20240293 Ver 1_Site Plan_20240222

Alater kles("nif,
E�IVHRONR`MNTAL QU
State of North Carolina
f14�atment of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM. SSGP 02-2017
Shoreline Stabilization Application Form
Three copies of the app ication (including attachments) and the ARRU991jgn_fee should be sent to:
If sending via US Postal Service If sending via delivery service (UPS, FedEx, etc.)
Karen Higgins
,ns Karen Higgins
DWR — 401 & Buffer Permitting Branch DWR — 401 & Buffer Permitting Branch
1617 Mail Service Center 5�2 N. Salisbury Street
Ralelgh,NC 276p9-1617 Raleigh, NC 27604
A. Applicant Information [15A NCAC Q?h -0�502 a I
I. Owner information
Name:
Mailing Address: CA J-1
it
Telephone NumbE?r: 3M, o Fax Number:
E-mail Address: i tw evo'?
LJ
2. Agent/ contact P rson 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:
Name:
Company Affiliati n:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Project Information 1;5A NCAC 02H.050a & b U
I. 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. " /4
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 ma� 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: Nearest Town:
Lake/ river/ ocean adjacent to property: �Llt
Property size (acres): —I, -3 J"- _Q _CrYS
Subdivision name or site address (include phase/lot number):
Directions to site - please include road names and numbers, landmarks, etc.:
-1
t 7 W,
5 . Alor, 4�7
/_ U,
t
Latitude (ire dec7 al degrees)— 24. 0 21 Longitude (decimal degrees)
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): t,e
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided', or why itis necessary)-
J11(
a7
7. Will work be conducted from land? o water?
F� r?
F
S. Total amount of impacts below the normal pool lake level / Normal Water Level
Permpe Ompacts incl di all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
11 �
_=11 X — ='d
Temporary impac s 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:
Temp
7ra�yimpakc(tepor,�y clearing, (temporary �ang, construction corridor) in square feet:
V1 I
10. Please describe th vegetation above the normal' pool lake level/ Normal Water Level and 50
feet landward to bimpacted (number of trees, for instance):
FORK SSGP 02-2017 Page 2 of 5

In
12. Please
each it
a. A
b. U
c. L(
d. Lc
e. Lc
KV
Ammw-
FORM: SSGP 02-2017
ild R bompton
f7
Agent's Signature' v
k_N.OM UDatsignatureis valid onif an Outhorization letterfrom the owner is provided,
proximately sketch the following information on this plan and provide dimensions for
7:
roposed vegetation clearing
wtion of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
tion of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
tion of any proposed structures such as buildings, retaining walls, docks, etc.
tion of any excavation or dredging below the Full Pond/ Normal Water Level elevation
Page 3 of 5

c.:
,� r� o
it � � ��
r1
Side View m
FuH Pon
NqrmalWaterLeve
�
ore ine
2kxi5aft.
iprap
j
Alb
additional
if
E
A.: 1,\4
Liu.
E
Plan
View
P.,J/ NWI.
p
FORM: SSGP 02-20,17
Page 4 of 5

ft. bank
MR
3 ft. below full pond water level
Existing bank
4 ft. above full pond water level
0
2 ft. additional clearing
- If necessary
FORM: SSGP 02-2017 Page 5 of 5

Alater kles("nif,
E�IVHRONR`MNTAL QU
State of North Carolina
f14�atment of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM. SSGP 02-2017
Shoreline Stabilization Application Form
Three copies of the app ication (including attachments) and the ARRU991jgn_fee should be sent to:
If sending via US Postal Service If sending via delivery service (UPS, FedEx, etc.)
Karen Higgins
,ns Karen Higgins
DWR — 401 & Buffer Permitting Branch DWR — 401 & Buffer Permitting Branch
1617 Mail Service Center 5�2 N. Salisbury Street
Ralelgh,NC 276p9-1617 Raleigh, NC 27604
A. Applicant Information [15A NCAC Q?h -0�502 a I
I. Owner information
Name:
Mailing Address: CA J-1
it
Telephone NumbE?r: 3M, o Fax Number:
E-mail Address: i tw evo'?
LJ
2. Agent/ contact P rson 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:
Name:
Company Affiliati n:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Project Information 1;5A NCAC 02H.050a & b U
I. 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. " /4
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 ma� 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: Nearest Town:
Lake/ river/ ocean adjacent to property: �Llt
Property size (acres): —I, -3 J"- _Q _CrYS
Subdivision name or site address (include phase/lot number):
Directions to site - please include road names and numbers, landmarks, etc.:
-1
t 7 W,
5 . Alor, 4�7
/_ U,
t
Latitude (ire dec7 al degrees)— 24. 0 21 Longitude (decimal degrees)
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): t,e
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided', or why itis necessary)-
J11(
a7
7. Will work be conducted from land? o water?
F� r?
F
S. Total amount of impacts below the normal pool lake level / Normal Water Level
Permpe Ompacts incl di all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
11 �
_=11 X — ='d
Temporary impac s 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:
Temp
7ra�yimpakc(tepor,�y clearing, (temporary �ang, construction corridor) in square feet:
V1 I
10. Please describe th vegetation above the normal' pool lake level/ Normal Water Level and 50
feet landward to bimpacted (number of trees, for instance):
FORK SSGP 02-2017 Page 2 of 5

In
12. Please
each it
a. A
b. U
c. L(
d. Lc
e. Lc
KV
Ammw-
FORM: SSGP 02-2017
ild R bompton
f7
Agent's Signature' v
k_N.OM UDatsignatureis valid onif an Outhorization letterfrom the owner is provided,
proximately sketch the following information on this plan and provide dimensions for
7:
roposed vegetation clearing
wtion of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
tion of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
tion of any proposed structures such as buildings, retaining walls, docks, etc.
tion of any excavation or dredging below the Full Pond/ Normal Water Level elevation
Page 3 of 5

c.:
,� r� o
it � � ��
r1
Side View m
FuH Pon
NqrmalWaterLeve
�
ore ine
2kxi5aft.
iprap
j
Alb
additional
if
E
A.: 1,\4
Liu.
E
Plan
View
P.,J/ NWI.
p
FORM: SSGP 02-20,17
Page 4 of 5

ft. bank
MR
3 ft. below full pond water level
Existing bank
4 ft. above full pond water level
0
2 ft. additional clearing
- If necessary
FORM: SSGP 02-2017 Page 5 of 5

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