20191402 Ver 1_Shoreline Stabilization_20191011

:.., 201 91 402
r; State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
ENVIRONMENTAL QUALITY FORM: SSGP 02-2017
Shoreline Stabilization Application Form
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 Permit nn
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC 27699-1617 Raleigh, NC 27604 F ll
"UC r 1 12019
A. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner I
Name:
Mailing
Telephone Number: q19._ 6�e,, `-s �3D Fax Number:
E-mail Address: �) ""/.'a' i ,
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:
htto://www.saw.usace.armv.mil/Portals/59/docs/regulatorv/regdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf)
Name:
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Fax Number:
B. Project Information [1SA 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: kNearest Town: 5e,710
Lake/ river/ ocean adjacent to property:�G�
Property size (acres): a3 d�c i�eSS
Subdivision name or site address (include phase/lot number): 61,4:,
A- e � �o
Directions to site -please include road names and numbers, landmarks. etc.: fl,-O / S
*14110 R,� C,. A6 o/y Lei
Latitude (in decimal degrees) 3&, !!�OY3 9 7 Longitude (decimal degrees)_
5. Describe the existing land use or condition of th�ite at the time of this application
�S>G (residential, undeveloped, etc.): 0-/��it cm6&- �.5�`•-uz�l�
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):c:�d
151ivrell,% -e Fia-t bo-. f
7. Will work be conducted from land? E9---"- From water? ❑
8. Total amount of impacts below the normal pool lake level / Normal Water Level
onk 6/6
�d
Permanent impacts (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
Temp r impacts in square feet:
Z 7_00
9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet
land -ward
Permanent i acts,,(including back fill, excavation, rip rap, retaining walls, etc.) in square feet:
�V S G
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):/'� `,�i,,,� y4r&PS
Al
11. Sign -�
Owner/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 02-2017 Page 2 of 4

U.S. Army Corps of Engineers (USACE)
Form Approved -
APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT
OMB No. 0710-0003
33 CFR 325. The proponent agency is CECW-CO-R.
Expires: 01-08-2018
The public reporting burden for this collection of information, OMB Control Number 0710-0003, is estimated to average 11 hours per response, including the time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services,
at whs.mc-alex.esd.mbx.dd=dod-information-collections(a mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall
be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT
RETURN YOUR APPLICATION TO THE ABOVE EMAIL.
PRIVACY ACT STATEMENT
Authorities: Rivers and Harbors Act, Section 10, 33 USC 403; Clean Water Act, Section 404, 33 USC 1344; Marine Protection, Research, and Sanctuaries Act,
Section 103, 33 USC 1413; Regulatory Programs of the Corps of Engineers; Final Rule 33 CFR 320-332. Principal Purpose: Information provided on this form
will be used in evaluating the application for a permit. Routine Uses: This information may be shared with the Department of Justice and other federal, state, and
local government agencies, and the public and may be made available as part of a public notice as required by Federal law. Submission of requested information
is voluntary, however, if information is not provided the permit application cannot be evaluated nor can a permit be issued. One set of original drawings or good
reproducible copies which show the location and character of the proposed activity must be attached to this application (see sample drawings and/or instructions)
and be submitted to the District Engineer having jurisdiction over the location of the proposed activity. An application that is not completed in full will be returned.
System of Record Notice (SORN). The information received is entered into our permit tracking database and a SORN has been completed (SORN #A1145b)
and may be accessed at the following website: http://dpcid.defense.gov/Privacy/SORNslndex/DOD-wide-SORN-Article-View/Article/570115/al l45b-ce.aspx
(ITEMS 1 THRU 4 TO BE FILLED BY THE CORPS)
1. APPLICATION NO.
2. FIELD OFFICE CODE
3. DATE RECEIVED
4. DATE APPLICATION COMPLETE
(ITEMS BELOW TO BE FILLED BY APPLICANT)
5. APPLICANT'S NAME
8. AUTHORIZED AGENT'S NAME AND TITLE (agent is not required)
/
First -' L9i e Middle - Ae 1 1(I Last - �rr v�Qlw�
First - Middle - Last -
Company -
Company -
E-mail Address - d/ ^
E-mail Address -
6. APPLICANT'S ADDRESS:: / L
k::Alovtd u
9. AGENT'S ADDRESS:
Address- /d�� 141,11
Address -
City - I State - Zip- 2461 lbountry - VJ-1-Ve
City - State - Zip - Country -
7. APPLICANT' PHONE NOs. w/AREA CODE
10. AGENTS PHONE NOs. WAREA CODE
a. Residence b. Business c. Fax
a. Residence b. Business c. Fax
783 -- y6 64-
STATEMENT OF AUTHORIZATION
11. 1 hereby authorize, to act in my behalf as my agent in the processing of this application and to furnish, upon request,
supplemental information in support of this permit application.
SIGNATURE OF -APPLICANT DATE
NAME, LOCATION, AND DESCRIPTION OF PROJECT OR ACTIVITY
12. PROJECT NAME OR TITLE (see instructions)
/d1` 1<1e4 L..) - i
13. NAME OF WATERBODY, IF KNOWN (if applicable)
14. PROJECT STREET ADDRESS (ifapplicable)
!__,,�- A C
Address//6;
15. LOCATION OF PROJECT
Latitude: -N �� �S�f �� Longitude: -W 77%, i%,K-�- i�fL'
City State- NL Zip-
16. OTHER LOCATION DESCRIPTIONS, IF KNOWN (see instructions)
State Tax Parcel ID '4 Municipality jeinnt
Section - Township - G017'11 Range -
ENG FORM 4345, MAY 2018 PREVIOUS EDITIONS ARE OBSOLETE. Page 3 of 1

17. DIRECTIONS TO THE SITE 6
-57
he,-7nrve wr H leC6 T1�
�5
18. Nature of Activity (Description of project, include all features)
we- iwt// /.)e- C�Dr�t� �f,c w t 1/ 4)
bD G! o C If C u�� l�
bo- l d l9f 0 0" f- d� «'-J
w.w
Wk� bo'- Fkvol?c
19. Project Purpose (Describe the reason or purpose of the project, see instructions)
1
USE BLOCKS 20-23 IF DREDGED AND/OR FILL MATERIAL IS TO BE DISCHARGED
20. Reason(s) for Discharge
21. Type(s) of Material Being Discharged and the Amount of Each Type in Cubic Yards:
Type Type Type
Amount in Cubic Yards Amount in Cubic Yards Amount in Cubic Yards
22. Surface Area in Acres of Wetlands or Other Waters Filled (see instructions)
Acres
or
Linear Feet
23. Description of Avoidance, Minimization, and Compensation (see instructions)
ENG FORM 4345, MAY 2018 Page 3 of 2

24. Is Any Portion of the Work Already Complete? ❑ Yes ®No IF YES, DESCRIBE THE COMPLETED WORK
25. Addresses of Adjoining Property Owners, Lessees, Etc., Whose Property Adjoins the Waterbody (if more than can be entered here, please attach a supplemental list).
a. Address-
City - 52m v 1-c— 9 Icy State - Zip - Z —rz-�12
b. Address-
City - Sew State - L Zip -
c. Address -
City - State - Zip -
d. Address -
City - State - Zip -
e. Address -
City - State - Zip -
26. List of Other Certificates or Approvals/Denials received from other Federal, State, or Local Agencies for Work Described in This Application.
AGENCY TYPE APPROVAL* IDENTIFICATION DATE APPLIED DATE APPROVED DATE DENIED
NUMBER
' Would include but is not restricted to zoning
building, and flood plain permits
27. Application is hereby made for permit or permits to authorize the work described in this application. I certify that this information in this application is
complete and accurate. I further certify that ess the au ority to undertake the work described herein or am acting as the duly authorized agent of the
applicant.
SIGNATURE O �PLICANTDATE SIGNATURE OF AGENT DATE
The Application must be signed by the person who desires to undertake the proposed activity (applicant) or it may be signed by a duly
authorized agent if the statement in block 11 has been filled out and signed.
18 U.S.C. Section 1001 provides that: Whoever, in any manner within the jurisdiction of any department or agency of the United States
knowingly and willfully falsifies, conceals, or covers up any trick, scheme, or disguises a material fact or makes any false, fictitious or fraudulent
statements or representations or makes or uses any false writing or document knowing same to contain any false, fictitious or fraudulent
statements or entry, shall be fined not more than $10,000 or imprisoned not more than five years or both.
ENG FORM 4345, MAY 2018 Page 3 of 3

Legend
E-911 Addresses utility
Easements
All Other
— Conservation
Tax Parcels
Easement
AdministrativeAreaBoundaryLine_1 K
County
CountyBoundary_1 K
Railroad-1 K
5/5/2019 iy s o: G A L V
N
A
Feet
0 60 120 180 240
0 0.01 0.02 0.03 0.04
Miles

/e I
Lake
(At Full Pond/ Normal Water Level)
Cu
C
E °}
`o °
z v
C
O
Side View
3 ft !.";" full o'stater l-1 4 ftabove full pond mate, level 2 ft. additional clearing
necessary
Existing bank
10 ft, bank
height
Side Vi
FORM: SSGP 02-2017 Page I of 3
ea
Oy
�
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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)
l
Full Pond/ Normal WaterLevel,
Shoreline_.
'-J
Full Pond/ Normal Water Lev
n rerine
2ft.x150ft.
addltlonal d—ing -
B necessary
F
Plan View
Lake
W Full Pond/ Normal Water Levell
Existing Dock
/30ftK7ft
3ftx 150ft
Below fill pond/ N WL
_ 4ftx 150ft
Above full pond/ NWL
FORM: SSGP 02-2017 Page 3 of 4

IF
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Legend
E-911 Addresses
Easements
Conservation
Easement
utility
All Other
Tax Parcels
AdministrativeAreaBounda k
ine 2K
County
CountyBoundary_2K L.,O+
Railroad_2K A n
Person County GIS
N
A
Feet
0 130 260 390 520
0 0.025 0.05 0.015 0.1
Miles

Cr3
Y�
CURVE DATA
CURVE
1*111
RADIUS
ARC TAN
CHOND ERG
CHORD
C 30
13.47•U8•
2.0.W
62. 56 31.43
S34.47.58^W
62 41
C- 31
211 2 36•
26C. 00
IM 28 56 54
S56.02.50`2
128,92
C 32
13'18.41'
260 00
60 41 30. 34
S77'O3'28•R
60,27
C 33
31.54.11•
280 00
185. 7.1 96. 15
1164'45'43•E
181 a
C- 49
37.5A'1I•
3.10 04
218. 31 111.3'2
N54.45'43•E
714. 35
c 50
C 51
55.48.25`
07.39'30•
210-DO
335 GO
Y01 54 111.21
44 78 22.42
S55'48-36••
M31-44.08-E
196.5s
44. 74
HYCO LAKE
BOUNDARY DATA
CONTOUR DATA
AND ROAD DATA
.•,'(,jNE EIEAR ING 0'.51
l INt
BEARING DIST
l� 60 NII.45-10•1 51 44'
]4
N77.54.2J`E 123 96'
I!�1 NOO.38•,5'W 8. S4'
I .RQ N4t•48 45 40. S2'
l 25
L- 26
N71.54'23'I 58 48'
N83.42.49•E 6 83'
I 1 NAI.4R,.6t J6. 33'
I. ]7
N83.42'49•E IT2.71'
N N67.21. M-I 11/ 9A'
L- J6
SB 1.42.49•11 t79 54•
95 1L58'23.37•E 21. 10•
I- 37
S27.54.23.9 61 310'
L- IN•23-'T3l1••Ef 794O62•
61
L. 3
1A
S27-54.23•W 6a.
S61.30.45`k 00
I m $11191 90
L- 430
S5
S2754S3W 6 84
89 09L 11.114'
64
9977•''
S2400•F 74
1I - 91 4]'4H•C7512
I- 92 S30Q'6T'I1•1 73 55
1- a5
L 86
S73.09134•0 3C 47'
FLY *13'03'0 63. 53'
1 93 530• 5'E IJ.94'
l 87
SSI'f9'S5.9 51.06'
1 9• Nro• 'J494 61 a4•
I 95 M47.4 yy1 79 54'
L "a S61.52' •W 104.01'
1 1F9 S70'27.2WIM 68 43'
l 1so 586.40'S 10-1 04'
1111 S79.23'11 9U. 6J'
1 182 N53.01.2J` 50.24'
l ,83 SUS'30'ti •W 3 1 T
1W 558'10'43`W 79'
I 185S6J•13 '11•E 1 78'
186 547'I7. 16•C 2'
l to, SJ I'Ol•s VF II `
t 186 S15.54.52•t 9!,
I IR9 S40.10`40•W a9.
1 190 S82'01.25.1 74
1D1 N35.28'2,.. ,39. to
t t92 N5a•09.03.9 128.
37• lK
I 193 173'38'SI •F 77.BO•
194 556.40-59`E A,.10'
- 195 SO4.45'la•E 90. GA.
I I GE NU
6a • NA 11 f OUND
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If • IRON FOUND
IS o IRON SET
o MATIBMAI?CAt
POINT
CE CDWARVATION EASEMENT
- - NON-SORYLYED I. INFS
WUL WATER VSF LINE
UNLESS SIGNED. SEALED AWAY DATTD. THIS IS A
PRELIMINARY PI I. NOT FOR RECORDATION, SALES
OR CONVEYANCES --
HAMLEfi-JONINNGS
h ASSOCNIES,_ PA _
PROFESSIONAL LAND SA04yilRS
ti S LAMAR STRFFT PO BOX 1216
ROXBORO NORTH C.AROLINA 27573
I I3761 599-6742
CAROL IMA POWER
A LIGHT COMPANY
HYCO LANF
PI.A1 CAH l� HANCLR Q�
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REGISTER Of DEEDS
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3 OF 6
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STATE OF NORTH CAROL INA
COU" OF� PERSON ,,
I, &AT3i_ autJp". REVIEW OFFICER
OF PERSON COUNTY, CERTIFY THAT THE MAP
CA PLAT TO WHICH THIS CERTIFICATE LS
AFFIXED MEETS ALL STATUTORY REWIREMEN/S
FLIRT RECORDING
_ALN9k-- 9 _n_t,-ta
YIfW OF ILER TNITF
CAROL INA WO'R
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CONTOLR DATA
CAROL RNA POWER
A LIGHT COMPANY
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I HMITY CERTIFY THAT THE SUBDIVISION PLAT AS
DEPICTED HEREON HAS BEEN GRANICO FINAL APPROVAL
PURSUANT TO THE PERSON CO SUBDIVISION REGULATIONS
Pnw�1A•A. 04_2L-!JDATE
PI AM INN AND ZONING T--
ADMINISTRATOR
PLAT OF SURVEY
THE RESERVE
AT IIYCO LAKE
CUNNINGHAM TWP., PERSON COUNTY, N.C.
HAMLETT-JENNINGS A ASSOCIATES, C-948
212 S. LAMAR STREET, ROXBORO, N.C.
MAY 2013, NEAL C. HAMLETT L-2465
BAR CRAFN I rw<A . MM r I
MAP 4 OF 6
NOTE DASIFD L INS ALONG I,YCn 1 Mt.
420• CONIOUIR WERE ADOPTED FROM
TIE PLAT OF SURVEY RECORDED AT
PLAT CABINET 15 PAGE 994 NO
G
F itSURVEY WAS PERFORMED ON
THE UA51(FU INES At i"IS IF
CORNERS 94ORN ALONG .0LAKE
V
420• CONTOUR ARE MATIFMAT I CAL
Lj
POINTS UNLESS NOTED.
N
NORTH cmot IN.A PfR`w. CONTY
I, REAL C. NANLEtl CER^IF, DAT 1HI1
SURVIT CREATES A SUBDIVISION Of. N, WITHIN
PIR5914__ CCUNTY. FITNESS MY MID AND SEAT INNS
AG _ 'IT oOF /WY--E_j1. 21 11,
PPOFFSSIDMAI IA/D SI.IRVf YOR
I. NL,A4S__1LANLETT . CERTIFY THAT 11111
PLAT RAS DRAWN UNDER MY SLPFRVISION FROM
AN ACTUAL SURVEY MADE ODER NT SLPERVISION
'DUO DESCRIPTION RECORDED IN BOON
PAI __ _,YEFTC.RE 1(O11ENi. THAI THE BOODARIFS
NCL
I SURVED ACLEARLY INDICATED AS DRAM
•"
FROM INFORMATION FGINO IN TOOK ._L__. PAGE
1__: JMAl THE RATIO O PRt CISf WH AS CAL-
; ( ._•�
CUTATED IS I._ �O, QQQ• THAT tN15 vl Ai RAS
PREPARED IN ACCORDANCE WI TN G.S. 4730 AS
:OQ:•`ESS/�•
7•:
AMENDF , FIT TtE55 MY O71GIMA1 SIGMA TIME,
:Q�
:d.465 r;
REGISr AFTON NUMBER AND SEAL THIS 6 DAY
OF ___ AY_ AO 70.18_
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SURVEYOR �.
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RE 019tkAllON NUBL'R ... L-tA65