20140525 Ver 1_Shoreline Stabilization_20140527

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Department of Environment and Natural Resources
DWRDivision 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 PAID
Raleigh, NC 27699 -1650 MAY 2 7 2014
I. Applicant Information [15A NCAC 02H .0502(a)] NR -__W_RW OUALITY -__W_
Branch
1. Owner Information
Name: Kerry Capel
Mailing Address: P O Box 1083
Wadesboro NC 28170
Telephone Number: 704 - 695 -2920 Fax Number:
E -mail Address: [e-mail]
2. Agent/ Contact Person Information
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 /repdocs /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:
E -mail Address:
Person to receive the Certification Approval:
Fax Number:
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,
FORM: SSGP 10 -2013 Page 1 of 4

e,tc.,), ri,p rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
and construction access corridors,. You may use the diagram provided atAhe 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- Montgomery Nearest Town: Mt. Gilead,
Subdivision name or site address (include`phase /lot number):
From Highway 73, turn south onto Lilly's Bridge Road Go approximately 4 miles
and it is the first driveway on the right past Diana Drive.
5., Describe the existing land use or condition of the, site at the time,of°this application
(residential, undeveloped, etc.): residential on recreational
6 Property size (acres): /- � 3 14r- /C:f
7.- Lake/ river/ ocean adjacent to property: Lake Tillery
8. Describe proposed work,(include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Excavator to slope the bank 3 to 1 add fabric, ,and install
class 3 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:
100 linear feet x,4 ft. divided by 43560 = °0091 acres
11 Total amount ,of disturbance (including all clearing, back fill,, excavation, rip rap, retaining
wall's, etc.) above the normal pool lake level/ Normal Water Level and 50,feet land -ward in
square feet or acres: 100 linear feet x 4 ft. divided by 43560 = 0091 acres
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 msta'nce -):
wooded grass —There will probably be 2 -3 pine trees that will have, to be removed
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Ow er /A enf' ignature* [15A NCAC'02H 0502(f)l Date
'Agent's signature is valid onlyff an authorization `letter from the owner is provided',
FORM SSGP10 -2013 I Page 2 of'3

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APPENDIX G
Moderate, Rip Rap Stabilization
VEGETATION AND EROSION
CONTROL FABRIC
EXISTING GRADE
3
CLASS `2 RIP RAP
1�
2
EROSION CONTROL FABRIC
TYPICAL CONDITIONS
36" TO 72" ERODED CUT
WAVE EXPOSURE
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