20140076 Ver 1_Shoreline Stabilization_20140123

State of North Carolina
DWR Department of Environment and Natural Resources
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 Unit
1650 Mail Service Center
Raleigh, NC 27699 -1650
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: Peter Seidel
Mailing Address: 100 Ecklin In.
Cary NC 27519
Telephone Number
E -mail Address:
919 - 624 -0429
pseidel94 @gmail.com
2. Agent/ Contact Person Information
Fax Number:
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 /reguiatory /regciocs /Permits /SAMPLE AGENT AUTH
ORIZATION FORM.pdt) must be attached if the Agent has signed this application form.
Name: NA
Company Affiliation:
Mailing Address:
Telephone Number:
E -mail Address:
Person to receive the Certification Approval:
NA
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,
etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
FORM: SSGP 10 -2013 Page 1 of 4

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: Person Nearest Town: Semora
Subdivision name or site address (include phase /lot number):
Talley Pointe / Lot #22
Directions to site - please include road names and numbers, landmarks, etc.: From
Roxboro take Hwy 57 North (Semora Rd.) - Cross the Hyco lake 3 times and at the top of
the hill take a left on Rainey Ridge. Next right onto Barefoot Landing. Next right into Talley
Pointe. Next right onto North Stillwood. Second to last lot on the left.
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): undeveloped, zoned residential
6. Property size (acres): 1.08 acres
7. Lake/ river/ ocean adjacent to property: Hyco Lake
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Dredge to 6 foot depth at normal water level in area
where boathouse will be built. Install rip rap along shoreline.
9. Will work be conducted from land? ❑X 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:
4500 square feet
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: 1000 square feet
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): Vegetation above normal
pool lake level is grass. No trees will be removed as part of this work.
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1/16/2014
Owner /Agent's Signature* [15A NCAC 02H .0502(f)] Date
Agent's signature is valid only if on authorization letter from the owner is provided.
FORM: 5SGP 10 -2013 Page 2 of 6

Vicinity Map
336
1 7.
FORM: SSGP 10-2013 Page 3 of 6

Site Plan
Hyco Lake
Boat House (At Full Pond / Normal Water Level)
34ftx48ft
Full Pond/
Normal Water Level
Shoreline
Cleared Area
8ftx120ft
Talley Pointe
Lot #22
Area
Rip Rap
3ftx120ft
Below full pond / NWL
Rip Rap
3ftx120ft
Above full pond / NWL
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 4 of 6

Photographs of Shoreline
FORM: SSGP 10-2013 Page S of 6

Photograph of Shoreline Indentation
Note: No work will be done in this section, unless rip rap is required.
t ,
FORM: SSGP 10 -2013 Page 6 of 6