20160996 Ver 1_401 Application_20161016

State of North Carolina
Department of Environment and Natural Resources
F Division of Water Resources
15A NCAC 02H.0500—Water Quality Certification,Shoreline Stabilization
Division of Water Resources 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 2 0 1 6 0 9 9 6
I. Applicant Information [15A NCAC 02H .05024a)]
1. Owner Information
Name: Ann Zinser
Mailing Address: 3900 Channel Point Ln
Denver NC 28037
Telephone Number: 6033403544 Fax Number:
E-mail Address: [e-mail]
DEQ-WATER RESQt1RCES
2. Agent/Contact Person Information 401 &BUFFcR�F_RPRfiTtNG
A signed and dated copy of the Agent Authorization letter must be attached if the Agent has
signed this application form.
Name: Dean Fisher
Company Affiliation: Lake Norman Custom Dock
Mailing Address: PO Box 1439
Denver NC 28037
Telephone Number: 7044832144 Fax Number: 8665794539
E-mail Address: [e-mail]
Person to receive the Certification Approval: Dean Fisher
II. Project Information L°5A NCAC 02H .0502'a( ) & ()]
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,
etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
FORM:SSGP 10-2013 Page 1 of 3

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: Lincoln Nearest Town: Denver
Subdivision name or site address (include phase/lot number): C-0.7 'It q `� i y q, V'74
14,;4T TV3900 Channel Pointe Ln Denver, NC 28037
Directions to site- please include road names and numbers, landmarks, etc.:
Hwy 16 Bus S turn left on Webbs Rd. Continue onto Silver Jade Dr. Right onto
Rustling Woods Dr. Right onto Channel Point Ln. 3900 Channel Point Ln.
Latitude(in decimal degrees) 35.519110 Longitude(decimal degrees) -80.962697
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Vacant residential
6. Property size (acres): 0.55 acres
7. Lake/ river/ocean adjacent to property: Lake Norman
8. Describe proposed work(include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Installation by land with Bobcat of riprap with fabric to
stop erosion of3-4ft bank at shoreline. Removal of small underbrush and undermined trees
as needed
9. Will work be conducted from land? XD YES From water? ❑NO
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:
Approx 6x120ft or total 600sgft along shoreline
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: Approx 10x100ft access path thru buffer with
10x150ftgradin /access alone shoreline or 2500sgft total impacted
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): Existing large pines with
small trees and grasses at shoreline
V` rDean Fisher 0 10/11/16
Owner/Agent's Signature` [15A NCAC 02H .0502(f)1 Date
FORM:SSGP 10-2013 Page 2 of 2

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