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Home My WebLink About20140320 Ver 1_Shoreline Stabilization_20140402zit)\ko�Zb State of North Carolina Department of Environment and Natural Resources XW 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 0 1650 Mail Service Center Raleigh, NC 27699 -1650 APR 2 2014 I. Applicant Information 115A NCAC 02H .0502(al] WA 1. Owner Information Name: ev"ZS S L 041 Mailing Address: y7y� r�ia<rJ,�s��P P.�7T£25o1�1 1"f 4- 20 AL ,CL12.L /nlC -T 601. N. G, �7� l5 Telephone Number: 3 J 6` -25" '3- y 7rff Fax Number: E -mail Address: L o V, G}/RZS19 62 G I'f.4 4, 2. Agent/ Contact Person Information A signed and dated copy of the Agent Authorization letter (a form can be downloaded here: htto: / /www.saw.usace.army. mil / Portals /59 /docs /regulatory /reFdocs /Permits/ SAMPLE AGENT AUTHORIZATION FORM.odf) must be attached if the Agent has signed this application form. Name: e! ,7 TS L 0 Company Affiliation: Mailing Address: �7yC� r2 /F�tl�S�4/ /P ,o�e7Tct2sd;✓ �;�LL 2d�o� TC) 14 c , .2-7a l� Telephone Number: 3-36 `�; 3- 1/9rr Fax Number: E -mail Address: �, 0 L/, C 1XI A?Ts 1908 G M loi L 6 1y Person to receive the Certification Approval: G/ c/2 : Y s 1_6 y 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 -2011 Page 1 of d 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 C, As fC L L Nearest Town F�cs a c�2 �J /V, Subdivision name or site address (include phase /lot number) 56 7 4-'/tJt ,<A)0LL AC/1i'S P0Aa /_ c%o.s 60'e Aj,r .Z ?jg I 1— ®T o� Directions to site please include road names and numbers, landmarks, etc iAk-[ NC - /i`i d j-'e "M Mt'dA ( 0J,C La- eIf-7) 7Lf /CiJ /Z 14 A/?- d')70 c9„noNo /,D TuRu LIFT 0 Tv 57471 F /ZV /S( , �So ,6'4d J LFi9,Q27 7"A'/ LFF'T ()N FLMJ2F IE J 7uelJ L A17 OdTo P7A Z ,-N )LL A r 2 t`S 40 L AST JWd It �f Q.J LF'FT ZS S�>, 5 Describe the existing land use or condition of the site at the time of this application (residential undeveloped etc) RrS 1VriJ7 kj k Rd f4£ 6 Property size (acres) 1 AC 2F 7 Lake � river/ ocean adjacent to property 7 s— N V G 0 L- A lG C 8 Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or why it is necessary) /cad i4 W0/o/JAIL RIP RX P AL ONd- .W&Mf L /nJ! 76 P/e Cat ,v_ fu 2 7N,Fn FR O.s / V N 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 j FT X %S F7, 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 % F T X 7S f l 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) /10 &174,tTA TIOA) .Z/y,-ArTe-4 0%4qA 7W4,-) P2AS,5 XLbdC SNO,li1_IA)Z' FORM SSGP 10 -2013 Page 2 of 3 Vicinity Map Miatr� NCtsSQ Pine l x <- C ®https- / /mepsyoogl - wnVmaps /ms ?ie =UTc" - -- 4 2446663.00O48ebadab & d95ceee9 &dg= feature ? - — — - - -- ® Maps - ::_7 37' Greensboro IIC - W '4bW + Go Sle - 0 ... loy.crisl9®ptW.com . Get directions tty places i& ODD ( A NC-62 Il and IIC -119 Il d2.9 mi 55 rains 11166.10 1 b,� r:- ' T'k Driving directions to 667 Pine Knoll Acres, Leesburg, NC 27291 p Mebane. NC Y �rtm 1. Head west on E Center St tc,;ard II 4th S< $ r 2. Take the 3rd right onto N 2nd Sit 3. Take the 3rd left onto W Graham St 0 .t. Turn right onto NC -119 NIN 1st St ct` Continue to follc,i NC-1119 N a 5 5. Slight right to stay an NC -119 N r St °� 6. Turn right onto Osmond Rd C 7. Turn left onto State Rd 15611Solomon ` Lea Rd 8. Tane the 1st left onto Graystone Point Rd �'- r 9. Turn right onto Graystone Point r 10. Grayittons Paint turns right and becomes Pine Knoll Acres r 11. Turn left to sta. on Pine Knoll Acres ® 567 Pine Knoll Acres T Leesburg IIC 27291 Save to My Maps r i 1 (9�/n /Agent's Signature' 5A NCAC 02H 2 f Date *Agent's signature is valid only if an authorization letter from the owner is provided. SSGP 1% _--- _ - f,,.crescft Pc;. erPc in Design Animations SWM Show Review Kew 11111i"Whe Lay- tin z• '�-i•5v. r- ,: , � ReSd --- - }} - J . iq� text O T -4 *,D vew B ! II a/a R «: °Ar LI i IE ■�i f = �+n" Q lice• ,sJ 0ekte -.— - — --- -- -- -_ -- -- - '_—t2 to S—AAet 1 { } _f ies. 2 1 z g q. Lake (At Full Pond/ Normal Water Level) Full Pond/ Normal Water Leg Shoreline � � r Rxp po'g'o 1 F.T x 75 F7 , k -C.(JW �"ucc �eup /Nw� � - X/ I LOT #a � 7 .1 F7'X7SFi A.3 o ✓c /-eI-L 1V0,'4-)1iV iJ L 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 IM2013 Paso 3 of 3 f . �►A�r` +' " Her- j�� ._ -..r � .y _ _ _ ._--- .�..• -- ..ter' _ - ,- A.. a- OA 71