20230759 Ver 1_Site Plan_20230601

,
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.)
Paul Wojoski Paul Wojoski
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 .OS02(a)]
1. Owner Information
Name: Robert Clark
Mailing Address: 7698 Red Robin Tri
Denver, NC 28037
Telephone Number: [phone] Fax Number: NNA
Address: a.-'+ • - • 2•..w1diza •. of
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:
httr)://www.saw.usace.armv.mil/Portals/59/docs/reizulatorv/regdocs/Permits/SAMPLE AGENT ALITHORIZ
ATION FORM.pdf)
Name: Charlie Washburn
Company Affiliation: Marine Construction LLC
Mailing Address: PO Box 6400
Hickory, NC 28603
Telephone Number: 828-495-3040 Fax Number: N/A
E-mail Address: office@?marineconstructionllc.com
B. 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, 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 property (where work is to be conducted)
County: BDrke Nearest Town: Connally Springs
Lake/ river/ ocean adjacent to property: —Cage Rbgdhicg
Property size (acres): 1.35 Acres
Subdivision name or site address (include phase/lot number):
_ Lot 47, Harbor Ridge Subdivision Section 2, 105 Beacon Ridge Dr.
Directions to site - please include road names and numbers, landmarks, etc.:
Included in packet
Latitude (in decimal degrees) 35.779 Longitude (decimal degrees)-R1.512
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Residential, undeveloped
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
We o Stabilesthe gharaline with ri roman to prevent further_emsion
7. Will work be conducted from land? _)L 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:
374 sgft
Temporary impacts in square feet:
0 sgft
9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet
land -ward
Permanent impacts (including back fill, excavation, rip rap, retaining walls, etc.) in square feet:
74A sgft
Temporary impacts (temporary clearing, construction corridor) in square feet:
(Construction corridor= 1.g:zn sgft)
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): l at is wooded.
We elan to remove 13 trees but will replant them 1 for 1 with Native Hardwood trees.
11. Sigripture
Owner/Agent's Signature* [15A NCAC 02H .0502(f)] Date
`Agent's signature is valid only if on authorization letter from the owner is provided.
FORM: 55GP 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 dredging below the Full Pond/ Normal Water Level elevation
Shoreline
tUd GGeGrip N o c VfAAn�
Plan View
Full
Lake
IAc Fun Pood/ Normal Water Lsveq Existing Dock
30ftx7ft
3ftx150ft
_�. Bel. Ulpord/NWL
-moo
4 ftx 150 ft
Above full pond/ NWL
t .,
no sm IN= IBM am
4'tX I $1 f4. Aboe,
O« Pond 1 NWj-
FORM: SSGP 02-2017 Page 3 of 4

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a
Wilk a 0aet
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3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing
f necessary
FORM: SSGP 02-2017 Page 4 of 4