20140058 Ver 1_Shoreline Stabilization_20140116

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State of North Carolina
Department of Environment and Natural Resources
D,
Division of Water Resources
15A NCAC 02H 0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources 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 Un
1650 Mail Service Center
Raleigh, NC 27699 -1650
I. Applicant Information [15A NCAC 02H 0502(a)]
1 Owner Information
Name. Aaron Vezendy
Mailing Address 8024 Hinsdale Lane
Denver, NC 28037
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JAN 1 6 2014
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of_ . _ . ALIrY
Telephone Number. (704) 516 -4151 Fax Number- N/A
E -mail Address- AARONVEZ @GMAIL COM
2 Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here
htt /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-
Company Affiliation-
Mailing Address.
Telephone Number Fax Number
E -mail Address
Person to receive the Certification Approval
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
FORM SSGP 10 -2013 Page 1 of 4

2 Provide a detailed site plan showing property boundaries and proposed locations of
vegetation clearing, structures (buildings, retaining walls, docks, impervious surfaces,
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
LINCOLN Nearest Town Denver, NC
Subdivision name or site address (include phase /lot number) N/A
Directions to site - please include road names and numbers, landmarks, etc • 1) North on
Bus Hwy 16, 2) East on Unity Church Rd , 3) Right on Graham Rd , 4) Right on Shipps Ln 5
Left on Hinsdale Ln , 6) Last house on right. 8024 Hinsdale Lane
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) 0 341 acres
7 Lake/ river/ ocean adjacent to property Lake Norman
8 Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary) The existing wooden sea wall is decaying and damaged
which has resulted in backwash and erosion Will remove existing structure, slightly backfill
to retain original property shape and install new stabilization with geo- textile and rip -rap
9 Will work be conducted from land? ® From 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
520 ftZ
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 300 ftZ
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) planted grass lawn, 5
mature hardwood trees
January 15, 2014
Owner /Agent's ignature* [ S NCAC 02H 0502(f)] Date
Agent's signature is valid only if an authorization letter from the owner is provided
FORM SSGP 10 -2013 Page 2 of 5

Lake
(At Full Pond/ Normal Water Level)
Full Pond/
Normal Water Level ..
Shoreline
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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 5

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Slight backfill to retain shape of point.
FORM: SSGP 10-2013 Page 5 of 5

FORM: SSGP 10 -2013 Page 4 of 5

8024 Hinsdale Lane, Denver, NC - Google Maps
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8024 Hinsdale Lane, Denver, NC - Google Maps
1/14/14,3:2
Imagery 02014 DigitalGlobe, Orbia Inc, U.S. Geological Survey, Map data 02014 Google 100
https: / /www.googIe.com/ maps /preview #!q = 8024+ Hinsdale +Lane%2C +Denver%2C+NC& data=! lm4! 1... 3! 1d318612d- 80.981423!3d35.46582!3m2!1! 1148! 2i7534f13.1!4m2!3d35.46582!4d- 80.981423 Page 1

8024 Hinsdale Lane, Denver, NC - Google Maps 1/14/14, 3:2
https: / /www.google.com/ maps /preview#!q= 8024+ Hinsdale+ Lane %2C +Denver962C +NC& data= !lm4!1... 186! 2d- 80.981423!3d35. 46582! 3m2! li1148! 2i753!4fl3.1!4m2!3d35.46582!4d - 80.981423 &fid =7 Page 1

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