20200055 Ver 2_Shoreline Stabilization_20200206

DWR
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources FORM: SSGP 10-2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be
to: 1
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Nil
I. Applicant Information [15A NCAC 02H .0502(a)] vll''"
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:
http //www saw usace army mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) 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 decimal degrees) 35.551297 Longitude (decimal degrees)-80.952551
S. 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 shore line 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:
2100 SF this is for the full 415' of shoreline
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 of Soil for the full 415' of shore and 300 SF of Asphalt Removal
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
Owner/Agent's Signature
Luke King
Printed Name
[15A NCAC 02H .0502(f)l
'Agent's signature is valid only if an authorization letter from the owner is provided.
2/3/20
Date
FORM: SSGP 10-2013 Page 2 of 3

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