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Home My WebLink About20200203 Ver 1_Shoreline Stabilization_20200205DWR DMsion of Water Resources State of North Carolina Department of Environment and Natural Resources Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization FORM: SSGP 10-2013 Shoreline Three copies of the application (including to: Division of Water Resources 401 & Buffer Permitting Unit 1617 Mail Service Center Raleigh, NC 27699-1617 1. Applicant Information [ (SA NCAC 02H .0502(a)) 1. Owner Information- Name: Srkm 1 6y-c Mailing Address: ar CAAkev1 V1 Form 20200203 and the application fee should be sent _flA,('Z(Qv,\\e t,;(. u�� Telephone Number: AYJ') Ilv- 0451 Fax Number: E-mail Address: bonke P . ( � 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.ar my.mil/Portals/59/dots/regulatory/regdocs, mits/SAMPLE AGENI AUTH ORIZATION FORM.pdf) must be attached if the Agent has signed this application form. Name: _ c \CAI SGv07> 1 V\.S Company Affiliation: `J-drChm Mailing Address: l-20 Telephone Number: _16w4-111-V501 Fax Number: E-mail Address: 1 f'o'c\. f'vc eri; r^5 '@ U .; Person to receive the Certification Approval: II. Project Information 115A NCAC 02H .0502(a) & (t: j 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: I ff& \\ Nearest Town: VIAQ,V1 Subdivision name or site address (include phase/lot number): Directions to site - please include road names and numbers, landmarks, etc.: l 1 + `i2 -+vk,. arC) s "F r�n.t� ctr. ('� [J a4r\c CLJkevi' L r� cm Latitude (in decimal degrees(P Longitude (decimal degrees) 5. Describe the existing land use or condition of the site at the time of this application (residential, undeveloped, etc.): L5,c t< r\A,C, 6. Property size (acres): a -j S 7. Lake/ river/ ocean adjacent to property: `q\c:.e M 01(A tav\ 8. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or why it is necessary): 64 C-es 1, (R , P 5<P aP� ee_ 6o r�(r� -V-A \� C,3 C)e -fP r.cyc` t c) 9. Will work be conducted from land? K From water? ❑ 10. Total amount of disturbance (including all excavation, back -fill, rip rap, retaining walls, etc.) below the normal pool lake level/ Normal Water Level in square feet or acres: I5D sy, f=} o 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: (V (X) C� 4•t, 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): r) Owner/Agent's Signat ' [15 l CAC 02H .0502(f)l Dat "Agent's signature is valid only if an authorization letter from the owner is provided. FORM: 55GP 10-2013 Page 2 of 3 Lake (At Full Pond/Normal Water Level) Full Pond/ Normal Water Level Shore ine 7 vol-� a-4-- Please approximately sketch the following item, such as 10 ft x 100 ft)`: CJL dimensions for each 1. All proposed vegetation clearing 2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation 3. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation a. Location of any proposed structures such as buildings, retaining wails, docks, etc. S. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation 6. Location of construction access corridors FORM: SSGP 10-2013 Page 3 of 3 i ;fi C06 tineroY�anl �JlL6Ke N A/ li / Ifl fl •Y j /125 '•• CALMON NOTE u• THERE MAY BE UTILITIES OTHER THAN THOSE SHOWN THE SURVEYOR ASSUMES NO RESPONSIBLn FOR URUnES NOT SHOWN HEREON. R IS THE CONTRACTOR'S RESPONSIBILITY TO VERIFY THEIR LOCATIONS. CALL BEFORE YOU dC 1-soo-632-49 8 wllliom ] O'Neill Q Tarty 1)00 o O'Neill DB 1531 RV 1665 Sot hat W10 Pg6 GENERAL NOTES: t rw MMdM MnWa >).eNFI a WJSM!]M. M tMI Ce (Owlan), w aFM. 4 swM« ). See d M'. r11M 1]IJ. .^P I1N d.al IM N� IYIa, 117 ay./d Y 4M.. Y IM 1,y d l.ah, t! d CRaF lad aM biM CdpM.n ldw Mini w d•«n w WMM iwaM nll►M H.F4enW we+O MY1 . M YwF bM M nM . un9hb r ..�MM Mt. np iwd a.aM wwwLL TlrsMx N dM �MIaF d MM w.a/. � W Mpya �.rM n rF r. M4 Fy. A f LvnaL was d r wabT 0 Y� IN+dI Aa1wY nFlr 1 s.e.« WuaW w r1dF MW ]S 9sIIs. 1!' Asw. N Nan TLL av (iW .41 hV. r wwI a. M aYd a andd. twy ydyw. 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