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Home My WebLink About20140978 Ver 1_Shoreline Stabilization_20140915State of North Carolina Department of Environment and Natural Resources Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization FORM: SSGP 10.2013 Division of Water Resources 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 2 0 1 4 0 9 7 8 Raleigh, NC 27699 -1650 Applicant Information 1. Owner Information Name: t&e v I Mailing Address: .t lz6ae 1a N7(oI iF_ Telephone Number: J11— 1413 - / ZS g Fax Number: E -mail Address: ke. V i n no Q U 1 00 - CA'yX 2. Agent/ Contact Person Information A signed and dated copy of the Agent Authorization letter (a form can be downloaded here =_'_ r it��'t _i"if t•- i.�;' -i /, r� ,n�� -1T tr -;70 �'i'il Ern ,?_� n must be attached if the Agent has signed this application form. M Name: Company Affiliation: Mailing Address: Lb to S c� Telephone Number: Fax Number: E -mail Address: R Person to receive the Certifitation Approval: u. Project Information [_> I•,'v_ t _ '' =(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 KARLA J. NORSWORTHY KEVIN E. NORSWORTHY LIC 6091088 6190727 1312 GLENDEN FALLS WAY PH 919 - 866 -0705 RALEIGH, NC 27614 PAY TO THE Pale 1of4 66- 7549/2531 2203 DATE ;y 6.cwiry FUwm Owu, m Brit WAbIAL Simply Brighter. federal credit union PO BOX 58429 Ralelq i NC 2765p &)Dysa+J�tJ,�,1 P, ed MEMO 16 b %�'fngL� of a 1: 253 L 754941:00000 2465600 L Silo 2 203 "1 �W E M c= 1 State of North Carolina z fg n Department of Environment and Natural Resources Division' of Water Resources p,; 0 1 4 0 `7 7 u Division of Water Resources 15A NCAC 02H .0500 - Water Quality Certification Instructions for Application FORM SSGP 10 -201 (Shoreline Stabilization 401 WQC to accompany USACE GP30, GP79, or GP80 I 'A'. rye ® - — Instructions for Shoreline Stabilization Application When to use this form —This application form should be used to apply for a 401 Water Certification to impact: SEP 1 2014 Description U S. Army Corps of Engineers (US CE) Per Federal Energy Regulatory Commission (FERC) regulated lake shore or bottom GP30 Tennessee Valley Authority (TVA) regulated lake shore or bottom GP30 Local government regulated lake shore or bottom GP30 USAGE Reservoir owned /regulated lake shore or bottom GP79 Private lake shore or bottom GP80 When this form should not be used - This application form cannot be used for wetland or stream impacts. This information does not apply to landowners within the twenty coastal Z counties that are affected by Division of Coastal Management (CAMA) rules. n P�'� =) For more information - If you have been advised that ^� Z you require a 401 Water quality Certification, and would like more information about: Icn �-- ➢ The application process c , - Y ; = „ "_ • ' , i,- -- - - -- '`i' , -_ _ ➢ How to download an application form. _ ➢ Application fees: - -- - -- - - - = - ;V j O -� i if you are unable to download this information or application, please call (919) 807 -6300 to CD request an application with instructions O = "f Please note - Not all impacts require written authorization from DWR. This may include the co -^� construction of docks or boathouses if there is no dredging or filling involved (other than the pilings). For more information, please visit the following website: Now to apply- When submitting an application to DWR, please use the following instructions as a checklist in order to ensure all required Items are submitted Adherence to these instructions will help facilitate a quicker review time and reduce the amount of requested additional information. INSTRUCTIONS FOR APPLICATION SSGP307980 08 -13 & SUPPORTING DOCUMENTATION Page 1 of 3 T E 1 � Jgii � iPYT2,� �`'a✓iT 2i ` �� • � j � � i l ' � � �G1�1 E 11 NC DENR Raleigh Regional Office Provide four (4) copies of the application and supporting information (maps, drawings, etc.), as well as the appropriate application fee (see below), to the Division of Water Resources, 401 & Buffer Permitting Unit, 1650 Mail Service Center, Raleigh, NC 27699 -1650. Applicant Information Owner Information: Please provide complete and accurate contact Information ❑ Agent Information: Per - _, , an agent may be given signatory authority for the owner /applicant if a signed and dated copy of an Agent Authorization letter is Included with the application. (A sample form may be found at II. Project Information ❑ Vicinity/ Site Map: Some type of site map so that someone unfamiliar with the area can locate your project. A county map or USGS topographic map Indicating the project location is usually sufficient. ❑ Site Plan: A site plan showing the location of the shoreline, location of the Impacts to the shoreline and /or lake bottom and the location and any vegetated areas that will be Impacted. In most cases the site plans do not have to be professionally prepared. However, if you intend to conduct hydraulic dredging, professionally prepared drawings will likely be required for the spoil structures. See example below ❑ Photograph of shoreline to be impacted/ disturbed ❑ Description of property and existing features on and near the site ❑ Description of project and impacts/ disturbance proposed III. Signature ❑ Per ; - -- ° , - ? ; {, , , the application shall be considered a "valid application" only if it bears the signature of a responsible officer of the company, municipal official, partner or owner. This signature certifies that the applicant has title to the property, has been authorized by the owner to apply for certification or Is a public entity and has the power of eminent domain. IV Application Fee ❑ The application must be accompanied by the appropriate application fee (checks made out to the NC Division of Water Resources). The application fee Is as follows (pursuant to, _ - -- - ): ➢ $240.00 for impacts to lake (below normal water level) of less than 1 acre ➢ $570 00 for impacts to lake (below normal water level) of greater or equal to 1 acre INSTRUCTIONS FOR APPLICATION SSGP307980 08-13 & SUPPORTING DOCUMENTATION Page 2 of 3 `s • Division of Water Resources State of North Carolina Department of Environment and Natural 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 Raleigh, NC 27699 -1650 1. Applicant Information 1. Owner Information Name: KeJi rN NJ0r1,w0J- +t)L Mailing Address: 012- G I en cl ✓ _12a1P i a `� NL IJ Telephone Number: q19' H/3 - / 7591 Fax Number: E -mail Address: Ke y i n n 0 0) _kg 00 , C-o w\ 2. Agent/ Contact Person Information A signed and dated copy of the Agent Authorization letter (a form can be downloaded here: must be attached if the Agent has signed this application form. Name: Company Affiliation: Mailing Address: Telephone Number: Fax Number: E -mail Address: Person to receive the Certifitation Approval: H. Project Information [__1- __ - __ , - -- , ^(a) & (b)] 1 Attach a vicinity map (i e. stet 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 FORM. 55GP 10 -2013 Page 1 of 4 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-,-cn kk ; ,n Nearest Town: _'p;> I Vn rN Subdivision name or site address (include phase/lot number): Dfo i kg ` 'PL Directions to site - please include road names and numbers, landmarks, etc.. a t1 *V rA I N LS2 e��v� AQ n .L °41"� Pt• t.`k, t tiv� `� r� � V. L - Praa vr''// zq C] 5. Describe the existing land use or condition of the site at the time of this application (residential, undeveloped, etc.): Q;,�}� y ; a 1 Property size (acres): , <o2 y4,,r -cs Lake/ river/ ocean adjacent to property: 4aoke 8 Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or why it is necessary): 1 / I " / ti� s e 9IoT 9 Will work be conducted from land? From water? O 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: 4t*tn� S uxz -ea- b 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: ( 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): Qc,; FORM- SSGP 10 -2013 Page 2 of 3 J / Owner /Agent's gn ture' (;_ <<''_ %,! ; (f)J Date 'Agent's signature is vand only if an authorization' etter from the owner is provided Lake (At Full Pond/ Normal Water level) ?toF04J V'-,p me PNo�,�� cac�WC ik. outr Full Pond/ y S' formal Water Level 3 Shoreline 5-7 rtPloct A, u�%AVJE WC-A&d ' I' *"B'eI.w Wa;'zr Please approximately sketch the following information on this plan (provide dimensions for each item, such as 10 ftx 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 � ' 7 / 10, 323 RUNNING WAR 14- 3 31, 2 ft Norsworthy Printed:Sep 08, 2014 - =32 32' R =231 69' ( View of Dwelling 02/05/13) qj `�1� �S' Ncn sev ii e�s� �r too � � r ro (t t ss ) \ Now dr Formerly Cp4 e\\,\ Andrew K. Boggs, et ux )p, ( D DO 121 P 513 B 1817, P 331 ) Chd --N 6412'E 13466 �• �`E, /, d _,E -� 1153 \ As\ w � \\ �. Vt \` 9asa �1GPCeo• ode � � � y�ov ]' cov�c , 700 —Year Flood Limits See Notes ) aP� \ \\ G��if \�a �3o`ye �+` /• y Fps �\ �`,x/ `} • ( 1151, 1152 Now or Former! y �P '0 \FO(c,�d David E. White, et ux '>r \ \\ " D B 1169, P 570) \ ``\ q� A s_ A D B 1297 P 162 P8 2002, P 415 R:P h'4 ►I b'z 3 %roo MoNCZ_ 1 a ` i ( Lake Royale 1 y , XJ� Now or Formerly r� vaa(�c, ca. 11 be S �c 7 �oh� So' Lake Royale P 0 A , Inc ( 08 1803 P 923 j 50' Tar River Basin Riparian Buffer f SURVEY FOR ORSWORTHY & WIFE, - ARLA NORSWORTHY Kevin Norsworthy, et ux) Cypress Creek Township, Franklin County, NC Date: February 5, 2013 N 60 120 180 FEET f Professional Land Surveyor, PA Louisburg, N C 27549 (File No 2626 -2) �--5e- dIk00-.2 J4 -7W jt A. I lie fir: at 3 M