20150271 Ver 1_Shoreline Stabilization_20150313

u
State of North Carolina
2 0 1 5 0 2 7 1 Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H.0500 —Water Quality Cl eertificate Shoreline Stabilization
lJi V 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 Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699 -1617
Applicant Information [15A NCAC 02H .0502(a)]
Owner Informat n
Mailing Address: WQt VebSY?fJ I, 4LV-
MAR 1 3 2015 !�
Telephone Number: Fax Number:
E -mail Address: k jss e-
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 pd f) must be attached if the Agent has signed this application form.
Name: T�`5 Da4�5
Company Affiliation:
Mailing Address: ? €•{- �I
Telephone Number:
E -mail Address:
$Lq— -7+3 -vv%7 Fax Number:
Eno 'PC C"
ry
Person to receive the Certification Approval: �� iq`tk-(�4
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 3

¢Tr.;, rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
=cress r�rrid^rs. vol 1 m use the diagram provided at the end of this
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale
of some sort- a varo -mr- 4,hn pi n�nri�p era °.
4. Location of the property (where work is to be conducted)
v�r- ivcai c�i i Uwi is ��„�TU✓L NL- _
l
Subdivision name or site address (include phase /lot number): 0AJ siq
r
Directions to site - please
��;1.- ti0.�✓ -� includeroadnames and numbers, landmarks, etc.:
04 41�1 U40- t^s_ r_
:,
Ye-
V �
i' 41, CL, rral Mv�-,L_s L.� � e d LJ1C_ 4'A , r,t> a � �!� � LA c,,h
— r
VT-
Latitude (in decimal degrees) 65. iY3$S� Longitude (decimal degrees) —Y5 • �7 ?Y'IS_
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.):
6. Property size (acres): >+ Ae-g- iZ__
7. Lake/ river/ ocean adjacent to property: -
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Sao 4; t ��e (w��l: � sc�rc J-C j
y. Will work be conducted from land? LJ 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:
6,00 Z i b'fi
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: VV0 S. iF4
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 feet landward to be impacted (number fof1trees, for jinstance): M /,.,� t­ k r�
�X 9 11v�jC '!,`JV�- �L�sjru-1- J &,I &N �tl�iS� (ter �Ct� D—p"�
4, take
Owner /Agent's Signature* [15A NCAC 02H .0502(f)]
Date
D "I 140- 7-1�49
*Agent's signature is valid only if an authorization letter from the owner is provided.
FORM SSGP 10 -2013 Page 2 of 3

3/812015 Bnnler # 1 Mpg
pz 14
�A-�. �1 ,
tpLft)JS
Z.:)
7
6s� �
r
la
r
?'ki644
i
S r
84-c e,
^
W G'N�GN
f-
1 n �o ray sf OfCr— �5'r -b NI U -3C
vi✓. � S -� FDO r i;� I4 E 1(, Kr
r
p 91t j - --CTLZ
p Y �Pr
ScsmF-
AREA—S
0101-0- F,tL
c
https //mad google cord /scs /mail - static /js/Ic-gmail main en X\AMe1A81)g 0/ m= m_ i, t, it/ am= OIMa4U5G_ UGMM7RLH9D9-- 9dxo7- 7A]zABJDsF8H -z WNW 1/1
https //mad google cord /scs /mail - static /js/Ic-gmail main en X\AMe1A81)g 0/ m= m_ i, t, it/ am= OIMa4U5G_ UGMM7RLH9D9-- 9dxo7- 7A]zABJDsF8H -z WNW 1/1

3/8/2015 IM G_2393.JPG
https:HmaiI.google.com! /scs/rnail -static �fjs/IFgmail.main.en.... 1/1

3/8/2015 IM G_2396.JPG
https: / /mail.google.com/ /scs/ mail - static /_fjs/lrgmail.main.en.... 111