20160931 Ver 1_More Info Received_20161013

State of North Carolina
Department of Environment and Natural 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

I. Applicant Information \[\]
15A NCAC 02H .0502(a)
1. Owner Information
Name: Brian Donehoo
Mailing Address: 224 Milford Ci
Mooresville NC 28117

Telephone Number: 7044881622 Fax Number:
E-mail Address: [e-mail]
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
) must be attached if the Agent has signed this
_AUTHORIZATION_FORM.pdf
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)
vicinity map
1. Attach a (i.e. street map) clearly showing the location of the property
with respect to local landmarks such as towns, rivers, and roads.
site plan
2. Provide a detailed showing property boundaries and proposed locations
of vegetation clearing, structures (buildings, retaining walls, docks, impervious
FORM: SSGP 10-2013 Page 1 of 3

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.
photograph
3. Attach a 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: Iredell Nearest Town: Mooresville
Subdivision name or site address (include phase/lot number):

Directions to site - please include road names and numbers, landmarks, etc.:

Latitude Longitude
(in decimal degrees)(decimal degrees)
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.):
6. Property size (acres):

7. Lake/ river/ ocean adjacent to property:
8. Describe proposed work (include discussion as to how hardening of shoreline has
been avoided, or why it is necessary): I had originally submitted the permit with a
RipRap wall. Instead we are going to do a solid wall. The length of the wall will be
approximately 70-75 feet instead of the initial 60 feet of Rip Rap

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:

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: 75 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):
FORM: SSGP 10-2013 Page 2 of 4

*
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.

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.
FORM: SSGP 10-2013 Page 3 of 4

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 4 of 4