20170632 Ver 2_Shoreline Stabilization_20200807

•
Water Resources
ENVIRONMENTAL QW' -'
'R �/ 7—L�6 _-2� 11 4��
State of North Carolina
Dep ment of Environment and Natural Resources
Division 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 zip,
,i+�s+tion@_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 Et Buffer Permitting Branch DWR - 401 Et Buffer Permitting Branch
1617 Mail Service Center 512 N. Salisbury Street RECEIVED
Raleigh, NC 27699-1617 Raleigh, NC 27604
A U G 0 7 2020
A. Applicant Information [15A NCAC 02H .0502(a)]
1. owner Information NCDEQ/DWR/NPDES
Name: /144-e- 13C'
Mailing Address: Ly / 4 Z 144r��s S 14
7_� 2g7c
Telephone Number: 'S6 y 5-93 7.5—/41 Fax Number:
E-mail Address: M4eA 150-✓h PO L4m, /Y,T
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 mit/Portals/59/dots/reputatory/rep,docs/Permits/
Name:
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Fax Number:
B. Project Information [15A NCAC 02H .0502(a) Et (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
FORM: SSGP 02-2017
Page 1 of 3

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: Ge, , I-, •i Nearest Town: R- / io, ,ft T
Lake/ river/ ocean adjacent to property: 44 k _ W L f:
Property size (acres): D • y
Subdivision name or site address (include phase/lot number):
Directions to site - please include road names and numbers, landmarks, etc.:
v�Tfi Po,'nr /?� -%�4 �'j�,� I-�'-�Y f�� — , r4�LT cy. f�ytiy �r4µNfi�S�"',%Iz
Latitude (in decimal degrees).;5• Zoy Longitude (decimal degrees)Z
Orr
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): t,e ILe" "r c. /
6. Describe proposed work (include discussion as to how hardening of shoreline has
been avoided, or why it is necessary): Dtl�ta, he
7. Wilt 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, backfilt, rip rap, retaining walls, etc.)
in square feet: / Oo 6
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
square feet:
ry impacts
fill, excavation, rip rap, retaining watts, etc.) in
ry clearing, construction t
&.c7- 1> is
in square feet:
04 Of-FIand- Ebj
FORM: SSGP 02-2017 Page 2 of 5

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):
Nak-%
11. Signature
Owner/Agent's Signature" [15A NCAC 02H .0502(f)j 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:
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
La ke
(At Full Pond/ Normal Water Level)
Full Pond/ Normal Water Level
Shoreline
Plan View
Level elevation
FORM: SSGP 02-2017 Page 3 of 5

W
La ke a�
(At Full Pond/ Normal Water Level)
c
M,_
EL
0 O
Z
O
Side View Q
L.L-
r-ui Pend/ Normal Water Lf
Shoreone o
2 ft.. 150 ft.
addni—I de-ni;
if necessary
Plan View
Lake
(At Full Pad/ Notmel Weter Level) Existing Dock
/30ftx 7 ft
3ftx 150ft
Below full pond( NWL
4ft x 150ft
Above full pond( NWl
FORM: SSGP 02-2017 Page 4 of 5

near Belmont — Gaston
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