20200429 Ver 1_Shoreline Stabilization_20200327

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State of North Carolina
De#araraat of Fisirrat and Natural Resources
Divisiaa of Water Resources
15A NCAC 02H .0500 — Water Quality 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 Pasta/ Service If sending via delivery service (UPS, FedBx, 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: J o L Ft,L
Mailing Address:
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C t L M r'YAC-Y t S N c- 0'-1-'10 k �.
Telephone Number. 3 5& --4 1'S - D-L- Fax Number: tiJ I A
E-mail Address: S •�V L K 44cc) -i O.0 — Y- r. C o-Y-'1
ME
MAR 2 7 2020
-WA?cR R'970URCES
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Z 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:
httt)://www.saw.usace.armv.mil/Portats/'59idoes/re latory/regdocs/Permits/SAMPLE AGENT AUTHORIZA
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Name:•-'��� � � Nn L
JJ
Company Affiliation: L t9 �-E � ���
Mailing Address:
P -v fin) .�) 15 Co
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Telephone Number.
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E-mail Address:
B. Project Information 115A NCAC 0211.0502(a) & (U
Fax Number: 1
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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.
SCE
https://files.ne.gov/ncdeq/Water%20QuaIity/Surface%2OWat...OPermits/SSGP%2002-2017%2OShoreline%2OForm_final.docx 2/18/20, 4:27 PM
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Y 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/ buffo 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 t''e-J-eJ'i Nearest Town: A&bc're S V 1
�Lak / river/ ocean adjacent to property: �,JOY 1'yLO­r-N
Property size (acres):
01 q I PC-
Subdivision name or site address (include phase./lot number):
.�l (Z-O'Aa-M k oJ 1 0 L'C r ->$ 3�
Directions to site - please include road names and numbers, landmarks, etc.:
-1? 1T34—PC-- 150 }�w��oS L�J,1CDc�F.Ira�� M \.25
L C Fit' N-t� ih 1 O �4; w L� • O , `f ry-m t L-F—S
Latitude (in decimal degrees)_ ([.! Longitude(decimalecimal (� z
degrees). 1` 1 `J� �' V, 1 �J D
5. Describe the existing land use or condition of the site at the time of this application (residential,
undeveloped, etc.):L-
6. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Et t-DE
TZ:� '2>G st-f f;' —a- �1S/NCB
two C-1�- --v- 6 )cv2-G &--1
%. Will work be conducted from land? From water? /
8. Total amount of impacts below the normal pool lake level / Nonnal Water Level
Permanent impacts (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
'3C70 S+-
Temporary impacts in square feet:
NIR
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:
https://files.nc.gov/ncdeq/Water%20Quality/Surface%2OWat...OPennits/SSGP%2002-2017'/o2OShoreline%2OForm_final.docx 2/18/20, 4:27 PM
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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):
N a
11. Signature
Owner/Agent's Signature* [15A NCAC 02H .0502ffl1 Date -�3 'dam
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 drmemiom 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
Full
Plan
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ke kl-
�t Ul�ater level)
V�-Y
(�tP�
Ceo
https://files.nc.gov/nedeq/Water%20Quality/Surface%2OWat...0 Perm its/SSGP%2002-2017%20Shoreline%20Form_final.docx 2/18/20, 4:27 PM
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Lake
Existing Dock
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Fuif Pond( Mormal Wat�Levet -t.. r '
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Plan View
(At NA Pond/ Normal Water Level) M
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Side View
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3 ft. betow full pond water le A 4 ft. above full pond water level 2 ft, additional clearing
"if necessary
https://files.nc.gov/ncdeq/water%20QuaIity/Surface/20wat....0Permits/SSGP/o2002-2017%20Shoreline%20Form_final.docx 2/18/20, 4:27 PM
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