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Home My WebLink About20150601 Ver 1_Shoreline Stabilization_201506172 0 1 5 0 State of North Carolina Department of Environment and Natural Resources t° 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 Resources 401 & Buffer Permitting Unit 1617 Mail Service Center Raleigh, NC 27699 -1617 - /10, a'@- - - - - - _.' ",Rog, JUN F 1 y 2015 D' 1. Applicant Information f 15 NCAC 022H .0502(a)j 4 BUFq R'pE� R 1. Owner Informa�tiion�� s �� Name: �/� s� /�. ham'! l/ /0 Mailing Address: Telephone Number: Number:. E -mail Address: 2. Agent/ Contact Person Information A signed and dated copy of the Agent Authorization letter (a form can be downloaded here: ocs/reRu1ator,r /reRdoe,/ hermits /SAMPLE AGENT AU T H ORIZAT!ON F0ErV1. -df) 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 Certification Approval: I1. Project Information (15A NCAC 02H .050-21a) Ul - 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 w 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) : y Count SSG, Nearest Town: - - Subdivision nam or site address (include phase /lot number): v Directions to site - please include road names and numbers, landmarks, etc.: 4j Latitude (in decimal degrees) LongiVde (decimal degrees) 5. Describe the existing land use or condition of the:si ' at. -the time of this application (residential, undeveloped, etc.): �"�Si�71 6. Property size (acres): 7. Lake/ river/ ocean adjacent to property: _Il�i-r/ 8. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or why it is necessary): _� /QC_ 9. 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: Ab 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 i pacted (number of trees, for in ance): v Own gent's Signature* Printed Name Date Agent's signature is valid only if an authorization letter from the owner is provided. FORM: SSGP 10 -2013 Page 2 of 3 Norjh Caroll a. Stunly Countv / r rrr 04 — f-W ■w SE Lm". %A e AR lm xftd Fftbbo .Wdwd ► 0 VC ------- -------------------------------------------------- -- It Talon COud ----------- PRELIMINARY ONI ------------ ------ NOT FOR; RECORDIN( CONVAYENCES, SALES OR CONSTRUCT1 PRELIMINARY ONLY Ier 0.659 ACRIS 20673.9 09. rr. 9) NOTIC: Buildingd1monoloi ■1lown hem" era from olul linfolmil Noudolou w%tlo Z�d 5-10 aw Dwmwd I" o"k. yrWA - 10 IL • Wo - Ill It If i It It C2 3, Pa M PIL go LAn THIny 4 . / M A/vl ny J La ke (tat Full Pond /Normal Water Level) �' Z-9 Cei Full Pond/ Normal Water Level Shoreline i a 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 Jz C.) geC 0 oa Allenton Norwood Church 0 Randall 's o C N Emerald Shores GOO as ood' 'each Low- 'e5 CO Cr_ 0 r�7 Norwood Dam HYdrO 731 JUN 401 & SUFF ER p E SOU ES ER INr, .+T.' , `a's. •.. V�. ' ^� y Ir• , ,rr ��_ •arm ,/` �. :� �� ,�r► �� Ill ` ` if. �F y.. � - lr� �., j ` /'. �+ ::. ol <- '�' -' r a, a > 3 rI «` yr` W.— wn i i f ` K •� �+ /, M AIM• +� '"�. jf I K li•I JCS',.. a ..:. e `