20140465 Ver 1_More Info Received_20140714

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 the application fee should be sent to:
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: Chris Smith
Mailing Address: PO BOX 26:
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King, NCB a*93
Telephone Number: 336- 830 -5246 Fax Number: N/A
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:
htto: / /www.saw.usace.armv. rnil / Portals /59 /docs /reizulatory /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: 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,
and construction access corridors. You may use the diagram provided at the end of this
application form.
FORM: SSGP 10 -2013 Page 1 of 4

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: Mooresville
Subdivision name or site address (include phase /lot number): The Point, phase 7, Lot 72B
169 Rehobeth Lane Mooresville, NC 28117
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, Bare eroded Shoreline
6. Property size (acres): 0.63
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): Stabilize Shoreline with Rip Rap, Prevent erosion
9. Will work be conducted from land? ❑ 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:
300 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: 280 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 since all work done
by barge.
Own6/Agent's Signature' [15A NCAC 02H .0502(f)]
7111/14
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
Lake
(At Full Pond/ Normal Water Level)
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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
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
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FORM: SSGP 10-2013 `�`— Page 3 of 3

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