20200107 Ver 1_Shoreline Stabilization_20200117

Water Resources
ENVIRONMENTAL QUALITY
p/UoC U U( 0 -/L--
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 - Water Quality Certification, Shoreline
FORM: S
Shoreline Stabilization Application Form
Threcopies 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, FedE
Karen Higgins Karen Higgins
DWR - 401 & Buffer Permitting Branch DWR - 401 & Buffer Per ' ' �,�
1617 Mail Service Center
Raleigh, NC 27699-1617
A. Applicant Information MA NCAC 02H .0502(a)1
1. Owner InforT%ion
Name: ` \k
Mailing Address:
Telephone Number: \ Z\3'@
E-mail Address: C c \-"Q.,
2. Agent/ Contact Person Information
512 N. Salisbury Street
Raleigh, NC 27604
TU UE,
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/Portals69Zdocs/regulatorv/reg gcs/Permits/SAMPLE AGENT AUTHORIZ
Name:
Company Affiliation:
Mailing Address:
Telephone Num
E-mail Address:
B. Pr Information
Fax Number:
[15A NCAC 02H .0502(a) & (b))
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.
V/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

13. Attach a photograph of the shoreline/ buffer proposed to be stabilized. In ( clude a scale of
some sort- a yard stick, shovel handle, etc.)
4. Location of the property (where work is to b(e� conduct \
County: Z. 4- &,X\ Newt
Lake/ river/ ocean adjacent to property: y
Property size (acres): • ��� 5
Subdivision name or site address (include phase/lot number
erections to site - please i clude road names and numbers landmarks `c.:
OEM
Latitude (in decimal degrees)%S `�\�)Q Longitude (decimal degrees)F_"��
5. Describe the existing land use or condition of the site at the time of this application f
(residential, undeveloped, etc.): i_�� i t�C.-ttc(
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): _�Xi! h�5 u✓ondcs� 1Cq,,.Alt I`f �a (� fie,.,oaL
L400}e__ SC51--ALA 51A,ythciil� P.. u� c•. r �I r�+.t r i�nit tr( c(srJ'(34
7. 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:
Z6 7 s5 Pr.
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 fill, excavation, rip rap, retaining walls, etc.) in square feet:
R2 Sri ., f7-
Temporary impacts (temporary clearing, construction corridor) in square feet:
HAS j:�
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): YA d
_ i�'ecs ;�, j,r, �� t.•-�`l� l�-� ort�Ti.r+r� --�
11. Signature
1 27 /%
Ow r/Agent's Signature' [15A N AC 02H .0502(f)] Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 02-2017
Page 2 of 4

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.
1. a•.W91 W aIJr CA�avauvn Ur areaging oeiow the Full Pond/ Normal Water Level elevation
II Pond/ Normal Water
�
Shoreline',�
Plan View
NO
Lake
(At Full Pond/ Normal Water Level)
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mune
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Plan View kA M P E
FORM: SSGP 02-2017
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Page 3 of 4

3 ft. below full pond water level
Existing bank
10 ft. bank
Side
4 ft, above fWi pod water level 2 ft. aciftorul clearly
of necessary
FORM: SSGP 02-2017
Page 4 of 4

1/11/2020
GO gle Maps 180 Balmoral Dr
Richard Tifone
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