20151132 Ver 1_Shoreline Stabilization_20151030

State of North Carolina
Department of Environment and Natural Resources
W'R
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
Three copies of the application (including attachments) and the a
to:
Division of Water Resources P
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699 -1617
ent
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information 2 0 ' S
Name: Dennis E. Moore ' 32
Mailing Address: 8633 Howard Drive
Terrell, NC 28682
Telephone Number: 702 - 240 -1512 Fax Number:
E -mail Address: denlynn0l @gmail.com
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http: / /www.saw.usace. army.mil/ Portals /59 /docs /regulatory /`regdocs /Permits /SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name:
Company Affiliation:
Mailing Address:
Telephone Number:
E -mail Address:
Person to receive the Certification Approval:
Fax Number:
II. 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, structures (buildings, retaining walls, docks, impervious surfaces,
etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
FORM: SSGP 10 -2013 Page 1 of 3

and construction access corridors. You may use the diagram provided at the end of this
application form.
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: Catawba Nearest Town: Terrell
Subdivision name or site address (include phase /lot number): 8633 Howard Dr. , Terrell,
NC 28682 (Lot 16)
Directions to site - please include road names and numbers, landmarks, etc.:
Hwy 150 to Kiser Island Rd (across from Marshall Steam Plant), 1.5 miles on Kiser
Island Road, Left onto Howard Drive, First house on right. 8633 Howard Dr.
Latitude (In decimal degrees) 35.572662 Longitude (decimal degrees) 80.963307
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Residential
6. Property size (acres): 0.67
7. Lake/ river/ ocean adjacent to property: Lake Norman
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Rip rap applied due to continuous erosion of
horeline.
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:
450 sauare feet
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres: 2050 square feet
12. 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): I do not plan on
displacing any vegetation. There is one tree that needs some backfill prior to placing rip
ra p.
/Z -711S
Owner /Agent's Signature* [15A NCAC 02H .0502(f)) Date
*Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10 -2013 Page 2 of 3

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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. Location of construction access corridors
FORM: SSGP 10 -2013 Page 3 of 3

CATAWBA Geospatial
Information Services
Real Estate Search
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Parcel: 461602692122, 8633 HOWARD DR TERRELL, 28682
Owners: MOORE DENNIS EARL,
Owner Address: 8633 HOWARD DR
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