20200197 Ver 1_Shoreline Stabilization_20200203

2 0 2 0 0 1 9 7 State of North Carolina
Department of Environment and Natural Resources
Division of Water Res tt����iG��)s
i5A NCAC 02H .0500 — Water Quality Certification, Sh intl6n
Ft :SSGP 023p
Shoreline Stabilization Application Form
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, e
Karen Higgins Karen Higgins
DWR -401 & Buffer Permitting Branch DWR -401 & Buffer ort6
1617 Mail Service Center 512 N. Salisbury Stre
Raleigh, NC 27699-1617 Raleigh, NC 27604 `, 202�
A. Applicant Information [15A NCAC 02H .0502(a)l
I. Owner Information
Name: James Eddy Laton
Mailing Address: 48133 Access Drive Albemarle NC 28001
Telephone Number:
E-mail Address:
704-467-3599 Fax Number:
[e-mail]
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:
http://www saw usace armv mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM pdf)
Name: James Eddy Laton
Company Affiliation:
Mailing Address: 48133 Access Drive Albemarle NC 28001
Telephone Number:
E-mail Address:
704-467-3599 Fax Number:
[e-mail]
B. Project Information 115A NCAC 02H 0502(a) & (b)1
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 OZ-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: Stanly Nearest Town: Norwood
Lake/ river/ ocean adjacent to property: Lake Tillery
Property size (acres): .90 Acres
Subdivision name or site address (include phase/lot number): None
Directions to site - please include road names and numbers, landmarks, etc.:
Hwv 52 to Norwood to Pee Dee Ave/Indian Mound Road Go approx. 6 miles and turn
right on Access Drive, follow all the way to the end
Latitude (in decimal degrees) Longitude (decimal degrees)
S. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): shoreline is undeveloped home on site
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Rip rap to be installed
7. Will work be conducted from land? [yy 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:
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:
Temporary impacts (temporary clearing, construction corridor) in square feet:
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): Scrub brush to be cleaned
11. Sign ture
I-31- 20
Ow r/Agent's Signature 15A NCAC 02H .0502(f)) Date
FORM: SSGP 02-2017 Page 2 of 5

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 Leval Plevntinn
II Pond/ Normal Water Lev
Y 1 � � �
Shoreline
2— 4. x 3aa(fi
Plan View
Lake
(At Full Pond/ Normal Water Level)
Pt; P rap
3fj. X 300 4
FORM: SSGP 02-2017 Page 3 of 5

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Lake.
F-FulMnd/'Normal Water Level)
Side View
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Plan View
FORM: SSGP 02-2017 Page 4 of 5

10 ft. bank
Side
3 ft. below full pond water level 4 ft. abate full pond water level 2 ft. additional clears%
'If necessary
Existing bank
oml
FORM: SSGP 02-2017 Page 5 of 5

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