20170046 Ver 2_Shoreline Stabilization_20170202

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NC GeneerrallLLiceennse Contractor # 49723
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SUBJECT: Shoreline Permit Application, Lot 945 Bay Pointe Drive
January 30, 2017
The attached Shoreline Permit Application is submitted in full as this project component
was inadvertently omitted from the dredge application received by your office on January
10, 2017 for the same address. Approval for the dredge application was granted on
January 23, 2017 with letter DWR#17-0046. If you have any questions, please let me
know. 304-629-6096 or [e-mail]
Thanks,
Donna

State of North Carolina
Department of Environment and Natural Resources
DWR 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
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information . ,
Name: I )UN 1( 1�
Mailing Address: 7
Telephone Number: Jr- I(J(� Fax Number: — 4oi U'S'A
U
E-mail Address: _t e_
2. Agent/ Contact Person Info ation
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
ORIZATIONNFFORM.pdf) must be attached if the Agent has signed this application form.
Name: ✓ (A P [Y- Vin
Company Affiliation: Lcknca-'+e_rS C it c -4r> X 9 E':SV 64ft 5 I ✓1 C
Mailing Address: cis 1 ?,-4-h PA .
-TroU+n' aayl , 1-\C_ Z61(a(0
Telephone Number:vIJT�12,91—(aa91,- Fax Number: �4-J�ZB -340
E-mail Address: Hnnw Q'_ �Qh��S rdQ'�/�5 t�G/YtCri� l'nm
Person to receive the Certification Approval:
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)
County: L i ocol nNearest Town: T_ `n"yr e r
Subdivision name or site address (include phase/lot number): Vy e5�' T:I)a
L(D4 5
Directions to site - please include road names and numbers, landmarks, etc.: �I(o
1Jor�h i + on 5f. i NC. -1(A
e r kl n fo
decimal degrees)__j5„rj J*703 Longitude (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): ZZ
7. Lake/ river/ ocean adjacent to property:Je
8. Describe proposed work (include discussion as to how hardening of shoreline has been
17
avoided, or why it is necessary): �QCP_ C< t7�fOki rxa�elU ,,Jq 0�
d Z7 l o r.5 bdj
ergs pn eon
9. Will work be conduce from land? ❑ From water? [�
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
TI 4LLZ`J
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining erroc�C,
walls, etc.) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres:
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):
Ir—
Owner/Agent's Signature
Printed Name
[15A NCAC 02H .OS02(f)l
Agent's signature is valid only if on authorization letter from the owner is provided.
I -Z7-17
Date
FORM: SSGP 10-2013 Page 2 of 3

Nora
I -OwLa ke
(At Full Pond/ Normal Water level) "
Cj
oAtL
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. Location of construction access corridors
See A46Lc�e� Ariel S'+e Tla.n �► ncludi n
ev iou.SIV/ a??roved 6red� e a.re� .
4, See Sore IIY-ie ?�lo+0S.
FORM: SSGP 10-2013 Page 3 of 3

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