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Home My WebLink About20170849 Ver 1_Shoreline Stabilization_20170710State of North Carolina Department of Environment and Natural Resources K_ I r1a Division of Water Resources Water Resources 15A NCAC 02H .0500 - Water Quality Certification, Shoreline Stabilization ENVIRONMENTAL QUALITY FORM: SSGP 02-2017 Shoreline Stabilization Application Form IF, IJ "A Three copies of the application (including attachments) and the application fee 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 Branch 1617 Mail Service Center 512 N. Salisbury Street 2 0 1 7 0 8 4 9 Raleigh, NC 27699-1617 Raleigh, NC 27604 A Applicant Information [15A NCAC 02H .0502(a)] 1. Owner Information Name: e L L A W Mailing Address: (_5' A A)CAV�5 ROAD Telephone Numbe��"AVV4S!S-CoGAA- Lix=N�r: 0�kCt- E-mail Address: W my-, Is 7-k-7 0— C-I(Y\ (\k (__ , C-O(Y-\ 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.armv.miI/PortaIs/59/docs/reRuIatorv/reRdocs/Permits/SAMPLE AGENT AUTHORIZ ATION FORM.pdf) Name: Company Affiliation: Mailing Address: Telephone Number: Fax Number: E-mail Address: B. Project Information [15A NCAC 02H .0502(a) & (b)] /I. 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. 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: Nearest Town: CKOX-MRD, Lake/ river/ ocean adjacent to property: " Yco Property size (acres): _4 Subdivision name or site address (include phase/lot number): L -0,T 20 2:1 Z_q k C.)o 0 NA ANZ)v�(a - ( C)__E)_LK_ Directions to site - please include road names and numbers, landmarks, etc.: Latitude (in decimal degrees) Longitude (decimal degrees) 5. Describe the existing land use or condition of the site at the time of this application (residential, undeveloped, etc.): X��\ L 6. Describe proposed work (include discussion as to how hardening of shoreline has been R4 avoided, or why it is necessary): To YLIP- I Y, I I I\J C, Rk?- ik�A P M 7. Will work be conducted from land? 1AJ From water? EI 7- 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: LE& -L_- V 80" -_ 1 ('0 vf�� P�fn- 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 (inclujing back fill, excavation, rip rap, retaining walls, etc.) in squgre feet: I COU- - x ",3,K 80 -: z4o sivAk Te ts (temporary clearing, construction corridor) in square feet: 10. Please describe the vegetation above the normal pool lake level/ Normal Water Level and 50 feet andward to be impacted (number of trees, for instance): �C) ) M�,k7�' 11. Signaturg \ Owner/Agent's Sig t re te Agent's signature is valid only if an authorization letterfrom the owner is provided. DlQl;a:-x--kf3o% -M !��, mL -. VRWVk R LDOCOS) C)&UZ)A V�kRO-CAL n ti -\1 Lkx T Uk,, t T 1 6 T?D LW- -f \ A)4 10 VIIDN� I k'A �'-o - T 4A AW M \J c -i -V�� k "-\- Y-\A-2--lX'-1 0� �R - AS13 - r,)(,44- MoRe� 12. Please approximately sketch the following information on this plan and provide dimensionsfor 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 (At Full Pond/ Normal Water Level) I I i? % j3 -Z�. ep -fye-?tw- "tL �64 D Full Pond/ Normal Water Shoreline Plan View Full Pond/ Noffnal Water L aalrore'rine— — ' ' ft. x 150 ft. Aditinnal clearing ' if -V Cn Lake jAt Full Pond/ Normal Water Level) Riprap Existing Dock / 30 ft � 7 ft 3ftx 150 ft Selim NO PMW NWL 4ftxI Ab— full pond/ NWL E AMP E Plan View 0 IMI IMI � IMI IMI Is -n Nc� 9a 01- Wkm W � tj L"- VQ tj C, W P(� Lt-XkL pRy,,,J,� Pau- ?0&30 W ATOI- WW - __j Lake (At Full Por d/ Normal Watte7vel),- :3 EL- 0 0 Z -C zIV) '0 C 0 Side View CIL LL. 3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing *if necessary Existing bank 10 ft. bank Side Vi A or MPLE TaxParceiViewer 716117, 3:28 PM Search anj L .1 h nj Rd K10" Woodkind Elementary p 'CIO Ceffo -Z C"00 W) ill� 00 C G vvmlrtbl�11* conc d C rftj Rd M Oe WaQ 5 taff Fbryd o,tA U PIP (-)I Hill j V LICK Lo ng, Store SIOL C, G u S 40? 4fo U1 Roberlson gd OLIVE HILL 0 Leasburg Rd 0- 79.158 36.495 Declipc- Esri., Inc., Person County GIS to https://gis.personcounty.net/TaxParcelViewer/ Page 1 of 1 okjk� -17 e. 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