20170831 Ver 1_Shoreline Stabilization_20170706

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
WaterResources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
ENVIRONMENTAL GUAL:TY FORM: SSGP 02-2017
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent to:
If sending via US Postal Service
Karen Higgins
DWR — 401 & Buffer Permitting Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
A. Applicant Information
1. Owner Information
Name:
Mailing Address:
If sending via delivery service (UPS, FedEx, etc.)
Karen Higgins
DWR — 401 & Buffer Permitting Branch
512 N. Salisbury Street
Raleigh, NC 27604 LR cc
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15A N CAC 02 H .0502 (a
173 Panoramic Lane
Boone.NC 28607
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6 2017
Telephone Number: 804-205-0381 — Fax Number:
E-mail Address: [e-mail]
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter must be attached if the Agent has
signed this application form. (A form can be downloaded here:
httP://www.saw.usace.army.miI/PortaIs/59/docs/regulatory/regdocs/`Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pd
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
B. 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, buildings, retaining walls, docks, impervious surfaces, rip rap,
FORM: SSGP 02-2017 Page 1 of 3
3 i

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: Caldwell Nearest Town: Granite Falls, NC
Lake/ river/ ocean adjacent to property: Lake Hickory
Property size (acres): 1.04 acres
Subdivision name or site address (include phase/lot number): Lot 14, Plantation Pointe
Subdivision, 6149 Plantation Pointe Dr. Granite Falls, NC 28630
Directions to site - please include road names and numbers, landmarks, etc.: From Hickory,
Rt 321N 1.4 miles, right onto Grace Chapel Rd 2.9 miles, right onto Rocky Mt Rd 1.2 miles,
rip,ht onto Lovelady Dr & right onto Plantation Point Dr
Latitude (in decimal degrees)_15.79826-3 Longitude (decimal degrees) -81.340478
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Residential
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Existing shoreline is significantly undercut. Shoreline will be
graded to reduce slope and rip rap installed to prevent further erosion.
7. Will work be conducted from land? Yes From water? No
8. Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent impacts (including all excavation, backfill, rip rap, retaining walls, etc.) in square
feet: 141 ft. of shoreline x 3 ft. = 423 sq.ft.
Temporary impacts in square feet:
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, retaining walls, etc.) in square
feet: 141 ft. of shoreline x 4 ft. = 564 sq.ft.
Temporary impacts (temporary clearing, construction torriclor) in square feet:
Selective clearing and replanting within 50 ft. buffer of approximately. 15 acres
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): Undergrowth & small trees
will be removed. There are 10 trees within the 50 ft buffer that are larger than 6" in
diameter (5 Pines, 3 oaks, I maple, 1 birch). The 5 Pines, 2 of the 3 oaks, and the maple will
be removed leaving the birch and the largest oak trees in place.
11. Signature
Owner/Agent's Signature* [15A NCAC 02H .0502(f)] Date
'Agent's signature is valid only if an authorization letterfrom the owner is provided.
FORM: SSGP 02-2017 Page 2 of S

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.
Full Pond/ Normal Water Level" &d.&AP
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Plan View
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level
elevation
FORM: SSGP 02-2017 Page 3 of 5

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FORM: SSGP 02-2017 Page 4 of 5
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FORM: SSGP 02-2017 Page 4 of 5
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