20240196 Ver 1_Site Plan_20240201

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State of North Carolina
Department of Environment and Natural Resources
Novi Division of Water Resources
Vilatey" 1,?esou.r'o,,!s 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
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FORM: SSGP 02-2017
Three copies of the application (including attachments) and the amlication fee should be sent to:
If sending via US Postal Service If sending via delivery service (UPS, FedEx, etc.)
Karen Higgins Karen Higgins
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 [,L5A NQAC QH OL02 Ua]
1. Owner Information
Name:
Mailing Address:
Telephone Number:
E-mail Address:
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qiLaq 'A Lea Fax Number:
2. Agent/ Contact Person Information
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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:
,Lttk:L/NLww,saw.usace.aLmy.i]LiI it UTHORIZ
A1]ON_L0RM.pdf)
Name:
Company Affiliation:
Mailing Address,
Telephone Number:
E-mail Address:
Fax Number:
B. Project Information [L5d� NCAC 02U_.Q5g2 a L_]
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, aindconstruction access
corridors. You may use the diagram provided at the end of this aipplication 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: Per;oyl Nearest Town: 4)e 6'(-C'
Lake/ river/ ocean adjacent to property: 4 Yro
Property size (acres): 1, 1
Subdivision name or site address (include phase/lot number): JQV Ile OQ I B CC-
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Directions to site - please include road names and numbers, landmarks, etc.:
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On.11"rR �Ien LiA
Latitude (in decimal degrees) -34,H40yok' Longitude (decimal degrees) _�Y
104- — &W
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Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.):
6. Describe proposed work (include discussion as to how hardening of shoreline has been
alded, or why it is necessary):
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7. Will work be conducted from land? Z From water? 11
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:
Temporary impacts in square feet:
0
Totall 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:
L(--O.V 9Q0 50 -26'" 112e X2 i
Tempora r� impacts (temporary clearing, construction corridor) in square feet:
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):
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FORM: SSGP 02-2017 Page 2 of 5

11. Signature
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w Owner/Agent's Signature* [1�3A NCAC 021j..05Q_Z(M Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
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
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. .............
FORM: SSGP 02-2017 Page 3 of 5

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Side, View
Lake
(At Full PMCV Narmal Mier
Lemll,
Existing Dock
sort X 7 It
3 ftx 150ft
Full Pond/ Normal Water Levell
Below fulponds' NWL
orene mu u
Riprap
4 so It
2 It. X 150 ft.
Ai— W V-41 NWL
ar9dMtdanal Clearing
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AMPIE
Plan View
7
FORM: SSGP 02-2017 Page 4 of 5

FORM., SSGP 02-2017 Page 5 of 5

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