20140744 Ver 1_Shoreline Stabilization_20140710

PAIDState of North Carolina
DWR DeparhUnt of Environment and Natural Resources
?_ 01 40744 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
Three copies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resourcesi-(��-- -�—/ -J
401 & Buffer Permitting Unit W V t5 0 V
1617 Mail Service Center
D
Raleigh, NC 27699 -1617 L 0 2014
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1. Applicant Information [15A NCAC 02H .0502(a)] �D reranc
1. Owner Information
Name: Donny Teague
Mailing Address: 199 harbor drive
Taylorsville, NC 26861
Telephone Number: 828 - 495 -8923 Fax Number: 828 - 495 -3629
E -mail Address: donnyt @huntingtonhouse.com
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 /regdocs /Permits /SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: Corev Teague
Company Affiliation:
Mailing Address:
179 browning dr
Taylorsville, NC 28681
Telephone Number: 828 - 495 -8554 Fax Number: 828 - 495 -3629
E -mail Address: corey @huntingtonhouse.com
Person to receive the Certification Approval: Corey Teague
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

etc.), rip rap, excavation, or, dredging below Full Pond'/ Normal'W,ater 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)
5
6
7
8
9
County: Alexander
Nearest Town: Bethlehem
,Subdivision, name or site address (include phase /lot number): Reitzel Rd
Directions to site - please include road names and numbers, landmarks, etc.:
From Hickory, North on-Hwy 127, Right on Chiggar Ridge Rd, Right on Davis Cove
Rd, Right on Reitzel Rd, Property located on Left
Latitude (in decimal degrees) 35.80075994 Longitude, (decimal °degrees) - 81.29717222
Describe the existing land'use,orcondition of the site at the time of this application
(residential, undeveloped, etc.): undeveloped — future residential
Property size (acres): 3.3
Lake/ river/ ocean adjacent to property: Catawba River — Lake Hickory
Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Shorline stabilization using rip rap to avoid further'
shoreline erosion
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:
approximately 175 ft in length and 2 -3 ft in width below the normal lake level
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: approximately 175 ft in length and 6 -8 above the normal lake level
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): Grass and weeds, no
trees
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 Page 2 of 3

Siff 19 • • • • ,
Norma
SI
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
FORM: SSGP 10 -2013 Page 3 of 3
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SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT -NO. PLAN NO.
PARCEL ID: 6a( 16 -2-0
STREET ADDRESS: A 6 -T"r2 6�' ,"
1 Afi- a,1S06ktlo N c 2F6N
Please print:
Property'Owher: QV -!J /J y -7—r19 C, J
Property Owner: 0 Y4 A -� 6 06
The undersigned, registered property owners of the above noted property, do hereby authorize
eoxzl y TfS C u , of A) A
(Contractor / Agent) (Name offconsulbrig firm)
to,act on my behalf and take,all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard' and special conditions, attached.
Property Owner's Address (if different than property above):
P'/
Telephone: toys_ JV �3
We hereby certify the above information submitted in this application is, true and accurate to the,
best of our knowledge
Authorized Signa re
'Date: D
AtithoriAd Signature
Date: d�J / 4