20200578 Ver 1_Shoreline Stabilization_20200429

ra-
State of North Carolina
IN
Department of Environment and Natural ResourcesDivision of Water Resources
Alater Resources 15A NCAC 02H .0500 - Water Quality Certification, Shoreline Stabilization
LNVInO-NMIF t:ALQUA-iTt FORM: SSGP02-2017
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 D 53 � R PR
A. Applicant Information 115A NCAC 02H .0502 a _
'; . ii))
APR 292ow
1. Owner Information
DENR -WATER RE':^
Name: June Allen I :4ANSPOUnIXIN 126_P%" 4NG UNIT
Mailing Address: 154 Lakeland C r l
MtGileag, N.C. 27306
Telephone Number: 704-984-0444 Fax Number: 704-984-6014
E-mail Address: [e-mail]
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:
htto-//www saw usace army m►l1Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTHORI2
ATION FORM.gdf)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
B. Project Information f15A 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

i�
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: M n n L v o m r
-- yNearest Town: M t r, ; I P A d' - N r 9 7 4 n F.
Lake/ river/ ocean adjacent to property: Tillery -
Property size (acres):
Subdivision name or site address (include phase/lot number): E n e r a l d Shores
Plat Book 5 PAge 73 Map B Section 2 Lot #10
Directions to site - please include road names and numbers, landmarks, etc.:
Latitude (in decimal degreesLX F, 0?-%'�?,?O longitude (decimal degrees)_::,
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Residential
5: Describe proposed work (include discussion as to how hardening shorelin has bee
avoided, or why it is necessary): ` f ,f
� d01Ga /� 7ld' �i0 �33di
7. Will work be conducted from land? 0 From water? ❑
8. Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent impacts (including all excavatio ckfill, rip p, taini walls
41 / �.) in square feet:
Temporary impacts in s re 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, exca on, p p, retainin walls, et ) in square f et:
Temporary impacts (temporary clearing, construction corridor) in square feet:
10. Please describe the vegetation above the normal pool lake level/ Normal W er Lev nd 50
feet landward to be impacted (number of trees, for instance): cs
11. Signature a�
4-17-2020
Owner/Agen Signature [15A NCAC 02H .0502(fll Date
s '
Agent's sign re is valid only if an 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 excavation or dredging below the Full Pond/ Normal Water Level elevation
Lake
(At Full Pond/ Normal water Level)
If Pond/ Normal Water
=a z2a am am
Shoreline
Plan View
IF
ExIong Dock
asr�snrrrr„r ■rare. rfrr�'rftbWfaXXWM
ris.�iwss.+�s`st+ x��
full fnd
�rr.rsr ri ram•
RIPMP
/ Z
FORM: SSGP 02-2017

Lake
(At FuH Pond/ Norn-
Side View
alliae-V
U-
3 ft. below fun pond water level 4 fL above full pond water level 2 ft additional spring
41 f }Oroe�yn•
FORM: SSGP 02-2017
Page 4 of 4

NMI
RI'K;
gg7jgagggp, WIF
We
sow,
A16

z
tk x
r.
tv '7!c]9wl _ _: ,fig a•�. r f.; - - _.__ ���...�",---"_ .."". ._s^ - -_�
d
a, � • � r i
r r �p-.1•'�� t( twa... � �.� ;.� tei�. - � .� - . - --,-. - ..-., ., _,.,.. r� .. _ ail
.'%j" S� Y /-1., '� '�' %� it � � `�'� �'���"'�•`, '� '' '�' �a-�v
"-'K4 '' .fit -.. �k�� fY �� �:• 4 zT�• �,y.` � '.t `.S �ytJ��-^�„'y' { Y'r*�y(. -.
7=71—
'�^ ,�(� i ` \yh� .,`rJ i,� •r}yd,i �+. Nr'M .f 1x '� ` 1 N' - t - 2'
. -JAL
4pw
AMI
5' W �r f :� Sw -'i2d •�h,L ;�,�V i iA ' h 1 J�: jt ).�0.+% '�
��. *� :ei..I..� ;��,x hFyy. •, 3d -`�j i � � �. ' �1,- .(3r'(C� r al�� �' y� �.
'' w !�i r:,• _1i .. ���• � z � �i+ i, � /- �=� d'.� lam" r