20200299 Ver 1_Shoreline Stabilization_20200225

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
gar; rs _ 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
_ . _ ,v,• _+: r FORM: SSGP 02-2017
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be seM T'e'
if sending via US Postal Service If sending via delivery service (UPS, FedEx,. etr,)
Karen Higgins Karen Higgins
DWR-401 & Buffer Permitting Branch DWR-401 & Buffer Permitting Branch
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC 27699-1617 Raleigh, NC 27604
A. Applicant Information i15A NCAC 02H .0502F.
1. Owner information
Name: ` 1.._0
Mailing Address:
Telephone Number:
E-mail Address:
�_k
`1 Cy -1A3's -2-50f1 Fax Number:
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•//%,Avv{ sav, usace arm�i m, ;;GENT AU?'HORIZ
ATION FORM.Pdf)
Name:
Company Affiliation:
Mailing Address:
Telephone Number.
E-mail Address.
Fax Number:
B.. Project Information 115A 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 mod. (Nichrde a scale of
some Sort- a yard sddr,, shovel handip, etc.)
d` Location of the property (where work is to be conducted)
U Narest Town:
Lake/ river/ oassn adjacent to property:
yshe (acres): Q . S NC
Subd Oldon name or site address (inchrde phase/lot number): C CALa� Ats-r Ud-- L-A
birecUM to site - please include road parses and numbem landmarks, etc:
S�� m,a- o p �� ►c�£o�
tatltude (fi de�cirrar db�r+Ksj. : -g?� -P,;> d Longiarde (dbcimd dsgrm)
5- tkscribo the erdstirts land use ar aonditlon of ftdte at the time ofthk application
(residential, undeveloped, etc): P�5 ��4,�)i-► �-1
G- Describe prof med work (hndu le disarssion asto howl i deni`rr-6 of shoreline has been
SVOMW4 or why it Is necessary):
7. WM work be conducted from land? � Ron n water? �]
& Total amount of impacts bolo --the rnonrral pool Woe level / Norei Water Level
Pe<rrnarnerrt 1111111P1111M (including M excavadoa;, baddK rip rap. retaining wak etc) in square feet:
X _
• Ternporary impacts in square tees -
t 1'l -sa
9. Total amount of imprAtsaboMethe normal pool laloe level / Norman Water level and Sofeet
landward
Permanent impacts (kxkxft back fig, emcwAdkx , rip rap. ret * tB waNs, etc) In square feet:
Temporaryk npacts (temporary dead construction corridor) in square feet:
10. Please describe the vegetation above the normal pool Me level/ Normal Water Level and 50
feet landward tottrd"(rnwnber of bum for Instance): SP =
DtL�v �
1L
2 - 20 - Zc--) 2v
/ ature� 5A H .0502(fll pate
Agent'ssbnatr" is waird of* If an =Wwrkgton kearfrom die owner is p VA*d.
FORM sssPo2-2017
Page 2 of 4

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
II Pond/ Normal Water
i IM Ml
Shoreline
Plan View
FORM: SSGP 02-2017 1
Full Pond/ Normal WaW L
- - � - _$ 114QG7U� s •
2 h.a LiOR
addlfp�--i s
.OnKn av
Plan View
Lake
(At Full Pond/ Normal Water Level)
UV&
%%UWU-.Rfl
WPM
Ustlng Dock
3halWfx
Bebw fill PMW WAIL
<h:19Dh
K._f.QP_&W A
but
m m m m [
Page 3 of 4

41
Lake
(At Full Pond/ !NormA
C
Ic
/0�SLAI
C
Side View
0-
LL-
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 a
height �gQ'
1 Qi°1
FORM: SSGP 02-2017 Page 4 of 4

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