20191413 Ver 1_Shoreline Stabilization_20191014

State of North Carolina
Department of Envhvansent and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 02-2017
Shoreline Stabilization Application Form +
Three copies of the application (including attachments) and the aslicatian fee should be sent to:
If sending via US Postal Service If sending vier delivery service (UPS, FedEx, etc.)
Karen Fliggins 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 [15A NCAC- 02H .0502(a,
Owner Information &
Mailing Address:
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Telephone Number: Fax Number: Rfisourr 's
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E-mail Address:
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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:
httn://www.saw.usace.anM-.nLil�Portals/59/does/reaulatorv/does/Permits,/SAIVIPLE. AGENT AUTHORIZA
TION FORM.of)
Company Affiliation: La 0L JV 'L_)OC _V_
Mailing Address:
Telephone Number: Fax Number: y
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E-mail Address:
B . Project Information [ 15A NCAC 02H .0502(a)& (D1]
l . 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.
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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. .5 i�� p 1 AC
3. Attach a photograph of the shoreline/ buffer oposed 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:
?JEpel LLI ��ct�i,(Y1�A fl'1ems( rtrC .
Lake/ river/ ocean adjacent to property:
Property size (acres): t b"a
Subdivision name or site address (include phase/lot number): _
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Directions to site - please include road names and numbers, landmarks, etc.:
Latitude (in decimal degrees)- Longitude (decimal
degrees) (0
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5. Describe the existing land use or condition of the site at the time of this application (residential,
undeveloped, etc.): / t r 1 eL OPE!�> L®---1—
6. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
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%. Will work be conducted from land? From water? V
8. Total amount of impacts below the normal pool lake level / Normal Water Level
d- LDS G ZlAQ_�4
Permanent impacts (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
Temporary impacts in square feet:
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:
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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):
11. Signature
Owner/Agent's Signature [15A NCAC 02H .0502 U Date o
Agent's signature is valid only if an authorization letter
from the owner is provided.
12. Please approximately sketch the following information on this plan and provide di nmio► s 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
Full Pondl
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Plan View 1
Side View
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am
3 ft. below full pond water level 4 ft. above full pond water level Z ft. additional clearing
if necessary
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a
Lake Norman
Airpark
0
4;
600 Normandy Rd
n

GIVE
LAKE NORMAN DREDGING INC. AUTHORIZATION TO OBTAIN THE NECESSARY
INFORMATION FOR STABILIZATION AND DREDGED PERMITS.
DATE: