20140466 Ver 1_More Info Received_20140521

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
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: John Travis
Mailing Address: 6220 Armstrong Road Clemmons, NC 28166
Telephone Number; 336 - 414 -6670 Fax Number: N/A
E -mail Address: itravis @kaplanco.com
2. Agent/ Contact Person Information
sent to:
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http: / /www.saw.usace. army. mil / Portals /59 /does /regulatory /regdocs /Permits /SAMPLE AGENT AUTH
ORIZATION FORM.0 ) 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: geodredgelarson @gmail.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 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: Iredel) 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 map
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Residential, Refresh Rip /Rap
6. Property size (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): Shoreline Stabilization adding rip rap , Erosion control
9. Will work be conducted from land? ❑ From water? LL 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:
5.70 sa. 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' 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 Page 2 of 3

Full Pond/
Normal, Water. Level ,
Shoreline
La ke
(At Full Pond / Normal water Level)
Iq 0 /
of 4 Me--
3'belovJ
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.
S. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
Page 3 of 3
FORM, SSGp 10 -2013