20200055 Ver 1_Shoreline Stabilization_20200108

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State of North Carolina
DWR Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10.2013
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Shoreline Stabilization Application Form 00
Three copies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resources
401 & Buffer Permitting Unit J- (i,C 1I\
1617 Mail Service Center ' h Raleigh, NC 27699-1617
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: Ryan and Larisa Kamp
Mailing Address: 215 Freshwater Lane, Mooresville, NC 28117
Telephone Number: 410-913-4660 Fax Number:
E-mail Address: [e-mail]
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
htto://www.saw.usace.army.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.odf) must be attached if the Agent has signed this application form.
Name: Luke King, King Farm Building Group
Company Affiliation: Owner, General Contractor
Mailing Address: 2125 Park Road Charlotte NC 28203
Telephone Number: 704 806 1983 Fax Number:
E-mail Address: [e-mail]
Person to receive the Certification Approval: Luke King
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: Iredell
Nearest Town: Mooresville
Subdivision name or site address (include phase/lot number): 134 Landover Lane
Mooresville, NC 28117
Directions to site - please include road names and numbers, landmarks, etc.:
Turn off of Barber Loop. The property is the last one at the end of the peninsula
Latitude (in decimaidegrees)35.551297 Longitude (decimal degrees)-80.952551
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):
7. Lake/ river/ ocean adjacent to property: Lake Norrman
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Repair shoreline rip rap and removal of existing asphalt
driveway.
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:
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: 900 SF
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): Grass
Ryan and Larisa Kamp 3/15/2019
Owner/Agent's Signature Printed Name Date
[15A NCAC 02H .0502(f)]
Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

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P.O. BOX 494 - DENVER, NC 28037
PHONE 7o4/483149o8
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