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Home My WebLink About20200168 Ver 1_401 Application_20200129State of North Carolina Department of Environment and Natural Resources Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, 1 2 9 2020 Shoreline Stabilization Application Form Three copies of the application (Including attachments) and the application fee should be sent to: Ifsending via US Postal Service Ifsending via delivery service (UPS, FedEx, etc.) Karen Higgins Karen Higgins DWR — 401 & Buffer Permitting Brunch DWR — 401 & Buffer Permitting Branch 1617 Mail Service Center 512 N. Salisbury Street Raleigh, NC 27699-1617 Raleigh, NC 27604 A. Applicant Information f 15A NCAC 02H 0502(av Owner Information Name: lt"SGll }%jc►i soti A4-iTtc' Mailing Address: 36Z I ir as-r 16rcc F rai PK0.i/OGJ A.C. 2IT116 Telephone Number: Fax Number: Toy- 29L- 117 z E-mail Address: �.tt�rL�. %1h..ttirL�yLi:tsf' GutolL . cok 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: hl6)://www.sew.mace.armvmil/Portals/59/docs/rc gdocs/Perrnits/SAMPLE AGENT AUTHORIZA TION FORM.odO Name: Company Affiliation: Mailing Address: Telephone Number: Fax Number: E-mail Address: B. Project information j 15ANCAC 02H .0502(a)&M 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. 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: 640A-MV0 rise vial r lTiLe ac� Lake/ river/ ocean adjacent to property: Property size (acres): L IS, Subdivision name or site address (include phase/lot number): rIAr L 2 rtW,-.n a T TIuC�, LmT 17 2y ! La &L Directions to site - pleaseInclude ro d names and numbers, landmarks, tc.: Lil[i�s brs-e, t !'� 7'0 OLi'✓i'k JrTrsh-er-/ vC I-Lkr� J r54r tV-L-. CakKK I-I"I %,2 rC cc, ✓Wt 1.5 Ar l TIO J Latitude (in decimal degrees) - degrees) Longitude (decimal 5. Describe the existing land use or condition of the site at the time of this application (residential, undeveloped, etc.): A t! dJe1esrTi-3 C PI a W 6. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or why it is necessary): ,Sitort(r-kt iS Ltmcferc.k.r vti&-pC2viO iCF %. Will work be conducted from land? v Y j From water? `t O 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: ill7c-2 (= r Temporary impacts in square feet: OJOO 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: 1 ( 0 0 sy f- �r Temporary impacts (temporary clearing, construction corridor) in square feet: l 5 Z> 0_ 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): 'rat z> 11. Signature Owner/Agent's Signature [ 15A NCAC 02H .0502a Date Agent's signature is valid only if an authorization letter from the owner is provided. F0 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 Lake (At Full Pond/ Normal Water Level) G" Full Pond/ Normal Water Level ----- --• ,73o Cwjrcr Shoreline n�� _ yrisS r Plan View Lake iM�wvuw,xu,«�wmwi ENrtinL Dock LtS� o..,. a C ,..M. YMMMW Nm aigap ,we,. ruiew,ymn EXAMPLE Plan View (At Full Pond/ Normal Water Level) fu E l- 0 z c Side ViewCL 10 ft. bank Side 3 ft below full pond water'.evel d (tabove full pond water level 2 ft. addltienal dean, necessary Existing bank FORM: SSGP 02-2017 Page I of 3 AMPLE DWR Division of Water Resources State of North Carolina Department of Environment and Natural Resources Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification Instructions for Application FORM SSGP 10-2013 (Shoreline Stabilization 401 WQC to accompany USACE GP30, GP79, or GP80) Instructions for Shoreline Stabilization Application When to use this form — This application form should be used to apply for a 401 Water Quality Certification to impact: U.S. Army Corps of Description Engineers (USACE) Permit Federal Energy Regulatory Commission (FERC) regulated lake shore or bottom GP30 Tennessee Valley Authority (TVA) regulated lake shore or bottom GP30 Local government regulated lake shore or bottom GP30 USACE Reservoir owned/regulated lake shore or bottom GP79 Private lake shore or bottom GP80 When this form should not be used —This application form cannot be used for wetland or stream impacts. This information does not apply to landowners within the twenty coastal counties that are affected by Division of Coastal Management (CAMA) rules. For more information — If you have been advised that you require a 401 Water Quality Certification, and would like more information about: ➢ The application process: http://portal.ncdenr.org/web/wq/swp/ws/401/certsandpermits ➢ How to download an application form: http://porta1.ncdenr.org/web/wq/swp/ws/401/certsandpermits/apply/forms ➢ Application fees: http://Porta1.ncdenr.org/web/wq/swp/ws/401/certsandpermits/apply/fees If you are unable to download this information or application, please call (919) 807-6300 to request an application with instructions. Please note — Not all impacts require written authorization from DWR. This may include the construction of docks or boathouses if there is no dredging or filling involved (other than the pilings). For more information, please visit the following website: http://Porta1.ncdenr.org/web/wq/swp/ws/401/certsandpermits/fags#always have to apply How to apply— When submitting an application to DWR, please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these instructions will help facilitate a quicker review time and reduce the amount of requested additional information. INSTRUCTIONS FOR APPLICATION SSGP307980 08-13 & SUPPORTING DOCUMENTATION Page 1 of 3 Provide three (3) copies of the application and supporting information (maps, drawings, etc.), as well as the appropriate application fee (see below), to the Division of Water Resources, 401 & Buffer Permitting Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617. Applicant Information ❑ Owner Information: Please provide complete and accurate contact information ❑ Agent Information: Per 15A NCAC 02H .0502, an agent may be given signatory authority for the owner/applicant if a signed and dated copy of an Agent Authorization letter is included with the application. (A sample form may be found at htta://www.saw.usace.army.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTHORIZATION FORM.pdfl II. Project Information ❑ Vicinity/ Site Map: Some type of site map so that someone unfamiliar with the area can locate your project. A county map or USGS topographic map indicating the project location is usually sufficient. ❑ Site Plan: A site plan showing the location of the shoreline, location of the impacts to the shoreline and/or lake bottom and the location and any vegetated areas that will be impacted. In most cases the site plans do not have to be professionally prepared. However, if you intend to conduct hydraulic dredging, professionally prepared drawings will likely be required for the spoil structures. See example below. ❑ Photograph of shoreline to be impacted/ disturbed ❑ Description of property (including location information and lat/long coordinates) and existing features on and near the site ❑ Description of project and impacts/ disturbance proposed III. Signature ❑ Per 15A NCAC 02H .0502, the application shall be considered a "valid application" only if it bears the signature of a responsible officer of the company, municipal official, partner or owner. This signature certifies that the applicant has title to the property, has been authorized by the owner to apply for certification or is a public entity and has the power of eminent domain. IV. Application Fee ❑ The application must be accompanied by the appropriate application fee (checks made out to the NC Division of Water Resources). The application fee is as follows (pursuant to G.S. 143-215.3D1: ➢ $240.00 for impacts to lake (below normal water level) of less than 1 acre ➢ $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre INSTRUCTIONS FOR APPLICATION SSGP307980 08-13 & SUPPORTING DOCUMENTATION Page 2 of 3 EXAMPLE La ke (At Full Pond/ Normal Water Level) , Dock 30ftx7ft Excavated Area zsaxlson Rip Rap Full Pond/ 3ftx 150ft Normal Water Level Below full pond/NWL T# Shoreline I 7p Rap 3ftx150ft Cleared Area , Above full pond/NWL 8 ftx 150 ft ' Lot A Existing Additional clearing I.- 5 ft 15 ft �7!/ 10 ft / rIi / Proposed INSTRUCTIONS FOR APPLICATION SSGP307980 08-13 & SUPPORTING DOCUMENTATION Page 3 of 3 LINE LEGEND PROPER m LINE SURVDID / PROPERTY LINE NOT SURVEYED ADJOINER PROPERTY LINE — P — OV£RNEN. POKER L9E MINIMUM BUILDING LINE / STATE RIGHT OF WAY --.--.- RAILROAD R/W - - - - - - ALLGCAITOM LIME PRE UM/NARYPLAT // I nB NOTFORRECOMA770M CONVEYANC£SOR&uES LAKE TILLERY / DUKE ENERGY PROGRESS. LLC @d, FA DASHED LINES LINES NOT SURVEYED EIP O MR O EKISTNG IRON PRE NEW IRON ROD DR 0 E)DSIING IRON ROD ECY ❑ NPK 0 EOSTNG CONCRETE MONUMENT NEW PARKER-KALON NAIL SET EPK O EEARNG PARKER-KALON NAIL ERRS O PP ® DaSTNG RAILROAD SPINE POLE CP • TELEPHONE P�EDA CALCULATED POINT WM 0 WATER METER EP EDGE. OF PAVEMENT NTS NOT TO SCALE ^Ic LOT 18ii THE LANDING > PLAT CABINET F. SLIDE 49A PREUM/NAARYFLAT k\ NOTFORREWRDA77ON, CONVEYANCES PROPOSED HOUSE LOCATION \ PPB MEETING WITH THE OWNLR \ RUSSELL MWILEY ON 11/21/2018 1/VlCffffTY MAP FLUSH P o/ LOT 17 THE LANDING PLAT CABINET F. SLIDE 49A DB. 803' PG. 189 1/2- OR SH i \ 25,755E Sq. Feet I * EIR / \ 0.59f Acres (D.I \ \ TAR REF. 8675-16-18-51-8878 / DER \ / \ M \ TAT 18 PLAT CABINET F LANDING. SLIDE 49A LYE TABLE \ i L U I REARING DISTANCE2204 \ / SIB3054 lE \ CURVE TABLE 'CURVE RADIUS ARC IEHGTH CHONG LENGTH 1 CHORD BEARING Cr MO00- I 4.92 0 18 CZ 1 4.gr I 4.e " ICE LINE ONLY PREUM/NAARYPLAT NOTFORREIMMM7110N, CONVEYANCESORSALES. NOTES 1. REPELtENCE DEED& DEED BOOK 801 PACE 189. T. TOTAL AREAS 0.591 ACRES (DHD.). 3. NO UTILITIES LOCATED OR SHOWN AS A PART OF THIS ROT PUN. 4. BC1D DASHED SHOWN PER PUT CABINET F. SLIDE 49A 5, PLOT RAN BASED ON Da NO CORNERS FOUND ON SITE S. THIS PUT IS SUBJECT TO ANY FACTS THAT MAY BE DISCLOSED BY A FULL AND ACCURATE TITLE SEARCH. 7. THIS PUT IS SUB.ECT TO ANY EASEMENTS. AGREEMENTS. OR RIGHTS -OF -WAY OF RECORD PPoOIt TO DATE OF THIS PUT, WHICH WAS NOT VI98LE AT THE TIME OF MY INSPECTION. Dr. 112- ER FlUS H % t PREMIA ARYPLAT NOTFORRECORDA770JV CONVEYANCES ORSI4IE& THIS MAP DOES NOT MEET N.C.G.S. STANDARDS 47-30 AND IS NOT FOR RECORDING. PLOTPLANONLY FAMPA.m BY FOR RUSSELL H. HUNTLEYand wife, &WYlaNNEDY PROFESS/OVAL LAND SURVEYOR CHRIST/NEHUNTLEY '°' P"`� STREET910 IJENNIFER 1ROYNO PNOVE Bto-Sn-tn+e - B/o-2m-2ssY No atMapt hoe been mad m a part of Mb liwmdary SLmy to abt b ar ahw dater caneemh9 DEED SOCK NEAR BOX PAGE 199 UT GRLEAO, NC RS Na L-,%W adateaeQ shq dq,db, eand'Bon, capac'A: cr /acoBm of a y uNRy oymunAy�d/puNK sarwx Ax/Itx 7OHN98A, FEE LET CpYTN. NOYIWI/DPY DA IE 11-27-2017 9YL£ND BY. .bW Fhb A'o. tAma N8 1 .BBB pm— tw m. -plot r �prgorbte agmay. STA 7E NOPIN L'ARLVDiA WALE- 7i20' DRA81N BM OY [MUINNG Na )he bmtlm aM ar arbfaee a/ uf/ity amW.v /Tea to Ne piopaty au � ere unbrom and ara mt a1om. TAX RFF. 6575-/1-Jl-8875 GRAPHC SCALE OIECYID d tSO.AfRE or [N /rtenB NBdap 1,lil/pZ. \\ PROPOSED T• -. 11. SDR-T, 56lK LAKE TILLERY RoR POOL E . — -. FLOOD POOL O.U. 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