20191661 Ver 1_Shoreline Stabilization_20191205

State of North Carolina
Depart. Bent of Fisher sent ad Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 02-2017 d,
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 I-iggins 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 115A NCAC 02H .0502(a ,]
1. Owner Information RECEiYEDIDE�0DWR
Name:
Mailing Address: DEC Q 5 209
PD Pt, I -A iW �- Lrq- r"F- water Resources
NC- a`9-6o-7 3 Pormi--i�-q 36ctbn
Telephone Number: Fax Number.
-ICA4 qDa G?0-31
E-mail Address:
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:bcvww.saw.usace.army.miVPortaisi59Aocs reaulatorv/reedocs,Permits/$AMPLE AGENTr1UTHORIZA
TION FORM.odfl
Name:- -re� V—1 j.1Lz'c�
Company Affiliation:
Mailing Address:
D. F'2 0 Y--
3 i Co
oa PJ-"�s�
Telephone Number: Fax Number:
-704 40'9 to3,9ct
E-mail Address:
B. Project Information 115A NCAC 02H .0502(g) & (U
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%2COuality/Surface%2OWater...%20Permits/SSGP%2002-2017%20Shoreline%20Forrrr_finat.docx 11/20/19, 12 27 PM
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 construction access corridors. You may
use the diagram provided at the end of this application form.
3. Attach a photograph of the shoreline/ bufl'e�r 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:�
Lake/ river/ ocean adjacent to property: J—R kE N t�(-M AJJ
Property size (acres):
0. to"3 a-
Subdivision name or site address (include phase/lot number):
�.7 J5(' %-i> VIL.ea- L Ppe
5 N,g-s- % LI-5 7- o17- "�> ; N C- '-I?6-73
Directions to site - please include road names and numbers, landmarks, etc.:
Ex I T 3(Q DQL%V;E) -I-3
O 1`xC 5 ►-er-f-t "-> V-ocL p c> - 3 m � ie s
p NTo ry">>L�y s t"3A �t�E3aNE t • 3 m 1e5 . i FT oN �bC� Li=� (ZD- b,
tom( -r o+-n C-4- 0.5 LcF-r
Latitude (in decimal degrees)- Longitude (decimal
degrees) 35 • (dS I Cl-eD
-610.q(QDLI7O
5. Describe the existing land use or condition of the site at the time of this application (residential,
undeveloped, etc.): 'Zes ( Dn-V-v♦PSL
6. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Z R Iota US It.) CC fiZ.� �ftilfZ
�� -To bi�- WALE R"111 to r m- fZ t-cs/h► (:�- Ig&dzr- 45
%. Will work be conducted from land? 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:
� 6D
Temporary impacts in square feet:
N(ft
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:
—Nln
https://files.nc.gov/ncdeq/Water%20Quality,)Surface%2OWater...%20Permits/SSGP%2002-2017%20Shoreline%20Form_final.docx 11/20/19, 12:27 PM
Page 2 of 5

Temporary impacts (temporary clearing, construction corridor) in square feet:
NIA
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):
N dN�-
11. Signa
Owner/Agent's Signature [15A NCAC 02H .0502(f)1 Date I �/
Agent's signature is valid only if an authorization lette
from the owner is provided.
12. Please approximately sketch the following information on this plan and provide dinrmiom 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
Uke
jolt RA prxrd/ blo I"W
4�+Y
Full Pond/
Plan
https://files.nc.gov/ncdeq/Water%20Quality/Surface%2OWater...%20Permits/SSGP%2002-2017%20Shore[ine%2OForm_final.docx 11/20/19, 12:27 PM
Page 3 of 5

Lobe
ftw "—* WSW �ffw
E X A M rPl E.
Plan View
Lake
(At Full Pond/ Normal Water Levvi)
E
0
0
;e i ii
c
0
Side View a
LL
*,duxmj�
i It b.*m %A P0.6 *OW lean 4 ft.Aow NA V�-4 wo9p, t—i I ft. . i"-;,i
Noric bank
In frt bw*
Side Vi
AMrw
&;mw P L
https://files.nc.gov/ncdeqlWater`/`2GQuality/Surface`/`2CWater ... %20Permits/SSGP%2002 -2017%2OShoreline%20porm-final.docx 11/20119, 12:27 PM
Page 4 of 5

0
8756 Popular Ln
Terrell
r•:
Lake Norman
State Park
River Noy
0
Troutm
U

Yel
i
_,�1i
Imo^.
� •.�
�
.1041.
y .
3

(;:5e
GIVE
LAKE NORMAN DREDGING INC. AUTHORIZATION TO OBTAIN THE NECESSARY
INFORMATION FOR STABILIZATION AND DREDGED PERMITS.
DATE: ��