20231025 Ver 1_Site Plan_20230725

;a 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
CNVIRONMENl-AL QUA411 Y 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, Fed Ex, 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: L. Brooks Gore Livina Trust. Susan & Brooks Gore
Mailing Address: 378 Race St.
Charleston, SC 29403
Telephone Number: 910-512-4889 Fax Number: NIA
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://www.saw,usace.armv.mil/Portals/59/dots/reaulatorv/readocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf)
Name: Charlie Washburn
Company Affiliation: Marine Construction LLC
Mailing Address: PO Box 6400
Hickorv. NC 28603
Telephone Number: 828-495-3040 Fax Number: N/A
E-mail Address: [e-mail]
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: Burke
Lake/ river/ ocean adjacent to property:
Property size (acres): 0.78
Nearest Town: Connelly Springs
RhMN-
Subdivision name or site address (include phase/lot number):
Lakeside Reserve Lot 161, Phase 1, 2233 Pike Peak Ridge
Directions to site - please include road names and numbers, landmarks, etc.:
Included in packet
Latitude (in decimal degrees) 35 782 Longitude (decimal degrees)-81.458
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Residential Uncleve-loped
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): We plan to stabilize the shoreline to prevent erosion.
7. Will work be conducted from land? y
From water? _
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:
270 sgft
Temporary impacts in square feet:
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:
Temporary impacts (temporary clearing, construction corridor) in square feet:
(Construction corridor= 1,350 sqft)
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): The lot is wooded and Undeveloped
11. Signature F
i 9-�iS�Pf?
6f,kee Z�L
2-/'7 --z0'2-
Owner/Agen 's Signature' [15A NCAC 02H .050 (f)1 Date
Agent's signature is valid only if an 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 below the Full Pond/ Normal Water Level elevation
Lake
(At Full Fond/ Normal Water Level)
135 1
Full Pore/ formal Water
i .� ... =10
Shoreline
ibfk x �35��. cclsrcw )6m Cdcnd()r
10-X4" t10 C,l>?arino�
Tfftvo°^
No'5
CornW
Plan Vier
Lake
(At Full Pond/ Normal WaterLeJel) Existing Dock
30ftx7ft
i
�ia�: w4 �'i'�i� w �a•iR�
i
ifnecessary
EXAMP" E
Plan View 1
A 135 fi- I
13e.10W Fvil p"W L
135 F'.
P�►e wu pond I
owl.
FORM: SSGP 02-2017 Page 3 of 4

P�bd� �I Por
La ki
(At Full Pond/ Nora
��w wit
fond � NYv�
0.1 1351fi' e0f6)WChd6 NrMcn No raearI
t�
�1 •
• ����, • •
C
SideView
LL-
3 ft, below full pond water level 4 ft above full pond water level 2 ft. additional clearing
*if necessary
Existing bank
10 ft. bank ZT
height c�Q'
10
yu m,.,
Side VAN % _ L E
FORM: SSGP 02-2017 7 Page 4 of 4