20191412 Ver 1_Shoreline Stabilization_20191014

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
Shoreline Stabilization Application Form
Thine copies of the application (including attachments) and the application fee should be sent to:
If sending via US Portal Service If sending via delivery service (LIPS, Fe&x, etc)
Karen Higgins Karen Higgins
DWR - 401 & Buff_er. Per Branch DWR - 401 & Buf)'er permitting Branch
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC27699-1617 Raleigh, NC27604
A. Applicant Information [ 15A NCAC 02H .0502(a)j
2 p 1 9 1 4
12
1. Owner Information
Name: f n I c--Mi E L- S.
Mailing Address:
0113
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Telephone Number:. Fax Number:
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E-mail Address: p�fmt�V%9
Yy-I S567Y (�Ol-• LOlY1
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:
hap: %+u\N.saxN.usace.amn.miI Portals 59 does re gulaton regdocs Pemrits SA\IPLE :\GENT Al 1 1101t[LI
TION FOR\I.odf)
Name: 7E�j!_�k K I A) 0 S�
Company Affiliation: pvt��
Mailing Address:
P o 3 o ZC 31 S Co
Telephone Number-, Fax Number:
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E-mail Address: _
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B. Project Information [ I �A NCAC 0211 .05021 a i Lr h Ij
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.
https://files.nc.gov/ncdeq/Water%20Quality/Surface%20WaterIX..._%20 Permits/SSGP%2002-2017%20Shoreline%20Form _final.docx 10/2/19, 10:06 AM
Page 1 of 5

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 constructionaccess 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: Nearest. Town:
U N C-C,L O DeN"I S2
Lake/ river/ ocean adjacent to property:
Property size (acres):
Subdivision name or site address- (include phase/lot number):
a,$1 o crVk� ? y L y" C
aeN -J c C__, N t. a'Tb 31
Directions to site - please include road names and numbers, landmarks, etc.:
Latitude (m decimal degrees) -
degrees) 35. L4 �984 9­0
Longitude (decimal
--6o. 9(ofa40
5. Describe the existing land use or condition of the site at the time of this application (residential,
undeveloped, etc.):
6. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
�63�s 4
%. Will work be conducted from land? From water? F31`ig-GC + L br4 (�, IZe /{C. 4
& Total amount of impacts below the normal pool lake level / NoWater Level
Permanent impacts (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
— 53o 4
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 f ll,_ excavation, rip rap, retaining walls, etc.) in square feet
https://files.nc.gov/ncdeq/Water%20Quality/Surface%2OWater%...%20Permits/SSGP%2002-2017%20Shoreline%20Form_final.docx 10/2/19, 9:58 AM
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U,
Temporary impacts (temporary clearing, construction corridor) in square feet:
NI
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.
trer/Age Ys tgnature [ 15A NCAC 02H .0502(1� 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 dunensions 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 Pond/ Normal Water
Shoreline
Plan View
Lake
(At Full Pond/ Normal water Level)
RWINS& ! O
a� aoo 64-.
2
�� c3ULl�t+Gr��
https:iitiles.nc.gov/ncdeq/Water%2OQuality/Surface%20Water%...%20Permits/SSGP%2002-2017%20Shore]ine%20Form final.docx 10/2/19, 9:58 AM
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AMPL
Plan View
Lake
(At Full Pond/ Normal Water Level)
i
Side View
10 ft. bank
Side
Dv
D
to
E�0
C
a
U-
3 ft. below full pond water level 4 ft. above full pond water ke'If el 2 ft. additional ry ar'ug
necessary
Existing bank
AMPLE
https://files.nc.gov/ncdeq/Water%20Quality/Surface%20Watef%...%20Permits/SSGP%2002-2017%20Shoreline%20Form_finaLdocx 10/2/19, 9:58 AM
Page 4 of 5

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2810 Cherry Ln
2810 Cherry Ln, Denver, NC 28037

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