20140528 Ver 1_Shoreline Stabilization_20140522

2C 1 40528
State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
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 @ [A M D
0 LS LM
I. Applicant Information [15A NCAC 02H .0502(a)1 LY, 2 2 2014
1. Owner Information
Name: pj ©b C �} r n/ - V Ai..ITY
w4
Mailing Address: sp��-2-Q
Telephone Number: q Fax Number:
E -mail Address:
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded
here: httD: / /www.saw.usace.armv, mil / Portals /59 /docs /reRulatory /re2docs /Permits/
SAMPLE AGENT AUTHORIZATION FORM.odf) must be attached if the Agent has signed this
application form.
Name: _.. 9 C r.: c?
Company Aff iliation: f h
Mailing Address: 12,0' 3o f
C'
Telephone Number: ?S 4 W'= 64,PY Fax Number:
E -mail Address: -ij p /,' !T 33 F
Person to receive the Certification Approval:
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 -2013 Page 1 of 4

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: F-�, N,,4 �'�` ev Nearest Town: ,f j �dlsr
Subdivision name or site address (include phase /lot number):
Inc R 0 �� a -, � P "�
J 4 , .�� c • ` ,
Directions to site - please include road names and numbers, landmarks, etc.: ,t
jo rt M C- A.,
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.):
6. Property size (acres): A 00
7. Lake / "river/ ocean adjacent to property: ) -� A k a
8. Describe proposed work (include discussion as to,how hardening of shoreline has been
avoided, or why it is necessary): jqWd k, �.� L� 5 � E-7V � O�
�9. Will work be conducted from land? g'� From,w,ater? ❑
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool lake level/ Normal Water Level irnsquare feet or acres:
wa 1� = 3 16
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: Q�`Irf cL 4 )%I � SNu w e, u -- 15;-e 1--, 57 --
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 feet landward to be impacted (numb �r of trees, for instance): h v- er,.�, -f-3,,N ,f� r 5
d b( v�/ifi� ;`� 5`U L 7LV6i rG. e
FORM: SSGP 10 -2013 Page,2 of 3

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Google Maps
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Directions•from USPost Office to 1,05 Teepee Cir
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Bu- ffigh S.-od\i,
https://*Ww.google.com/niaps/preview?f-
Drive 9.6 miles, 20 min
tam --1
105 Teepee Cir
a tip
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iA
01�
0 US Post Office
313 Main St, Bunn, NC 27508
Head, southeaacin NC-98-E/S Main St toward lags
t Buell Ave
Continue to follow NC-981E 2 ham,
28mi/4min
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X".0 US Post Office
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I of 2 5/18/2014 9:07 PI

Google Maps
https: / /www google.com/maps/preview ?mod
105 Teepee Or
c9
J iac i
rz
r' Turn right onto Sagamore Dr ,lie ram .
08m1
01 7 `Turn left onto Lake Royale /Sagamore Dr
04m1� °W�1
11 8 Take the 2nd left -to stay on Lake Royale /Sagamore Dru
0 2'mi
11 9 Take the 2nd left to stay on Lake Royale /Sagamore Dr
371 ft
11 10 Turn left to stay on Lake Royale /Sagamore Dr
04m1
41 11 Turn left to,stay on Lake Royale /Sagamore Dr
06m1
41 12 Take the 1st left onto Teepee Cir
G Destination will be on the right
10 ft
O 105 Teepee Cir
Louisburg, NC 27549
These directions are for planning purposes only You may find;that,constructlon projects, traffic, weather,
or other events may cause conditions to differ from the map results, and you should plan your route
accordingly You must obey all signs or notices regarding your route
Map data 02614 Google
2 of 2 5/18/2014 9:07 PM
Follow Sledge Rd, Shawnee Dr,and Sagamore
Dr to
M
Teepee Cir In Cypress Creek
tk
�a
�w= LukriRa
6 8 ml / 16 min
„+
la P, ' ��en
ke Pamk
1.
Own er A-1.
°1 2 Turn left onto,Sledge Rd-
1
25m1
r 3 Turn right onto Cheyenne,Dr
O 1 ml
r�
new
r° 4 Turn right to stay on Cheyenne Dr
-
262 ft
,;,4 � yr rnm
r' 5 Turn nghtonto Shawnee Dr
1'6m1
105 Teepee Or
c9
J iac i
rz
r' Turn right onto Sagamore Dr ,lie ram .
08m1
01 7 `Turn left onto Lake Royale /Sagamore Dr
04m1� °W�1
11 8 Take the 2nd left -to stay on Lake Royale /Sagamore Dru
0 2'mi
11 9 Take the 2nd left to stay on Lake Royale /Sagamore Dr
371 ft
11 10 Turn left to stay on Lake Royale /Sagamore Dr
04m1
41 11 Turn left to,stay on Lake Royale /Sagamore Dr
06m1
41 12 Take the 1st left onto Teepee Cir
G Destination will be on the right
10 ft
O 105 Teepee Cir
Louisburg, NC 27549
These directions are for planning purposes only You may find;that,constructlon projects, traffic, weather,
or other events may cause conditions to differ from the map results, and you should plan your route
accordingly You must obey all signs or notices regarding your route
Map data 02614 Google
2 of 2 5/18/2014 9:07 PM

Owner /Agent's Signature` [15A NCAC 02H 0502(f)] Date
`Agent'stsignature is valid only if an authorization letter from the owner is provided.
Full Pond/
Normal Water Level
®am M3 EM CM
Shoreline
Lake
(At Full Pond/ Normal Water Level)
Q�
moo. 00 mm
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Wit
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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 p `Tc
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 d
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: SSU 10 -2013 Page 3 of 3

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SYNTHETIC PRO,DUCTS,LLC
y§
M
800"
x
u VIN"a 6#F7'PjY (Technical Data,
Strength Rating (M)
Lbs -Ft/Ft
4,288
Modulus of'Elasticlty'(E)
psi
380;000!
Allowable Sheai
Lbs /Ft
3,446
Co- Extruded
Yes .
Thickness (t)
inches
030
Section Depth
inches
8
Section Modulus (Z)
Ina /ft
156
Section Width
inches
20
Moment of Inertia (1)
in °/ft
623
UV Stabilized
Yes
Ultimate Tensile Stress
psi
6,300
Standard
Packaging
sheets/
"bundle
20 &
10
Creep Limited stress
psi
4,000
Z"
>
tit
AisAlabania
rlerelopment
ftlaves a `avy-
strjle bulk-hertd.
eonstnittion Iv"tth
theEvelLast
4 1 Sevies,
The values shown are nominal and may vary The information found in this document is believed to be true and
accurate No warraribes of any kind are made as to the suitability of ESP sheet,pi6ng for particular applications
or results obtained therefrom Consult with a pIOTessional engineer °and /or contractor as to The suitability of this
product for your paiticulai application
1`000 ,Wyngate Parkway ( Suite 100 j Woodstock, GA 30189 '1 Tel. [phone] Fax: [phone]
sales @everiastseawalis.com I www.everiastseawalls.com

EXAMPLE AGENT AUTHORIZATION FORM
Property Legal Description:
Parcel ID:
Lotft. (if applicable) � Plan No. (if applicable),
Street Address (if applicable):
Prooerty Owner:
Owner Name (print): - 5 #g7rr Fin
Property Owner's Address (if differentthan the above): �e:--�'iP; ---,&
Owner Signature:
The above registered property owners of the above property, do hereby authorize
of 00, i��f
Agent Name
Agent Company Name;(if applicable)
to act on my behalf and take all actions necessary for the application, processing, issuance and
acceptance of this permit, certification�or authorization including all standard and speeiai`conditions
attached.
I hereby certify thatthe above information submitted on this form and application is true and,accurate
to the best of my knowledge.
Authorized Agent Name / Company:
Authorized Agent,Signature,
Date:

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