20170530 Ver 1_Shoreline Stabilization_20170428

State of North Carolina
Department of Environment and Natural Resources
sr
Division of Water Resources
ISA NCAC 02H .OSOO — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 02-2017
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fey- should be sent to:
If sending via US Postal Service If sending via delivery service (UPS, FedEx,
etc.)
Karen Higgins Karen Higgins ��'�
DWR — 401 & Buffer Permitting Branch DWR — 401 & Buffer Permitting Bch
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC NC 27699-1617 Raleigh, NC 27604
A. Applicant Information [? 5A NCAC 02H .0502(a)j 2 0 1 70 5 3 0
1. Owner Information
Name: Eyy` i LV +re P+
Mailing Address: P d
vC,
Telephone Number: Fax Number:
E-mail Address: 6d b S4/`a.e4 / 95 8 � A . L , Co
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorisation letter must be attached if the Agent has
signed this application form. (A form can be downloaded here:
El' T AtJTH-0 ! `3�wv 'vv. ��-.t;-iii/1'G :a �: �,�l �`v �>I (�r!iia`i.v( ,.JG:Sj _(i%li�:,H✓i._ 1 -iv i
-ATION FORM.odf)
Name:
Company Affiliation:
Mailing Address: D
APR 2 8 2011
Telephone Number: Fax Number:
E-mail Address:D QUALITY
STORMWAT R ERMI NG
B. Project Information [15A NCAC 02H .0502(a) & (b)j
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, buildings, retaining walls, docks, impervious surfaces, 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.
FORM: SSGP 02-2017 Page 1 of 3

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: _ M c ouw e I( Nearest Town: —14,e by
Lake/ river/ ocean adjacent to property: vvt p S
Property size (acres): s 55 D
Subdivision name or site address (include phase/lot number): L A. Ke- y - e t,,, �S-� a -� •S
Lo -9- .-
Directions to site - please include road names and numbers, landmarks, etc.: T.* w t1 F eJA o
rA0.r.ury ke CCicb Is L*s-1 to 4- 6 v _ k -c Q 6kA-
Latitude (in decimal degrees).
Longitude (decimal degrees) o AJ P L4
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): 1114 Cu -�
6. Describe proposed work (include discussion as to how hardening of shoreline has
been avoided, or why it is necessary): R, 'Ip Q io 12 J M,. L_
� rt :5 4-• S �, v-_ b S Ig �P l a wA-
7. Will work be conducted from land? C" From water? 0
8. Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent impacts (includinvll excavation, backfill, rip rap, retaining walls, etc.) in square
feet: 13(1 ?l 53 Ip � :.P Rap
Temporary impacts in square feet:
IV f-
9. Total amount of impacts above the normal pool lake level / Normal Water Level and
50 feet land -ward
Permanent impacts (including back fill, excavation, rip rap, retainin walls, etc.) in square
feet: 3119 5 s F+ iR p► ,n 3 `/ D 5 4 F+ S 4 aw• ry
Temporary impacts (temporary clearing, construction corridor) in square feet:
3 a o a-
10. 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): t i IN r s '
3
•,lA 5'NrK55
11. Signature
FORM: SSGP 02-2017 Page 2 of 3

q -'q 3 - ! ?
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.
12. Please approximately sketch the following information on this plan and provide
dimensions for each item:
a. All proposed vegetation clearing
b. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level
elevation
C. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level
elevation
d. Location of any proposed structures such as buildings, retaining walls, docks, etc.
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level
elevation
Lake
Full Pond/ Normal Water
Shoreline
Lake
(At Full Pond/ Normal Water Level)
Full Pond/ Normal Water Lev
"' 'rcSfiore}line �� ""

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