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Home My WebLink About20200327 Ver 1_Shoreline Stabilization_20200302State of ?North Carolina Depart of Fxsiawasent and NabwA Resources Division of Water Resources 15A NCAC 02H .~ - Water Quatlty Certification, Shoreline Stabilization FORM: SSGP 02-2017 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, etc.) 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 115A NCAC 02H .0502(" Owner Information /. Name: f� �A- f� K L 10 Mailing Address: ) (-0 (� PLJff t'j 17 - 5 M o, VcsJ 1 L_ C_C , � C a-� Telephone Number: • Fax Number: aOF) - 5)3-1H50 E-mail Address: �1�`�I� RUC--a3�t_, I 2. Agent/ Contact Person Information A signed and dated copy of the Agent Authorization letter must he attached if the Agent has signed this application form. (A form can be downloaded here: htto:iiwimw .usace.armti`.miLPortals .'59,'docs;reQulatorvreedocs/Permits/S.A.NlPLE AGENT AUTHORIZA TION FORM1l.uM .`11 Name C—FZ` 1Ov Ll✓�) _ _ Company Affiliation: �� (�P--l�� ( 1►v �Cn-�v— ! 1�� Mailing Address: M Kz Sv ► L , � �- �� 11-] Telephone Number: Fax Number: 7b4L4u%9- A31t-) E-mail Address: S n LDS �) L C- ✓�"iJ '� ��i CS -. Ct)Y B. Project Information 115A NCAC 02H .0502(a) & lhi1 l . 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. 6 y2V-T7-(� https://files.nc.gov/ncdeq/Water%20Quality/Surface%2OWat...0Permits/SSGP%2002-2017%20Shoreline%20Form_final.docx 2/18/20, 2:35 PM Page 1 of 5 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. 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: Z'�� Q� L Nearest Town: _ t Y� t�D (�>�S ✓ l t_ C_ E _E L Lake/ river/ ocean adjacent to property: j_ 1� p(Z {ram Jai Property size (acres): 0 ` <��b� Subdivision name or site address (include phase/lot number): PI tq tj r*�k cL-c is f+a C_Es G. NC_ aj-I ? Directions to site - please include road names and numbers, landmarks, etc.: IS i=t"1 ��cr-r 3Co t s�ca P�rmiq D�L -Tou.)ft -ZS I INCO(-N10 tJ m O r-> P i N N A c-c. e S r+a 2r=7s T�'K . (D,3 m t L-F s L L� rrT 0 N P L-n AJ %� o nJ P __ b . S n-'% t t_T_� 5 Latitude (m decimal degrees)_ Longitude (decimal "-ees) SS. (p 1 D Is t>. R3 J S l 0 5. Describe the existing land use or condition of the site at the time of this application (residential, undeveloped, etc.): j7 -E575 TIN I (--v t 6. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or why it is necessary): 1 A-0 C,6 L- I N (A (::�L-L 'k-DOKK. pOO d- %. 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: 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: Nip https://files.ne.gov/ncdeq/Water%20Qua1ity/Surface%20Wat...0Permits/SSGP%2002-2017%20Shoreline%20Form_final.docx 2/18/20, 2:35 PM Page 2 of 5 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): JJ o E- 11. Signature Owner/Agent's Signature [ 15A NCAC 02H .05021f )] Date c 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 dmmsions 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 CP a Full Pond/ Lake (At Full Pord/ Normal ti8ater Level] f� `�� sec e �o 5 >✓r �Q 6> Kk? % \- ChiST �jG- C ; Pw Plan View https://files.nc.gov/ncdeq/Water%20Quality/Surface%20Wat...0Permits/SSGP%2002-2017%20Shoreline%20Form_final.docx 2/18/20, 2:35 PM Page 3 of 5 Lake IN f�J bd/ rlunnl- leech Full Pond/ Normal Water t �hOMTne ZR.Mft. �/aliontl done • a�.u.r 0 Side View Existing Dock / Cr. 1fi 3 ftbelow full pond water level 4 ft. above full pond water level 2 ft. additional clearing elf necessary Existing bank 10 ft. bank height Side Vi I t_C https://files.nc.gov/ncdeq/Water%200uality/Surface%20Wat...0Permits/SSGP%2002-2017%20Shoreline%20Form_final.doex 2/18/20, 2:35 PM Page 4 of 5 166 Plantation Dr Plantatio h0 s a s� c fro oL/e L n �o a� Q` Rik,r ytl�v � �� i. ..�s�Ct+L'iF.