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Home My WebLink About20200433 Ver 1_Shoreline Stabilization_20200330ECEIVED State of North Carolina MAR 3 0 2020 Department of Environment and Natural Resources NCDEWWRINMES Division of Water Resources Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization ENVIRONMENTAL QUALITY 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, FeclEx, 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 SVn —DI&,yrewd Name: Mailing Address: 3 K ,'" e-*« C4 NL 77aC Telephone Number: Fax Number: E-mail Address: 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. mil/Portals/59/docs/reoulatorv/readocs/Permits/SAMPLE AGENT AUTHORIZATION FORM.pdf) Name: -J-0 L W; I ll(p,« Company Affiliation: tlnapl' _ IkAArS� Mailing Address: 1{t y ('� ' t+w y , J 50's* B-'a9f011 1%R' 2'4rv2. Telephone Number: 43q S114 Fax Number: E-mail Address: Jo#_ Q a6--J,,< 1:v;'% a- &-Cw, B. Project Information [15A NCAC 02H .0502(a) & g /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. 3. Attach a photograph of the shoreline/ buffer proposed to be stabilized, (Include a scale of some sort- a yard stick, shovel handle, etc.) FORM: SSGP 02-2017 Page 1 of 3 4. Location of the property (where work is to be conducted) County: '?"56 1 Nearest Town: F16Y.4er• 1'N�L Lake/ river/ ocean adjacent to property: i+q Ga L�-c- Property size (acres): lk^C- Subdivision name or site address (include phase/lot number): N. && CoV-t ,pr- Nc, .273,43 Directions to site - please include road names and numbers, landmarks, etc.: M I i1c-&6ees Ini11 Z t Tui;.a Dk- &e+•r• 04k PU, I, Latitude (in decimal degrees) Longitude (decimal degrees) 5. Describe the existing land use or condition of the site at the time of this application (residential , undeveloped, etc.): voalll-f,` 6. Describe proposed work (include discussion as to how hardening of shoreline has been avoided or why it is necessary): 6r0.wo, '>c A "a. PS P re-f `''add h-- QatJ -f-a -%:lur e OF sh6fv 1;1.4/ l*tu m6w i 59m"jw Z3 %,J4AA 7. Will work be conducted from land? From water? 8. Total amount of impacts below the normal pool lake level / Normal Water Level I> j 1 Permanent impacts (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet: 160 -'Pt L do UVAA _GVA 150, ton, x 1 t-AU Temporary impacts in square feet: 3 o 96 4�1-2 Gs► -&Z U-A- A- 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: 3 O G .Pry . 1 ��' l co-1 x. a'I Temporary impacts (temporary clearing, construction corridor) in square feet: 3 ov -�i ti -{fir- ',,, 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): 11. Signatur Owner/Agent's Signature* j15A NCAC 02H .0502(f)l Date *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: FORM: SSGP 02-2017 Page 2 of 4 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 La ke (At Full Pond/ Normal Water Level) to51 yS-� Full Pond/ Normal Water Level C` -AM � F Shoreline JdLiT Plan View FORM; SSGP 02-2017 Page 3 of 4 La ke (rat Full Pond/ Normal Water Level) Side View Full Pond/ Normal Water L r W '% re' i`ne — e ]ft. a 150 ft. a ldlti—1 clearing ' if necessary ft. additional clearing Lake "if necessary (At Full P-d/ Normal Water Level) Existing Dock /30ftx7ft �.�.l�.w. 1. .ems. VYYVr. at YV :'i�iZi�i itti•��r, .:full pond/ NWL 101 EXAMPLE Plan View �r FORM: SSGP 02-2017 Page 4 of 4 S" A I.,w - 1. Lk t L WWI 3 �� gF Maps 296 N Oak Cove Dr ME 296 N Oak Cove Dr Semora, NC 27343 Map data ©2020 2 mi G: '. 1 MapS 296 N Oak Cove Dr Imagery ©2020 Commonwealth of Virginia, Maxar Technologies, Map data ©2020 100 ft 296 N Oak Cove Dr Semora, NC 27343 SAMPLE AGENT AUTHORIZATION FORM PROPERTY LEGAL DESCRIPTION: LOT NO. __—_—__---- PLAN NO. �y1dZ.' PARCEL ID: 90%0 ' 0 l" 1 g"'7`Ilr ,ono STREET ADDRESS: V 9 (# i 104k &&J-- Co✓a �r .�.�pr mr-ec N L o?'73413 Please print: Property Owner: Property Owner: 160" Io"6114d The undersigned, registered property owners of the above noted property, do hereby authorize !��7c of AI.W-4 (Contractor / Agent) (Nam of Ling firm) to act on my behalf and take all actions necessary for the processing, issuance and acceptance of this permit or certification and any and all standard and special conditions attached. Property Owner's Address (if different than property above): $1 10-CLAce c.d- 7C>or`har, N(- P7'761' Telephone: q14 9-71g93N�-_ We hereby certify the above information submitted in this application is true and accurate to the best of our knowledge. Authorized Signatupa Authorized Signature Date: ----------------------- Date:---------