20170083 Ver 1_Shoreline Stabilization_20170120

I
Shoreline Stabilization Application Form
Three copies of the a pli; j `i jjuding attachments) and the application fee should
be sent to: 1
Division of Wa erReSSurces
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
• Applicant Information [15A NCAC 02H .0502(a)]D @ v t
1. Owner Information JAN 2 p 2017
Name: Joseph H. and Dixie T. Mazur
D 70RES
401 FF R P RMIT1
Mailing Address: 171 Summer Ln. Mill Spring, NC 28756
Telephone Number: 828.894.0330 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:
httr)://www.saw.usace.armv.miI/Portals/59/docs/rep-uIatory/rejzdocs/Permits/SAMPLE A
GENT AUTHORIZATION FORM.pdf) must be attached if the Agent has signed this
application form.
Name:
Company Affiliation:
Mailing Address:
1

Telephone Number: Fax Number:
E-mail Address:
Person to receive the Certification Approval: Owner
• Project Information [15A NCAC 02H .0502(a) & (b)]
• 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.
• 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, and construction access corridors. You may
use the diagram provided at the end of this application form.
• Attach a photograph of the shoreline/ buffer proposed to be stabilized.
(Include a scale of some sort- a yard stick, shovel handle, etc.)
• Location of the property (where work is to be conducted)
County: Polk Nearest Town: Mill Spring
Subdivision name or site address (include phase/lot number):
Lot D-21 Lake Adger Subdiv.
Directions to site - please include road names and numbers, landmarks, etc.: _
In Mill Spring, NC Hwy 9 to Garret Rd to Rt on Green Hills Rd to Left on
Lake Adger Pkwy. go past 2150 Lake Adger Pkwy turn Rt on Summer Ln. Last
drive on Lft before end of cul de sac. Take rt fork of driveway to 171 Summer
Ln.
Latitude (in decimal degrees) 35.33705 Longitude (decimal degrees) -82.20561
• Describe the existing land use or condition of the site at the time of this
application (residential, undeveloped, etc.): residential
• Property size (acres): 1 ac
2

• Lake/ river/ ocean adjacent to property: Lake
• Describe proposed work (include discussion as to how hardening of shoreline
has been avoided, or why it is necessary): The project is to stabilize bank
erosion by adding a geo-textile fiber barrier and ria -rap to 100' of the existing
shoreline. All material to be placed by hand.
• Will work be conducted from land? Yes From water?
• 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: 3 sq ft x 100' of 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: 3 sq ft x 100' of shoreline (rip -rap)
and up to 2 ft additional clearing land -ward x 100' shoreline to secure geo-textile
fiber.
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):
Only 2-3 small trees less than 4" in diameter will be disturbed. Almost all have
already fallen to a horizontal position due to bank erosion. Our goal is to disturb
existing natural shrubs and plants as little as possible, re -planting natural plants
or shrubs where needed and sensible.
I 111111h��� D* I
Owner/Agent's Signature` [15A NCAC 02H .0502(f)l
Date
"Agent's signature is valid only if an authorization letter from the owner is provided.
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Flood Zone: (Zone X) Minimal Flood Mil;
Flood Source-. Green Mver
Base Flood rievi,ion: NO( 3T.Illible, for this area.
Cou.m: PAIL
Politini Area: Polk Counts,
CID: 370104
Panel: 0649 't- D—vtoad
.M3p Number. 3710054900J
Panel Effective Date: 9;3.2003
Latitude: 3533705
Lon;irudr. .32.20561
Address locations are approximate.
271 5ummer Ln. MIN 5crine, NC

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