20191477 Ver 1_Shoreline Stabilization_20191024

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State of North Carolina
Department of Environment and Natural Resources
DWR
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources FORM: SSGP 10-2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: April Marie Bevan
Mailing Address: 3992 Blue Dory Ln
Denver NC 28037�
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Telephone Number: 4403154300 Fax Number:
E-mail Address: april [e-mail]
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http://www saw usace army mil/Portals/59/docs/regulatoryZregdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: Dean Fisher President
Company Affiliation: Lake Norman Custom Dock & Pile Driving, Inc
Mailing Address: PO Box 1439
Denver NC 28037
Telephone Number: 7044832144 Fax Number:
E-mail Address: Ikndockfta gmail.com
Person to receive the Certification Approval: Dean Fisher and April Marie Bevan
II. 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, structures (buildings, retaining walls, docks, impervious surfaces,
FORM: SSGP 10-2013 Page 1 of 3

etc.), 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.
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: Lincoln
Nearest Town: Denver
Subdivision name or site address (include phase/lot number):
EASTWIND COVE SUBDIVISION PH1 lot 16
Directions to site - please include road names and numbers, landmarks, etc.:
Take NC-16 Business. Turn left onto Webbs Rd. Turn left onto Eastwind Cove Rd.
Turn right onto Rivendell Rd. Turn left onto Blue Dory Ln. Property is on the right.
Latitude (in decimal degrees) 35.525431 Longitude (decimal degrees)'80.9954497
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): residential
6. Property size (acres): 0.514
7. Lake/ river/ ocean adjacent to property: Norman
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): install rip ran shoreline to prevent shoreline erosion
9. Will work be conducted from land? % From water? ❑
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool lake level/ Normal Water Level in square feet or acres:
1,050 sq ft
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres: 1,750 sqft
12. 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): natural area with trees
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Owner/A gnature* [15A NCAC 02H .0502(f)] Date
*Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSG 10-2013 Page 2 of 3

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 16 PLAN NO. PARCEL ID: 84401
STREET ADDRESS: 3992 Blue Dory Ln., Denver NC 28037
Please print:
Property Owner: April Marie Bevan
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Dean Fisher, President of Lake Norman Custom Dock & Pile Driving, Inc
(Contractor / Agent) (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):
Telephone:
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorize nature Authorized Signature
Date: / 11�� f Date:

10/17/2019
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CHUCK POOVEV, PLS #3762
R08ERT DEDMON, PLS 43899
3704 NC HIGHWAY#* NORTH
P.O. BOX 4gg44- DENVER, NC28037
PHONE:7o4/483/49o8
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Existing site photo 2
3992 Blue Dory Ln
Denver, NC 28037
April Marie Bevan