20131075 Ver 1_More Info Received_20131008

State of North Carolina
Department of Environment and Natural Resources
1 1 Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500 —Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10 -2013
Shoreline Stabilization Application Form
Four copies of the application (including attachments) and the application fee should be sent to:
Division of Water Resources
401 & Buffer Permitting Unit
1650 Mail Service Center
Raleigh, NC 27699 -1650
I. Applicant Information [15A NCAC 02H .0502(a)]}
1. Owner Information
Name: Steuart Key Wright
Mailing Address: 214 Willowbrook Drive
Wilkesboro, NC 28697
Telephone Number: 336- 977 -0757 Fax Number:
E -mail Address: Steuart.wright @irvannoy.com
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http: / /www.saw.usace.army. mil / Portals /59 /docs /regulatory /regdocs /Permits /SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: Kris Little
Company Affiliation: VannoV Construction
Mailing Address: 1608 Hwy 221 N inn (S F-R n W7 ?
Jefferson, NC 28640
Telephone Number: 336 - 877 -6501 Fax Number: l
E -mail Address: [e-mail]
Person to receive the Certification Approval: Kris Little
II. Project Information [15A 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, structures (buildings, retaining walls, docks, impervious surfaces,
FORM: SSGP 10 -2013 Page 1 of 4

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 a scale
of some sort- a yard stick, shovel handle, etc.)
4 Location of the property (where work is to be conducted)
County: Wilkes Nearest Town: Wilkesboro
Subdivision name or site address (include phase /lot number):
See Mailing Address: This is also Physical Address
Directions to site - please include road names and numbers, landmarks, etc: _
Hwy 268: Right on Jim Caudell; Left on Higgens• Left on Willowbrook
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):
7. Lake/ river/ ocean adjacent to property: Kerr Scott Lake
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Lake is eroding bank. Mr. Wright purchased property
around a year ago. This work is intended to prevent further erosion of the bank
9. Will work be conducted from land? XQ From water? XQ The intent is for the
track hoe to remain on land as much as possible However boom and bucket and
potentially tracks may come into contact with water
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool lake level/ Normal Water Level in square feet or acres:
See attached photos /dimensions total area of disturbance small 2' to 3' below
normal pool
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: See attached Photos /Dimensions 5'to 6' above normal pool
12. 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): Very minimal tree
impact, existing is primarily brush and clay dirt
FORM. SSGP 10 -2013 Page 2 of 3

Owner /Agent's Signature* [15A NCAC 02H .0502(f)] Date
Agent's signature is valid only if an authorization letter from the owner is provided.
Lake
(At Full Pond / Normal Water Levels
Full Pond/
Normal Water Level
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ft x 100 ft) *:
1. All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
3. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
4. Location of any proposed structures such as buildings, retaining walls, docks, etc.
5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
FORM: SSGP 10 -2013 Page 3 of 3

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