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Home My WebLink About20160171 Ver 1_Shoreline Stabilization_2016022220160171 State of North Carolina nXI/D Department of Environment and Natural Resources Division of Water Resources q1011111111'M� 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization DMsion of Water Resources FORM: SSGP 10-2013 Shoreline StabilizationApilication�Form P Three copies of the application (including at$hme iid-tttir application fee should be sent to: Division of Water Resources 401 & Buffer Permitting Unit 1617 Mail Service Center Raleigh, NC 27699-1617 1. Applicant Information [15A NCAC 02H .0502(a)) 1. Owner I Name: Mailing Address: Telephone Number: E-mail Address: R 4S o te ( Cross ` &t k- 1-a tve-, ,�) to 1AoPr- 00— c9ge) 31 In c( - 49q -3S97 Fax Number: 9 S0 ` 20 -1 to 1 ha,6ara-L c -D ISM -f L r. lvSor► _ e'no"'. 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, FORM: SSGP 10-2013 Page 1 of 3 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) T County: 1-1r) Col ►�-- Nearest Town: 3)e-V�VCr- Subdivision name or site address (include phase/lot number): ' S+J I wale rf .s,1 d I v <,1 oti )—O+ 1 q Directions to site - please include road names and numbers, landmarks, etc.: 14wi., 13 ic Ito 1 )bus/ e 1�Iltf �, ' -r#L � P 6A rrt � �f7nP TurK �t7T 60#, -Pt Nit. La - i n C 1GV o rL 5- /ILLX r. t- iakk o 11 W. ki I ioll-, Ldp1e._ (e4 Cross e7r,egL Laxe . Latitude #n dedmal degree ).�G1. 331 _ Longitude (dedmal degree!)�00 Jr o . to D b 5. Describe the existing land use or condition of the site at the time of this application (residential, undeveloped, etc.): f P51 ePJ- I' 5. Property size (acres): �P 7. Lake/ river/ ocean adjacent to property: 8. Describe proposed work (include discussion as to how hardening of shoreline has been tr avoided, or why it is necessary): k r"� cI+ 6 KL S0 Tee+ ' 01 r e mo, S I ' 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: 150 _,�a Karr_ fie.& ( I t. y 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: JA Liar-e_. 4�-_t + (_ 4 +f. 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): rf-es 4- _, (1 _ 2 It „ - V -- - Owner/Agent's Signature* 115A 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 Lake (At Full Pond/ Normal Water level) Full Pond/ / Normal Water Level Shoreline 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. 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