20230879 Ver 1_Site Plan_20230621

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State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
ENVIRONMENTAL QUALITY
FORM: SSGP 02-2017
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent to:
If sending via US Postal Service If sending via delivery service (UPS, FedEx, 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)]
1. Owner Information
Name: -Michael Blake
Mailing Address: 2013 Walden Glade Run
Apex. N 2759.1
Telephone Number: [phone] Fax Number: _N/A
E-mail Address: [e-mail]
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:Lwww.saw.usace army mil/Portals/59/dots/regulatory/regdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf)
Name: Charlie Washburn
Company Affiliation: Marine Construction LLC
Mailing Address: PO Box 6400
Hickory, NC 28603
Telephone Number: 828-495-3040 Fax Number: N/A
E-mail Address: office@marineconstructionllc com
B. 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, 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.
FORM: SSGP 02-2017
Page 1 of 3

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: glirkm. Nearest Town: Gonnelly Springs
Lake/ river/ ocean adjacent to property: Lake Rhodhiss
Property size (acres): 0.75 Acres
Subdivision name or site address (include phase/lot number):
Lot #41 Lake Vistas Subdivision Phase 2
Directions to site - please include road names and numbers, landmarks, etc.:
Included in packet
Latitude (in decimal degrees) 35.778 Longitude (decimal degrees) -81. 8
Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Residential, Undeveloped
Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary); wp plan to atahiliap the ghnmflnp with rinr n to
—prevent further
7. Will work be conducted from land? _ From water? x
8. Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent impacts (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
pen sqft
Temporary impacts in square feet:
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:
?20 soft
Temporary impacts (temporary -lea ring, construction corridor) in square feet:
(Construction corridor= Q sgft)
10. 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): Thp lot ie nnritQd _
to remy . 2 trees hi If Will replant new trees 0 e for One llb Native Hardwoods,
11. Signature
Owner/Agent's Signature` [15A NCAC 02H .0502(f)l Date
Agent's signature is valid only if on authorization letter from the owner is provided.
FORM: SSGP 02-2017
Page 2 of 4

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, hPln," tko Gr,ll o 41 r.l rw l _
Lake
(At Full Pond/ Normal Water Level)
(Full Pond/ Normal Water
Shoreline
No COOSY066n COM' lAK
N o imen i-'5
[� ma'0(Ak wf f l be
Ma i-edl in b0ny
Plan View
Lake
(At Full Pond/Normal Water Level)
Existing Dock
1"30
3ftx1SOft
Full Pond/ Normal Water LevelBelow full pond/NWL
'I oreMne ®_----
4ftx 150ft
2 fr.x 150 ft.
Above full pond/ NWL
additional clearing �
'ienecessary
I
E
Plan View E AMP EE
FORM: SSGP 02-2017
K I \ if . '( OM
Fv11 Qond I NwL,.
�. ���• X 110Ft' Above
Page 3 of 4

�}-
kbw FUl l pb NWI.
La ke
(At Full Pond/ Normal Wat
d
Side View
No co"3Nc i0o ccn-, )r- All material ,)41 {bE
n10 12(nVoran0 I nV6&5 Fldakd in by bare
M o an Vv rtmm a ktws -
M wI ll l (0c
1 MI "inAlcm W
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hI i` Ic4nkd lycts will
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Success
0
3 fit, below full pond water level 4 ft. above full pond water level 2 ft. additional clearing
If necessary
Existing bank
10 ft. bank a
height �Q
R
�tO
Side Vi
t MPLE
FORM: SSGP 02-2017 �Y B" 11 �-M ' (.�(. f �"' ���li>� 2�
Page 4 of 4