20170519 Ver 1_Shoreline Stabilization_20170427

2 0 1 7 0 5 9 State of North Carolina
department of Environment and Natural Resources
DWR Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
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 n�
401 & Buffer Permitting Unit pil'T CI
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1617 Mail Service Center R
Raleigh, NC 27699-1617 ST0�
I. Applicant Information [15A NCAC 02H .0502(a)] ��TFR FRq�Zry
1. Owner Information M/�2NG
Name: AIIeVhouse LLC cT"
Mailing Address: 17626 Randall's Ferry
Norwood NC, 28128
Telephone Number: 704 363 8149 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:
http://www.saw.usace.army,mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
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: 5SGP 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: _ _ Stanly Nearest Town: Norwood
Subdivision name or site address (include phase/lot number): _ Eagle Point Phase II
Lot 22 - address is 232 Ea le Point Dr.
Directions to site - please include road names and numbers, landmarks, etc.:
From Albemarle take 24 east toward Troy. Turn right on Indian Mound Rd.
From Indian Mound turn !eft onto Randall's Church Road. Then turn left onto
Eagle Point Dr. The house is on Right
Latitude (in decimal degrees) 35.264946 Longitude (decimal degrees) -80.09576
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Shoreline is residential undeveloped
6. Property size (acres): 0.6 Acers
7. Lake/ river/ ocean adjacent to property: Lake
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Prepare shoreline and applv Rip Rap and Stone
9. Will work be conducted from land? X� From water? [�
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:
Approximately X00 sg feet
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: About 25 yards of dirt will be added to the land to brim to same
Elevation of neii?hbor shoreline Veru little — almost none excavation _
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): About 15 small
brush trees will be affected. The area will be improved with grass, and develo Dment
approved Vegetation.
Owner/Agent's Signature` [ Date
`Agent's signature is valid only if an authorization letter from the owner is provided
FORM: SSGP 10-2013
Page 2 of 3

La ke
(At Full Pond/ Normal Water Level)
Full Pond/ 4
Normal Water Level
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Shoreline �; p
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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

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