describe proposed work (include discussion as to how hardening of shoreline has en
en
avoided, or why it is ne ssar ):
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/ Norm I 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 W ter 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 impact (number of tree or ' tance):
0� -fie,
1, s-zr-zv
Owner/Agent's Signature* [15A NCAC 02H .0502(f)] Date
*Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013
Page 2 of 3
La ke
(At Full Pond/ Normal Water Level)
Full Pond/ />11:9cel)
l
Normal Watter_Le el
Shoreline
s
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
Subdivision THE LANDING — MAP 3 ®f 3
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