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HomeMy WebLinkAbout20150833 Ver 1_Shoreline Stabilization_20150818State of North Carolina Department of Environment and Natural Resources 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 Four copies of the application (including attachments) and the application fee should be sent to: Division of Water Resources 401 & Buffer Permitting Unit 1650 Mail Service Center $ PAID Raleigh, NC 27699 -1650 - Applicant Information f 15A NCAC 02H .0502(a)j 1. Owner Information �yl Name: SMAnVIE ✓ /�L��°j�i Mailing Address: amm - lIX,ew% "ge. 1�4T,VSto1lP1 A sf Telephone Number: 33�' "3/0 `�>'G/ Fax Number: E -mail Address: l<m v 2. Agent/ Contact Person Information 20150833 rAK 1 g 2 0 15 ("1 A signed and dated copy of the Agent Authorization letter (a form can be downloaded here: http: / /www. saw.usace.armv.mil/ Portals /59 /docs /regulatory /regdocs /Permits /SAMPLE AGENT AUTH ORIZATf0k FORM.pdf) must be attached if the Agent has signed this application form. Name:�c� Company Affiliation: Mailing Address: Telephone Num r: 7 Fax Number: E -mail Address: e Person to receive the Certification Approval:�c�b�c�o -� II. Project Information f 15A NCAC 02H .0502(a) & NJ 1. Attach a vicinity map (i.e. street map) clearly showing the location of the property with espect to local landmarks such as towns, rivers, and roads. 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 4 e c.), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations, nd construction access corridors. You may use the diagram provided at the end of this application form. . 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: Z/"" /,/ Nearest Town: k4 111f Subdivision name or site address (include phase /lot number): Ge �(r� Of G/�7AIA�9 a( Directions to site - please inclu a road names and numbers, landmarks, etc.: 5. Describe the existing land use or condition of he site at the time of this application (residential, undeveloped, etc.):N'�—\\ 6. Property size (acres): 7. Lake/ river/ ocean adjacent to property: 8. Describe proposed work (include discussion as to how hardening of shoreline h been avoided, or by it is necessary): 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: 11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining walls, etc.) above the normal ool lake vel/ Normal Water Level and 50 feet land -ward in square feet or acres. S � • ��C�a����� 12. Please describe the vegetation above the normal pool lake level/ Norm I Water Level a d. 50 fe t landward to be impacted (number of trees, for i � � 47 Owner /Age ignatur ro:1115A Nj; zH .0502(f)] Date Agent's signature is valid only i an authorization letter from the owner is provided. FORM: SSGP 10 -2013 Page 2 of 3 SAMPLE AGENT AUTHORIZATION FORM PROPERTY LEGAL DESCRIPTION: LOT NO. 3? PLAN NO. PARCEL ID: 56,10 STREET ADDRESS: Lo% Please print: Property Owner: u1W114ftr %lxl-Hr Property Owner: The undersigned, registered property owners of the above noted property, do hereby authorize &'41"-) d �� (Contractor / Agent) (Name of consulting firm) to act on my behalf and take all actions necessary for the processing, issuance and acceptance of this permit or certification and any and all standard and special conditions attached. Property Owner's Address (if different than property above): /O7�a��•flv.��t/ lax i��r�lf�� /�, /L''� ��G��' Telephone: 330-;10-1361 We hereby certify the above information submitted in this application is true and accurate to the best of our knowledge. 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Lpcblvo [= i 00V a ,6C, �{oWr1 01.1 �(! fcf2c R�pttK GNoRD $6pw+t6 { ..•,;fG_ - - _ ,_I _„ ��„w t � �Gl1 C1�, IGI AQI Idd,d/ll w1�C•R7..�g'xRp Fl Shoreline L-1 U � 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. 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