20201298 Ver 1_Shoreline Stabilization_20201204

State of North Carolina
Department of Environment Quality
DWRDivision of Water Resources
15A NCAC 02 H .0500— Water Quality Certification, Shoreline Stabilization
Division of Water Resources FORM: SSGP 10-2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Applicant Information [15A NCACO2H .0502(a)]
1. owner Information
Name: Mark Zich
Mailing Address:
1338 Misty Lane
Hickory, NC 28601
Telephone Number: 828-228-1336
E-mail Address: [e-mail]
Project Information [15A NCAC 02H .0502(a) & (b)]
1. Attach a vicinity map (i.e. streetmap) clearly showing the location of the propertywith
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, structures (buildings, retainingwalls, docks, impervious surf aces,
etc.), 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 ascale
of some sort- a yard stick, shovel handle, etc.)
4. Location of the property (wherework is to beconducted)
County: Catawba Nearest Town: Hickory
Subdivision name or site address (include phase/lot number): Whistle Peace Lot 12
Directionsto site -please include road names and numbers, landmarks, etc.: Highway 16
to Springs Road to Sul burs rin s Road to Lynchburg Road to Reitzel Road to Misty Lane
Latitude (in decimal degrees) 35.803629 Longitude (decimal degrees)-81.235803
FORM: SSGP 10-2013 Page 1 of

5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): residential
6. Property size (acres): 0.92
7. Lake/ river/ocean adjace ntto property: Lake Hickory
S. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, orwhy it is necessary): install ri -ra on lake shore
9. Will work be conducted from land? • X From water? ❑
10. Total amount of disturbance (including all excavation, backfill, rip rap, retainingwalls, etc.)
belowthe normal pool lake level/ Normal Water Level in square feetor acres:
Install ri -rap two feet along 100 feet of shore line 200 s uare feettotal to revent
shore line erosion.
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres: none
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 feet landward to be impacted (numberof trees, for instance): Seventrees
t Printed Name Date
Owner/Agent's Signat re
[15A NCAC 02H .0502 f
*Agent's signature is valid only if an authorization letterfrom the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

C,111 Dnnrif
No
Lake
(At Full Pond/Normal Water Level)
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as10 ft x 100 ft) *:
1. All proposed vegetation clearing
2. Location of rip rap orfilIto be placed above the Full Pond/Normal Water Level elevation
3. Location of rip rap orfilIto be placed below the Full Pond/ Normal Water Level elevation
4. Location of any proposed structures such as buildings,retainingwalIs, docks, etc.
5. Location of any excavation or dredging beIowthe Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
FORM:55GP 10-2013 Page 3of3

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