20200165 Ver 1_Shoreline Stabilization_20200128

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State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
ENVIRONMENTAL QUALITY FORM: SSGP 02-2017
Shoreline Stabilization Application Form 2 0 2 0 0 1 6 5
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,, C.)
Karen Higgins Karen Higgins �a A
DWR-401 & Buffer Permitting Branch DWR-401 & Buffer Permitting Branch 1 1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC 27699-1617 Raleigh, NC 27 ^ a �n
A. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name:
Mailing Address:
Telephone Number:
E-mail Address:
660 Clearwater Lane
Semora, NC 27343
252-883-7025 Fax Number:
[e-mail]
2. Agent/ Contact Person Information
.IAN G8"',
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:
htto://www.saw.usace.armv.mil/Portals/59/docs/regulatory/reizdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
B. 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, 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

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: Person Nearest Town: Roxboro, NC
Lake/ river/ ocean adjacent to property: Hyco Lake
Property size (acres): 2.39 acres
Subdivision name or site address (include phase/lot number): Lot 7- Clearwater
Directions to site - please include road names and numbers, landmarks, etc.: From Roxboro -
take Highway 57N approx. 10 miles to Highway 119N. (these is a flashing caution light and a
Dollar General on the left. Turn right at the flashing light. This is Highway 119N. Take the next
right onto Cunningham Rd. Go approx. 4 %2 miles to turn right onto Franklin Rd. Go approx. 1
mile to turn left onto Heritage Harbor Dr. Go approx. %Z mile to turn right onto Clearwater Dr.
660 Clearwater Dr. is on the right.
Latitude (in decimal degrees) 36.51453611 Longitude (decimal degrees)-79.06527778
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Residential
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Installation of rip rap to protect shoreline from continued
erosion.
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:
203 square feet
Temporary impacts in square feet:
none anticipated
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:
609 square feet
Temporary impacts (temporary clearing, construction corridor) in square feet:
n/a
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): Mostly turf with some
areas of cleared mulch areas. Limited trees (potentially 5 trees) within 50 feet landward side.
FORM: SSGP 02-2017 Page 2 of 5

11. Signatu��
1- ZI- 2o2b
Owner/Agent's Signature' [15A NCAC 02H .0502(f)) Date
"Agent's signature is valid only if an authorization letter from the owner is provided.
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)
Full Pond/ Normal Water Level
Shoreline
Plan View
FORM: SSGP 02-2017 Page 3 of 5

a)
J
Lake
(At Full Pond/ Normal Water Level)
o °
Z N
C
Side View
Lake
rrr�rrr
� rrr
rrrr
FORM: SSGP 02-2017 Page 4 of 5

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
height
Side Vi -7
aR P
FORM: SSGP 02-2017 Page 5 of 5

1/7/2020
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Sherrick / Clearwater Riprap
Plan View
Shore
Line
Segment 3 Segment 2 Segment 1
Three segments of above normal lake level
Three segments of below normal lake level
1)
104 feet x 3 feet = 312
1)
104 feet x 1 feet = 104
2)
54 feet x 3 feet = 162
2)
54 feet x 1 feet = 54
3)
45 feet x 3 feet = 135
3)
45 feet x 1 feet = 45
Total
609 sq. Feet
Total
203 sq. Feet
Side View
1 foot 2 feet above
Below Normal level
Normal
Level

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