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HomeMy WebLinkAbout20140488 Ver 2_Shoreline Stabilization_20170313Division of Water Resources 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 t xr+r Shoreline Stabilization Application Form Three copies of the application (including attachments) and the application fee should be sent to: H Division of Water Resources 401 &Buffer Permitting Unit p � =201?'T 1617 Mail Service CenterRaleigh, NC 27699-1617 MAR 1 ;� Applicant Information [15A NCAC 02H .0502(a) Owner I Name: Mailing Telephone Number: Fax Number: E-mail Address: e- 2. Agent/ Contact Person ormation A signed and dated copy of the Agent Authorization letter (a form can be downloaded here: htta://www saw usace army mil/Portals%59/docsZreguiatory%regdo-.s/Permits%SAivIiPLE AGENT AuTH ORIZATION_FORKID&I 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. 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 rte 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- pert (where work is to be conducted) County: �Nearest Town: Subdivision name o sit ddre (include phase/lot number): Directions to site -please include ad namf$e��mbers, landmarks, etc.: Lora I Ude (decimal degrees) Latitude (in decimal degrees) g 5. Describe the existing land use or condition of thefie at.thg time of this application (residential, undeveloped, etc.): 6. Property size (acres): ✓'� ��-s -�� 7. Lake/ river/ ocean adjacent to property: /� 1��'� 8. Describe proposed work (include discussion as to how hardening f s oreline has been avoided, or why it is necessary): 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 norm pool lak jevel/ Normal W r Level in square feet or acres: a � 11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining walls, etc.) above the norm/al poolake level Normal Water Level and 50 feet land -ward in square feet or acres: / �O �-3 � 12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and 50 feet landward to be impa" (numb of trees, ins ce): Owner/Agent's ignature Printed Name Date 'Agent's signature is valid only if an authorization letter from the owner is provided. Page 2 of 3 FORM: SSGP 10-2013 Full Pond/ Normal Water Level W Shoreline La ke (At Full Pond/ Normal Water Level) - ') // � Lz" �' � 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 FORM: SSGP 10-2013 Page 3 of 3