20150590 Ver 1_Shoreline Stabilization_20150615

State of North Carolina
2 0 1 5 0 5 gDfyartment of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources 90RM•1SSGP 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 ; n
1617 Mail Service Censer ��(t
Raleigh, NC 27699 -1617 JV N Y 5
2015
DENR.
I. Applicant Information [15A NCAC 02H .0502(a)j 401 & BUFFER ESO, �S
1. Owner Information
Name: J� I An
IZ• Wlw6T " >
Mailing Address: __(oZZI.P WAU=f7 60&-C •
Telephone Number: _V3'251_5 F Nu� ber:
E -mail Address: 1�w rw 0., �t
2. Agent/ Contact Persolformation
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http: / /www.saw.usace.armv. mil / Portals /59 /dots /reizulatory /reRdocs /Permits /SAMPLE AGENT AUTH
ORIZATION FORM.vdf) must be attached if the Agent has signed this application form.
Name: I bM rAbSS
Company Affiliation: - skooe -1114G 5PX4 '%6'V '..VqC,
Mailing Address: 7-5>Io NL
_pyf:.I bj_�) �_4 L 7i
Telephone Number: �tv(ol Fax Number:
E -mail Address: VMC09_'5,SZ e-em" ArV"A l •COM
Person to receive the Certification Approval: v /% /f. W //JSTfl
0
II. Project Information [15A NCAC 02H .0502(a) & (b)j
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
r '

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.
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: � /� Nearest Town: Aoexy Aw r
Subdivision name or site address (include phase /lot number):
67-U# t JW7 t7Z5 6' 4X-C 1741.
Directions to site - please include road names and numbers, landmarks, etc.:
CmeCAST url NC f iW 17 7U /14 l rr aN To bkWh a= AA4 400.
Go % x /.S /hill ,wd 4-ed r54 < C*l
Latitude (in decimal degrees) 35.0►7— Longitude (decimal degrees) —77. �y37io
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): ,Li IAVA+ /4WiJ
6. Property size (acres): !•,S Ac"_ nn
7. Lake/ river/ ocean adjacent to property: %�"i� ,�) ✓� /� ✓c�i?
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or hy it is necessary): fi 1D � I.,i s b A k
tiJil s /de jiff 76� eviiiAc, tQkA o k SCC�.K-
9. Will work be conducted from land? 0 � 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:
1,` � (o' : 1110, � �-1 .
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 ffeLee__t landward to be impacted (number of trees'f, for instance): //tee- lnJW
Owner /Agent's Signature* j15A NCAC 02H .0502(f)1 Date
*Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10 -2013 Page 2 of 3

La ke
(At Full Pond /Normal Water Level)
L Ate+ G IBS'
?roxv-)
'P
Full Pond/
Normal Water Level
:'il Mks am aim aim
Shoreline
I
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
Z ;15�
C'YT,NV�or
- L-a2tn i v►� cGN -�,�
M�tw � 3 ► G1-o�l
u,�155 I�
FORM: SSGP 10 -2013 �1P ' ` �' Page 3 of 3

I rrzz�
Ju/v 20
20

6/10/2015 Google Maps
AGetting around
. Showy Traffic Bicycling Terrain Directions y U 6 -
, &V&
Baker Ln �&
'r- a d
be,�
P i.5
T.
M
'Pa a
eP�e`�" `
o �
Caiu��fc iR
�n
Map data 92015Google 50041
�%C,(" I " AA-j>
MQ.WINST"Tj�
https: / /www.google.com/ maps /@35.8867879,- 77.8925423,16z 1!1