20191623 Ver 1_Shoreline Stabilization_20191125

,.' State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Wafer Resources 1SA NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
LNVIRONttENTAL QUALITY FORM: SSGP 02-2017
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
DW R - 401 & Buffer Permitting Branch DWR - 401 & Buffer Permitting Branch
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC 27699-1617 Raleigh, NC 27604 REGBVEDIDEWDWR
A. Applicant Information (15A NCAC 02H .0502(a)]
NOV 2 5 2019
1. Owner Information Water Resources
Name: �'+rn�itting SQciion
Mailing Address: 2770 / o
1 6WN/-}�r�L-1 S lily C
Telephone Number: �i90 113i-) Fax Number:
E-mail Address: 'S'ffx-z ),/7)D Nrl ��,/�S��ifill4ii r F��z
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:
http://www saw usace army mil/Portals/59/docs/regulatory%regdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
B. Project Information 1`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, 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.
FORM: SSGP 02-2017 Page 1 of 3

a

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 oft a property (where work is to be conducted)
County: c ,I� 0e- y Nearest Town:
Lake/ river/ ocean adjacent to property:
Property size (acres):
Subdivision name or site address (include phase/lot number):
Directions to site - please include road n9mes and numbers, landmarks, etc.:
Latitude (in decimal degrees)?S�?��oZo= Longitude (decimal degrees)— 0- �;�'-�
5. Describe the existing land use or condition o site at the time of this application
(residential, undeveloped, etc.): — L
6. Describe proposed work (include discussion as to how harden' n of shoreline has been
avoided, or why it is necessary):
�t gi o�C1�1/
7. Will work be conducted from land? a- , From water? ❑
8. 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:
/19(-
Temporary impacts in square feet: / V
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 (temporary clearing, cpnstruction 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
Agent's
(15A NCAC 02H .0502(f)j Date
is valid only if an authorization letter from the owner is provided.
FORM: SSGP 02-2017
Page 2 of 4

r,
12. Please approximately sketch the following information on this plan and provide dimensions 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
Full Pond/ Normal Water L
2 ft.. 150 fL
.Mdorw demos
' If n mwy
La ke
(At Full Pond/ Normal Water Level)
Lake
lu wn Pond/ W—A warn Level) Existing Dock
/30 ft. 7ft
3 h.1501t
' 91J7Y Id cad! NWL
Y4ft.150ft
�Abc;w 4d PMW WAIL
i IMI( i &iL: — --
FORM: SSGP 02-2017
Plan View
Page 3 of 4

Lake
(At Full Pond/ Normal Water Level)
•a)
ix
C
Side View CL
M
LL.
3 ft. below full pond water level 4 ft above full pond water level 2 ft. additional clearing
*If necessary
Existing bank
10 ft. bank a
height DyQ'
FORM: SSGP 02-2017 Page 4 of 4

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LANDING �' 2" TAu. � ""�
OVERHEAp POIt£!R LINE
4 — — ADJOINER PROPERTY LIE
F SLIDE 49—A / �°�/ _ MONT OF WAY
DB 1578 PG 546 f// — ' — ' ANM" BUp.WIVG UNE
— ALLOCATION UNE
SANDING TRAIL
MONTGOMERY State NC
CURVE TABLE
CURVE
I RADIUS
I ARC LENGTH
I CHORD LENGTH
I CHORD NG
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FLUSH
PLUSH LOT 15 Al N341004 f 1310
°RGY PROGRESS INC. ' / �� DB. 806, PG. 235 L2 N847028 W
HF 8584-00-41-8718 —I'� TAX REF. 6575-18-31-7697 LJ N647f83J W 2p
LAKE TILLERY �0•
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FLUSH
? / LOT 14
1.5 EIP(CP&L) DB.
CAPPED EIR ., ` TALL 805, PG. S17
22,203.E Sq. Feet
FLUSH lrg� 0.51 ± Acres Nil
w
CAPPED7EIR \ (D.M.D.) / �Ey IR FLUSH �o
FLUSH / \ VACANT /
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EIP - EXISTIG RON PIPE I C
EIR - EX07M IRON Roo
EP -EWE OFPAVEMENr CAM DEVELOPMENT PROPERTIES, INC.
ICV - IRRMTION BOX LOT 13
R/W - ROMW OP WAY DS. 805, PG. 517
O
. -WATER METER
teal TAX REF. 6575-18-31-7419 / nnnNuuuni aUnOavo LIVE
TM - TELEPHONE PEDESTAL
NTS-NOT TO SCALE /
"THIS MAP MAY NOT BE A CERTIFIED SURVEY AND HAS NOT
BEEN REVIEWED BY A LOCAL GOVERNMENT AGENCY FOR
COMPLIANCE WITH ANY APPLICABLE LAND DEVELOPMENT
REGULATIONS AND HAS NOT BEEN REVIEWED FOR
COMPLIANCE WIT74 RECORDING REQUIREMENTS FOR PLAT&"
VICINITY MAP (NTS)
N C A RO`/��,,
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SEAL
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CAPPED El 1 Nrwy that thin map wan drown uadar m7 wpwdolon hom an actual
7 mach ua& r my mponlaen (dad daoaipgon raoo dod In Dooh
FLUSH i t 6 oWw ndarme n •rh•wraa senrea T CAB. F SLIDE 4" �.
DoOk aunapad a•w latieabd Y drawn•
pea ar other r&%roros scum
that the ratb of pramm or poi umd aoggw b 1:10,000+
and that Ud@ map maob U* ragdeomonb Of T" Dtandad at praotbo
/ for north (Iq ym at Ldoo).
17,la . DO 18 ,
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"As Oma•aoar I'm lfueaaTor Rap. xa
This rrmP dote not Inset N.C.G.S. standards 47.30 and Is not for Rsaordina

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