20151223 Ver 1_Shoreline Stabilization_20151123

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• State of North Carolina
DWR Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10 -2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resources ��
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699 -1617
Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: John & Elizabeth Bickenbach
Mailing Address: 1162 Kearns Hackett Road
Pleasant Garden, NC 27313
Telephone Number: 901 - 282 -8005 Fax Number:
E -mail Address: bick727 @aol.com
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2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
httr): / /www.saw.usace.armv.mil/ Portals /59 /docs /reRulatory /rep-docs /Permits /SAMPLE AGENT AUTH
ORIZATION FORM.Ddf) must be attached if the Agent has signed this application form.
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E -mail Address:
Person to receive the Certification Approval:
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.
FORM: SSGP 10 -2013 Page 1 of 3

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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,
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: Stanly Nearest Town: Norwood
Subdivision name or site address (include phase /lot number):
Edgewater on Lake Tillery, Lot 37 -- 260 Summerhouse Point, Norwood NC
Directions to site - please include road names and numbers, landmarks, etc.: —
From Highway 52 in Norwood, Turn left onto Pee Dee & Follow for approximately
3.5 miles. Turn right onto Randalls Church Road. Then turn left onto Edgewater Drive,
Summerhouse point is the 3`d road on the right.
Latitude (indeamol degrees) Longitude (declmoldegrees)
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): .74 acres
7. Lake/ river/ ocean adjacent to property: Lake Tillery
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
9. Will work be conducted from land? xt� From water? [J
10. Total amount of disturbance (including all excavation, backfrll, rip rap, retaining walls, etc.)
ow the normal pool lake level/ Normal Water Level in square feet or acres:
/do ' bf �jOR�i�Jd, u / 91-D
11. Total amou4i/of disturbance (including all clearing, back fill, excavation, rip rap, retaining
SIa walls, etc.) above the normal pool lake level Normal Water Level and SO feet land -ward in
square feet or acres: – 3d ' = /-Taa
.7.2. Please describe the vegetation e the normal pool lake level/ Normal Water Level and
50 feet landward to be impacted (number of trees, for instance):
r /Agent's Signature*1�15A
/1 /17�Zc 15
Date
FORM: SSGP 10 -2013 Page 2 of 3

I .
APPENDIX G
Moderate Rip Rap Stabilization
VFGETAllON AND EROSION
CONTROL FABRIC
EXISTING �
~ GRADE
3' MAX
y�r 3
CLASS 2 RIP RAP----
- __-.-----��
2 \-H|GH WATER ELEV.
EROSION CONTROL FABRIC----`-
D AL
' 36^ T0 72^ ERODED CUT
'
WAVE EXPOSURE
34
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