20191323 Ver 1_Shoreline Stabilization_20190930

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
- 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
- FORM: SSGP 02-2017
Shoreline Stabiliza Aj V!,etion Form 1 9 1 3 2 3
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 115A NCAC 02H .0502(x)]
1. Owner information
Name: LE
Mailing Address:
Telephone Number:
E-mail Address:
v
:c9 IeA r 3 0
Fax Number: l Qrrr►it:ing Sir.: „a
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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:
lila fiydty4'savr usace arm�r mill'Fchafs�59ldoes„e-� idi0i,/:'2 L1:rL/Permits/SAsdiflLE AGENT AUTHORIZ
ATION FORM.Pdf)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
B. Project Information (15A NCAC 02H .0502(«) & (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) Al/�
County: o rc�w _ w.. v Nearest Town: W ` C T (cv j WC
Lake/ river/ ocean adjacent to property: Le,.kr —T; I Iwo
Property size (acres): . 88
Subdivision name or site address (include phase/lot number):
(isvy Tvaa2:-E�e., (o(-A�- 1031
Directions to site - please include %ad namespnd nyAnbers, landmarks, etc:
Latitude (in dedmal degrees)?57,,;WP% Longitude (decimal degnees)Z--��,RY
S. Describe the existing land use or condition of the ti of this application
(residential, undeveloped, etc.):/ S'ir
6.
VA
Describe proposed work (include
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.
Temporary impac9 in square Beet:
9. Total -amount of impacts above the normal pool lake level /Normal Water Level and 50 feet
land -ward
back fill, excavation, rip rap, retaining walls, etc.) in square feet:
Temporary impacq&Wporary clearing, constriction corridor) in square feet:
10. Please describe the vegetation above the normal pod lake level/ Normal Water and 50
feet landward to be impacted (number of trees, for instance):
11.
Agent's Signature` [15A NCAC 02H .0502(01
7 /9-/2
D
Agent's signature is valid onlyifan authorization tetterfrom the owner is provided.
FORM: SSCP 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
Lake
(At Full Pond/ Normal Water Level)
Full Pond/ Norma! Water
Shoreline
y
Plan View
FORM: SSGP 02-2017
Lake
IQFun PMWH"dYJWMLCWQ Existing Dock
/ 30 [t:7 it
•� •a•• •aa�,a �ya�•
rrrrsrlrrrrrrrr� r rrr
Full Pond/ Normal Water
,r�lrr•, �>r •rr r•
me
r{ii`i�f�r a �i
•�i?iriia �� iiiii
PaPlan View
ge 3 of 4

70
c
Side View CL
10 ft. bank
Side Vi
FORM: SSGP 02-2017
3 fL below full pond water level 4 fL above full pond water level 2 fL adefidonal clearing
If necessary
7
Existing bank
AMPLE
Page 4 of 4

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oyh 1-1/4" Iron
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Found: /
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CP
Foundation
In place
Lot No. 1032
Fronk/in Roy A//en & W, -e,
Breon G A//en
Deed Book 585 Poge 849
PIN.- 6576-04-64-1624
Lot No. 1031
Foun
1/2" 1
Reba