20200386 Ver 1_Shoreline Stabilization_20200318

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
LNVIRONMLN t AL DUAL: tY
FORM: SSGP.02-2017
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent to:
!f 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 [15A NCAC 02H 0502(a)]
1. Owner Information _
Name: � -,-+ i-- (
Mailing Address:
k; b Sont`c�, A
Telephone Number: Z' 760- Fax Number:
E-mail Address: S 1-C: 1 ,=
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.army.MiIZPortals/59/docs/regulatoryZregdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf) 11 —
Name: �C�i .9 5 J ✓c, � .^
Company Affiliation:
Mailing Address: /�jj(i y w. �� .
Telephone Number: Fax Number:
E-mail Address: d 6" ;"t 1,t..(-41 -tc
B. Project Information [15A NCAC 02H .0502(a) & (b)]
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.
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

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: e —fit a C(k Nearest Town:
Lake/ river/ ocean adjacent to property: L.(A �_e
Property size (acres): I X(_�-e.
Subdivision name or site address (include phase/lot number): >w
eL a t/1 G - Lei i 5 fa 3' 5 e k re-5 s' �Zc 2 61.1'1Swooc) �!
Directions to site - please include road names and numbers, landmarks, etc.:��'�'��
Latitude (in decimal degrees)_ S�� �� 9 y� Z Longitude (decimal degrees) T
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): a'fJ "'-)
6. Describe proposed work (include discussion as to how hardening of shor line has been
avoided, or why it is necessary): _ e, /'PL4 nKC'S ?-"e L,le,j
AJ e.t It 44
6eL, . *eck
7. Will work be conducted from land? From water? 47Akd <<`L
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:
/41�)3;
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:
1,-7 1)
Temporary impacts (temporary clearing, construction corridor) in square feet:
10. Please describe the vegetation above the normal pool lake level/ Normal Vater Level and 50
feet landward to be impacted (number of trees, for instance):y. -
11
Signature
o;
Owner/A ent's ignature 15A NCAC 02H .0502 f ate
Agent's signature is valid only if on authorization letter from the owner is provided.
FORM: SSGP 02-2017
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 Pxravafinn ,,,- .4,-.4.- L-_i_._
- u -us1116 uciuw one run Mond/ Normal Water Level elevation
Lake
(At Full Pond/ Normal Water Level)
�
FuII Pond/ Normal Water Level &v'A'�-f `� Ali(P�pC960 G?
Shoreline C5 uu U � 777
t
Plan View
FORM: 55GP 02-2017
Page 3 of 4

'D
C
Side View
10 ft. bank
3 ft. below full pond water level
Existing bank
4 ft. above full pond water level 2 ft. additional clearing
- If necessary
AMPLE N I I
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FORM: SSGP 02-2017
Page 4 of 4

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