20170632 Ver 1_Shoreline Stabilization_20170522

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 i 2
Raleigh, NC 27699-1617
R
C@L�aC
D
MAY 2 2 2017
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: Mack Boyte
Mailing Address: 4142 Marquesas Ave.
Tega Cay, SC 29708
Telephone Number: 704-280-6658 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: 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: Gaston Nearest Town: Belmont
Subdivision name or site address (include phase/lot number):
Directions to site - please include road names and numbers, landmarks, etc.: 1-85 Exit 27
towards Belmont. Left on Southpoint Road, Right on Gaither, Right on Riverfront
1d5-1Z
Latitude (in decimal degrees) N 35 Longitude (decimal degrees) W 81 '
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Residential
6. Property size (acres): .6 acre
7. Lake/ river/ ocean adjacent to property: Lake Wylie
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Dredge channel for boat access
9. Will work be conducted from land? M✓ From water? Id
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:
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:
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): 0
FORM: SSGP 10-2013 Page 2 of 3

Owner/Agent's Signatureq%e /5— Printed Name /I Date
y
[15A NCAC 02H .0502(f)]
Agent's signature is valid only if an authorization letter from the owner is provided.
Lake
` I
Full Pond/
Normal Water Level
Shoreline
kf5
zX1:s11is
e
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

0
100 200 feet
ont Dr
4-