20191448 Ver 1_Shoreline Stabilization_20191024

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State ofNorth Carolina
Department ufEnvironment and Natural Resources
Division mfWater Resources
N/u/erBesuu,rcs 15A NC4CO2M.05U0—Water Quality Certification, Shoreline Stabilization
Lwvmo,ncnr^L_ Qv°L/r, FORM: SSGP02-2O17
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 Permitting Branch
1G17Mail Service Center 512N.Salisbury Street
Raleigh, NC 27699-1617 Raleigh, NC 27604
A. Applicant Information
l. Owner Information..
Mailing Address: 141&:3 Go_so4_Je,
2. Contact Person Information
A signed and dated copy of the Agent Authorization letter must be attached if the Agent has
signed this application form. (Aform can bedownloaded here:
AT0N FORKA.odf}
Name: LKA
Company Affiliation:
Mailing Address:
- '
Telephone Number: - 04 ber
E-rnai|Address: L_141\ Wwcff) n M a—vf. C&YVI
B. Project Information
1. Attachavicinitwnmgp(i.e.streetnnap),deadyshom/ingthe|ocationofthepropertyxvith
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 atthe end mfthis application form.
FORM: SSGP02'ZOl7 Page 1of3

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: CAAa v!jA- Nearest Town: Kerr s Fpn4
Lake/ river/ ocean adjacent to property: Kf Di YW&-el
Property size (acres): _ D b Q C r&S
Subdivision name or site address (include phase/lot number):
Directions to site - please include road names and numbers, landmarks, etc.:
Latitude (in decimal degrees). "Oto Longitude (decimal degreesJ'f CP07M
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Ye51c/1-/&A Shnr�E�� er"11
J
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):` )WJJq
7. Will work be conducted from land? U114 From water? [l
8. Total amount of impacts below the normal pool lake level / Normal Water Level
Pros I"
Permanent impac ('nclu ing all exlcavati n, btckfill, rip rap, retaining walls, etc.) in square feet:
_QA
Tempora impacts ins eet:
n d
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:
Temporary impacts (tempq;ary 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): j/,
4tll IV r_.9/VA&*W�
11. Signature
Owner/Agent's Signature` f 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

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO.
PARCEL ID: _thp/ 7 D 13% a t O3
STREET ADDRESS: �4 ---� ; -1—
Please print:
Property Owner:
Property Owner:
w; //1'
S
The undersigned, registered property owners of the above noted property, do hereby authorize
Of LI<W
(Contractor / gent) (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):
Z"1y
Telephone: 7.6 4
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature
Date:
Authoriz Signat/,r
ure/
Date: I®/ / (� / /

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Marshall Steam Station
8320 NC-150, Sherrills Ford, NC 28673
t
1. Head south toward NC-150 E
0.2 mi
N
2. Turn right onto NC-150 W
0.8 mi
3. Turn left onto Sherrills Ford Rd
02mi
r
4. Turn right onto Hob Ln
0.5 mi
r►
5. Turn right onto Cascade St
Destination will be on the left
338 ft
4163 Cascade St
Terrell, NC 28682
These directions are for planning purposes only.
You may find that construction projects, traffic,
weather, or other events may cause conditions to
differ from the map results, and you should plan
your route accordingly. You must obey all signs or
notices regarding your route.
https://www.google.com/maps/dir/Marshall+Steam+Station,+North+Carolina+150,+Sherrills+Ford,+NC/4163+Cascade+St, +Terrell,+NC+28682/@35.5... 1 i1