20210692 Ver 1_Site Plan_20211110

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: n±= ha, Nearest Town: Hi
czo nj-
Lake/ river/ ocean adjacent to property: M Y7/1
Property size (acres): rt
6 % 2cmS -
Subdivision name or site address (include phase/lot number):
T„I_ .� r - 'rill V) Wtb 5f-l7r QJ E 9Z►21IJG 2O&Dl
Directions to site - please include road names and numbers, landmarks, etc.:
I�il�lcd d�i��c�-ioF�� i✓x.I�d
Latitude (in decimal degrees) 35. SJ9� 27 l L-i• G Z
Longitude (decimal degrees) o�
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): -e-J -h Tl Lo1- VA �nc;sFin� o l.f
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):y j
- J .1
7. Will work be conducted from land? ❑ From water?
8. Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent im acts (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
316 7 51 V / V?r'-P Pt ImA,,,*- i- i ng,-a u
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 back fill, excavation, rip rap, retaining walls, etc.) in square feet:
Temporary impacts (temporary clearing, construction corridor) in square feet:
-} tihn ar i w.f r c {
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): 0
511 S I
11. Signatu
Owne A nt's Signature' (15A NCAC 02H .0502(f)) Date
'Agent's signature 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
La ke
(At Full Pond/ Normal Water Level)
f
AltiL
Full Pond/ f
L
ism
I
Lake
(At wnPnnd/N—alWater i-eq Existing Dock
/30hxlft
3ftx ISO ft
Below full pond/ NWL
Full Pond/ Normal Water Level
.x� ... s
r" l
Shoreline Riprap t AI full pond/ NWL
I ft. x 150 ff.
additional clearing
If necessary
4 .ek
3 t
Plan View
FORM: SSGP 02-2017 Page 3 of 4

NO Ne��sSw�`�
3
Evll pordf NWI�
c
Lak
(At Full Pond/ Norm I Water L
s �
{ Fut1 Pa^b�NWL--
Side View
U
2 ft. additional clearing
3 ft. below full pond water level 4 ft. above full pond water level *if necessary
10 ft. bank
height
,Side View
FORM: SSGP 02-2017 Page 4 of 4