20140466 Ver 1_Shoreline Stabilization_20140505

201 40468
State of North Carolina
r 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 PAID
401 & Buffer Permitting Unit
1650 Mail Service Center
Raleigh, NC 27699 -1650
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: John Travis
Mailing Address: 6220 Armsburgh Road Clemmons, NC 27012
Telephone Number: 336 - 414 -6670 Fax Number: N/A
E -mail Address: Itravis kaplanco.com
2. Agent/ Contact Person Information
Q
i
MAY -52014
t3R - wA u�-iN I
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: Shannon Miller
Company Affiliation: Owner/ Lake Norman Dredging
Mailing Address: PO BOX 3156
Mooresville, NC 28117
Telephone Number: 704- 664 -1010 Fax Number: 704 - 664 -6232
E -mail Address: eeodredgelarson @gmaii.com
Person to receive the Certification Approval: Mickey Larson/ Office Manager
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

r
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: Iredell Nearest Town: Troutman
Subdivision name or site address�(include phase /lot number):
228 Penicillin Point Troutman, NC 28166
Directions to site - please include road names and numbers, landmarks, etc.:
See attached ma
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Residential, Bare eroded Shoreline!
6. Property size (acres): 0.82
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): Shoreline Stabilization -with rip rap Erosion control
9. Will work be cond'uctedfrcm land? 0 From water? ALL WORK-DONE BY BARGE
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:
570 sq. 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: 380 sq. 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): Zero impact since-all
work is done by barge.
4/,19/14
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.
FORM: SSGP 10 -2013

LAKE NORMAN
DREDGING Sz MARINE
CONSTRUCTION, INC-
To Whom it may concern,
I doh n Travis hereby give Lake Norman Dredging, and any
of its representatives permission to obtain permits for work to be performed at:
22 8 B6n tc i I h T�i ftf-
`rr� ,,,, - IV
n I L*�
Thank you for your help in this matter,
(print name) jO Y1 4 4-ha ✓1 Lr-a v i 5
(sign name)
(phone #} - /`f - &k7 U
(date)
P.O. BOX 3156 [phone]
MOORESVILLE, NC 28117 FAX [phone]

State Park Rd, Troutman, NC to 228 Penicillin Point, Troutman, NC 28166 - Google Maps Page 1 of 2
Google
To see all the details that are visible on the
screen, use the "Print' link next to the map.
Driving directions to 228 Penicillin Point, Troutman, NC 28166
State Park Rd
Troutman, NC
Head south on State Park Rd toward Honeycutt Rd
0.4 mi
2. Take the 3rd left onto Morrison Farm Rd
2.4 mi
3. Turn right onto Penicillin Point
Destination will be on the right
0.5 mi
228 Penicillin Point
Troutman, NC 28166
https:/ /maps. google.comlmaps ?q= 228+ Penicillin+ Point , + Troutman,+NC&ie= UTF- 8 &hq =... 4/30/2014

4
ACF
1 /
! 1
ra
y
' � • rL "- .'"�� I bb i' x
T• � e
d
iM r
f
P r
416—
i
i�
W i
t
P t �
x
41
I
s�
4

.'0
Olt
r w*
A,.
A -
� ��r•- •-$,ter -� --
�,..""w°
"7pklw�-
1%
job'
NOW
y r
Af
•
r,.
ipr
ry
w
.. �-T--,-7,