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Home My WebLink About20191472 Ver 1_Shoreline Stabilization_20191024C� oi9N4a. 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 00 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) REC��1�P�� Karen Higgins Karen Higgins DEE .jR ,,-ild�� 5 DWR - 401 & Buffer Permitting Branch DWR - 401 & Buffer Permitting Branch 1617 Mail Service Center 512 N. Salisbury Street OCT 24 2019 Raleigh, NC 27699-1617 Raleigh, NC 27604 Water Rggoua'i'.i t Permitting Sf"^t;$p911 A. Applicant Information [I 5A NCAC 021-1 .0502(all 1. Owner Information %� % / t Name: 14Jhu w !"rl V►'�a h.C_ f � < r ► c �C /�! r�'t®i� Mailing Address: /S"6 7 / 'Ta r, 6- I% r ac oc AI C, l Telephone Number: /�y�y �J' Fax Number: E-mail Address: rj{�j /MC),r1 C pri g �r C�v l0 �� J'�'►ei I ! . G O ry%- 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: htp://www.saw.usace.anny.mil/fli2rtA_s/59/ci(i /regu • t /reedocs/Permits/SAMPLE AGENT AUTHORIZA TION FORM.pdL ,,{{ Name: Na,T"l,, Company Affiliation: / / A & r I Mailing Address: 156 7 i4wwgs- /V Telephone Number: %j 7 f CDg,'�2- Fax Number: E-mail Address: ry( i3lcyn �+J//Cr�7`!r�`` �rylG ri C'o+'� B. Project Information [ 15A NCAC 0211.0502ta) & (b)] 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. 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. 3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale of some sort- a yard stick, shovel handle, etc.) 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: ,S�C n J Y Nearest Town: Alorwoo-JI Lake/ river/ ocean adjacent � �r perry: Property size (acres): T r / Subdivision name or site address (include phase/lot number): Directions to site - please include road names and numbers, landmarks, etc.: 4tuy SZ �-o P66Or--C' Av. +0 AA' fCn"- Gz'►/16 w,� coves yeti ) -u.rPL C)1A 1- L r bo►* Latitude (in decimal degrees)_ Longitude (decimal degrees) Z 7i X277 i oo'Y / 5. Describe the existing land use or condition of the site at the time of this application (residential, undeveloped, etc.): %^Z5 S J16" A"::(, j 6. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or why it is necessary): N z r r- Irs ✓%d 'C CM w o l I %. Will work be conducted from la/nd.?.- -/ From water? g. 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: 7—"x /cc - 2C7o sF-F/- 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 full, excavation, rip rap, retaining walls, etc.) in square feet: Zl'X!610 = 900 seff Temporary impacts (temporary clearing, construction corridor) in square feet: — / 21Y /Od = /j2co -rfiL 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): W i () n(4 b-6 fi X-111y c.v\y � rti-cs cpLA,4- Owner/Agent's SignatureY [ 15A NCAC 02H 0502(f)j Date 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 dinsensions for each item: 1a,. All proposed vegetation clearing U. 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 %, full Pond/ Normal WaCM am d Shoreline Plan View Lake (AtrullPmufJNermalw—u-q Existing Dock /39ha 71, 2 h. x 150 it. ad�+.�onal dEwrmg • a nxessary Riprap 3h.150h &low lug pond/ NWl Ab— full p-d/ WNI EXAM P"' LiE Plan View �'./Y� / .aripra� o Zx !eC t is &CM[ON W a l 2"xjGU 841IC6� 50)- %� rcel-h ct5 -r- e A, we'll (� A tt W6p� G>1 Lake (At Full Fond/ Normal Water Level) 7. rip r&P ��JJ IA Ft,,,F ®- wa1/ Side View CL U- 3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing `if necessary { I FORM: SSGP 02-2017 Page 1 of 3 -Im P