20160114 Ver 1_Shoreline Stabilization_20160205

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quallty Certification, Shoreline Stabilization
Dh!lslon of Water Resources FORM: S56P 10-2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent
to:
1.
Division of Water Resources
401 & Buffer Permitting Unit' �► ����;��r
4 D
1617 Mail Service Center -- FEB
0 51016
Raleigh, NC 27699-1617 GERR-LArgD Or i;,L i -r(
STORHHATER PEJR►vtli TAG
Applicant Information [15A NCAC 02H .0502(a)]
Owner
Name:
Mailing
9 A 4 n �
14
Telephone Number: Bag 34ax Number:
E-mail Address:
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.mii/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: CQ�I-hlv_� 0c VknS
Company Affiliation:
Mailing Address:
Telephone Number: 439,N3i Fax Number:
E-mail Address: . C01�
Person to receive the Certification Approval:
JUA15
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,
FORM: SSGP 10-2013 Page 1 of 4

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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: -Ae-DQJwp l I Nearest Town: 4 a('I D N
Subdivision name or site address (include phase/lot number):
es
to site - please include road names and numbers, landmarks, etc.:
Latitude (in decimal degrees) _ J !K. 15'0Longitude (decimal degrees) 'E�
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): _ inr! 2i dwpr)
6. Property size (acres): I J ?)& nor&s 1
7. Lake/ river/ ocean adjacent to property: ko-G- .�D_✓r► e S
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it necessary): �o �(nJ� c�P_ 6hor a;Ap_
9. Will work be conducted from land? [�r From water? ❑
10: Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
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 pool lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres: Q S9 tae rc. te���
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):
Owner/Agent's Signature 15A NCAC 02H 0502(f) l
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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
(please provide dimensions for each Item, such as 10 ft. x 160 ft):
1) All proposed vegetation clearing (provide dimensions).
.2) Location of rip rap or fill to be placed above the Full Pond -elevation
3) Location of rip rap or fli i to be placed below the Full Pond elevation
4) The location of any proposed sutures such as buildings, retaining
walls# docks, etc.
6) The location of any excavation or dredging below the Full Pond
elevation.
6) Location of construction access corridors.

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Driving Directions to Sunset Point on Lake James:
• Take 1-40 West to Marion, NC
• Take Exit 86 (Highway 226) off of 1-40
• Drive north on Highway 226 approximately 1 mile to traffic light
• Continue north on Highway 221/ 226 Bypass approximately 5 miles to traffic light; Taco
Bell on R)
• Go through that traffic light
• Turn right at next traffic light (Business 221/226)
• Take a quick left onto Hankins Road
• Continue on Hankins Road until it dead -ends at Lake James Road
• Turn left onto Lake James Road, follow it out
• Turn right to the entrance of Sunset Point, continue on Sunset Point Parkway
• Bear left unto Big Tree Way and follow to the end

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