20160529 Ver 1_Shoreline Stabilization_20160523

State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
20 1
Shoreline Stabilization Application Form 0 52 8
Three copies of the application (including attachments) and the application fee should be sent
t°:PAID
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center � an/7
Raleigh, NC 27699-1617 V
MAY 2 :i ZOIo
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information pEQ W SOUK,
Name: 2IG11AfLD LZA(RRO�S 401 g, BUFFERPERMIT��NG
Mailing Address: 32 CAT A1.'> 6A 'RID" CT
LAME WYLIE . S. C. 29,71a
Telephone Number: 704 X319 06040 Fax Number:
E-mail Address: r i Chard %barr b W 5 1n0+M0.►% • C. orn
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/reeulatory/regdocs/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:
E-mail Address:
Person to receive the Certification Approval:
Fax Number:
II. Project Information [15A NCAC 02H .0502(a) & (b)1
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)
County: GAS -Too Nearest Town: '6ECMO N -r
Subdivision name or site address (include phase/lot number):
W9 Artaer Soap#JCfs U Zar»04i7 r1c 280/2 Col' vt SS
Directions to site - please include road names and numbers, landmarks, etc.:
FtoM i5t %moor _ w1C . —rA1Ct MC- 2713 Sou. -% &6Jt*p,g%t 12o.
I�jkt oA 0Q@ Aef_+Loft?0%AV blvd. Left on Le ke ?6,1 7i.
LP:'4' on SeGc,hy2ocal sor,nn La.we.
Latitude (in decimal degrees)Longitude (decimal degrees) .01 `110(04
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.):�Ame �I� pd
6. Property size (acres): . yS AC
7. Lake/ river/ ocean adjacent to property: LA1c6 %. Ilte
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): 1nSkalln{i am of rdL Q i 0 � O
GrosL10A 0 S�hOif� 1
9. Will work be conducted from land? 19 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: is?, 4.
2 6 4: &Ott of nn reup 6e Igo I&Vg 1,evel It base ql�tt+ 14Lh+ ��o�
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining L`�
walls, etc.) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres: q fttt dt 'l JF rig rap otross 4% X+ SIAD 55
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):
Z -Frte, . A PProxi nn*TCW S lv%c hs ►n ct%& c�cr
Nlfq 14 i 20 16
Owner/Agent's Signature` [15A NCAC 02H .0502(f)1 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 %% . /
Ckared Ate,, `
8 -Ft x 41 �t
Tf to(mr-�V
lint
� � 1�roPoSPc�
r
FZaP
` Ecow RAO 16ue1-
4 4
1Prapmy lint
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ftx 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

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