20221240 Ver 1_Shoreline Stabilization_20220907

State of North Carolina
Department of Environment Quality
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 02-2022
Shoreline Stabilization Application Form
&a4p,°V
A complete copy of the application (including attachments) and the ap_plication fee should he sent to:
If sending via US Postal Service If sending via delivery service (UPS, Feder, etc.)
Paul Wojoski Paul Wojoski
DWR — 401 & Buffer Permitting Branch DWR — 401 & Buffer Permitting Branch
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC 27699-1617 Raleigh, NC 27604
A. Applicant Information [15A NCAC 02H .0502(a)J
1. Owner Information
Name: Lioy p LawScit Wift ;ism .s r-. / $F1n (La Sept
Mailing Address: 487 z I. Gnvc-i i d
Con covc�, NC 2$0a6
Telephone Number: 704 _ 3 (a' - 31 i q
Fax Number:
E-mail Address: "pet,5+0Y. Ct 11IG1i ,pvt+l
Wl�;fscn
RECEIVED
S E P - 7 2022
DEO-WATER RESOURCES
401 & BUFFER PERMITTING
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter must be attached if the Agent has signed
this application form. (A form can be downloaded here:
http; 'wV6w.saw.usace.anny.mil Portals 59 docs/reguiatory/regdocs1Permits/SAMPLE11GEN1AUTHORIZA ,
TION I'ORMLrL
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
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E-mail Address:
B. Project Information [ 15A NCAC 02H .0502(a) & (h)i
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, buildings, retaining walls, docks, impervious surfaces, 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 proposeYd to be stabilized. (Include a scale of some
sort- a yard stick, shovel handle, etc.) A4d,
4. Location of the property (where work is to be conducted)
County: STd N[., y
Nearest Town:
Lake/ river/ ocean adjacent to property: rl ' / 1 C.V 1j
Property size (acres): 3 O_c
AlbeMo,,lrt~e
Subdivision name or site address (include phase/lot number):
l� v�r v�avv►. Lo4 to -11
Directions to site - please include road names and numbers, landmarks, etc.: 4 24 ,54rcmd Dlr,) fI b) ecl
we Hwy a9 /'7 + S-Frevrid py,�,E.
Latitude (in decimal degrees)_ 3 `.7 , 3 a% q d g Longitude (decimal
degrees)
- go. ogoC8?
5. Describe the existing land use or condition of the site at the time of this application (residential,
undeveloped, etc.): ye S
1
6. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Waves -61)Wt ba�� f ��°4-c 1 S *r)d to j titt Shay-�
• yhe ��'�tn J old Sea- Wa.(, hes voMcd cutd Gcllap5cc . (5c e p►cs-)
7. Will work be conducted from land? ) e S From water?
8. Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent impacts (including all excavation, backfill
Glop' S$ -�-�
Temporary impacts in square feet:
ac ' sg �t
retaining walls, etc.) in square feet:
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9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet land-
ward
Permanent impacts (including back fill, excavation, rip rap, retaining walls, etc.) in square feet:
aoo sg-
Temporary impacts (temporary clearing, construction corridor) in square feet:
Loo " r✓ � .
10. Please describe the vegetation above the normal pool lake level/ Normal Water Level and 50 feet ,,`` nfr
landward to be impacted (number of trees, for instance): g/U vele �c+;.-h or +pce s 4-e be e t+e 1 ed
o+ is le vc l a,vt c o p , uo -}-ve e s -tv be. R emDu ei or S v-a-d
% C c tvcd
11. Signature
By signing below, I, as the project proponent, certify to the following:
• The project proponent hereby certifies that all information contained
herein is true, accurate, and complete to the best of my knowledge and belief
• The project proponent hereby requests that the certifying authority
review and take action on this CWA 401 certification request within the applicable reasonable
period of time
,18.16(1 Gra4#40-70/21) ty,t,
Owner/Agent's Signature. [15A NCAC 02H .050401 Date
Agent's signature is valid only if an authorization letter
from the owner is provided.
12. Please approximately sketch the following information on this plan and provide dimensions for
each item:
a. All proposed vegetation clearing
b. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
C. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
d. Location of any proposed structures such as buildings, retaining walls, docks, etc.
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
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Lake
(At Full Pond/ Normal Water Level)
ff
Full Pond/ Normal Water Level
Shoreline
4Y'ce5 DY ticse-640w+
re move , Ko 3,6%4 5 Ye&
Plan View
x lol�
*low f.P
3'xlol
f\ vv! F,?vhd
Lake
)At FNI MAW/ No.nu Water level)
Full Pond/ Normal Water level
Ihx150ft.
aaWA., clean, Ll
•rl iva evvary
E AMPL
Plan View
Existing Dock
30ftc]ft
Wow full WNW/ NNW
:. Non
Riprap �i:; � Above AN pond/ NWt
ixilt
3 ft. below full pond water level
4 ft. above full pond water level
2 ft. additional clearing
"if necessary
10 ft. bank
height
Side View
Existing bank
0).
sit\ MPLE
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„d
v e Q O r P ixq:.
Lake
(At Full Pond/ Normal Water Level)
I a'
J
1
Side View
C
0
L
A' Mom)
a' A SOve
4
IF trap
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8/15/22, 8:58 PM
Page 5 of 5

From: Lawson Whitson [e-mail]
Subject: Shoreline pics
Date: Aug 22, 2022 at 8:35:07 AM
To: Lawson Whitson-)astor( nicjc.org
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