20171096 Ver 1_Shoreline Stabilization_20170829

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2 0 1 7 1 0 9 6 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
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
I. Applicant Information [15A NCAC 02H .0502(a)]
1.
R LE 0 W 12. R.,
AUG2,>)2017 Do
DEQ -WATER RESOURCES
Owner Information 401 & BUFFER PERMITTING
Name: YN S
Mailing Address: $ i b (j(LEI=CIt4v k1
O�-CEk c -K NC- x-76, r3
Telephone Number: qJq 609 '6310 Fax Number:
E-mail Address: +q'7CC'o•L-vM
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: N I A,
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Person to receive the Certification Approval: 1.v AJ 4y,,i S
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: F00 5&AV714 Nearest Town: ,S+-okeSdl4Q , NC
Subdivision name or site address (include phase/lot number):
Directions to site - please include road names and numbers, landmarks, etc.:
6a o o w Lt4Q .po l �- I q�-6 3 6 2 L�p4e P61 N� LANe
r 4 Q — IS-" 14 LLzW C4414 il__
Latitude (in decimal degrees) 3fl , Zy S qS Longitude (decimal degrees) Sv- C) ZZ a 3
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): (2Cs(Ah'4-t,
6. Property size (acres): 614k Ln� 044T& 4Cr14e
7. Lake/ river/ ocean adjacent to property: lej.A�S oeek
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): jnr5�d pp-rq 'i -p
9. Will work be conducted from land? 0 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:
A,o�/ 3--14F� X ao, Izo I#n&�-/ FCet -- of �s 4v­e11A?
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: !F4 X l Z o lr--r ems✓ -:ee,f-
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): !3 ('s ss' eS
all d w et � s el
Owner/Agen's Signature* [15A NCAC 02H .0502(f)] Date
rtAgent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

Ft
Norma
SI
La ke
(At Full Pond/ Normal Water Levet)
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ftx 100 ft)*:
1. All proposed vegetation clearing — 04, (Y ^/U -J,5 i s 2 -34
2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation 3
3. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation 1-3
4. Location of any proposed structures such as buildings, retaining walls, docks, etc. -- ✓ CIAQ
5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors \60,10—
FORM:
o,10—
FORM: SSGP 10-2013 Page 3 of 3

Lyn & Heidi Adams
308 Lake Point Lane
6/6/17
Scope of work: 2017 outdoor area cleanup project
�I This project will remove overgrown trees, restore and expand washed out beach, install riprap to
cease erosion at waterfront, replenish footpaths and cart paths (cart path and turn -around to be
,4poo IO secured with treated timber and compacted crush and run, such that tinted concrete can be
installed at a later date), and expand the rear lawn to allow for much less ongoing maintenance
l� and rain water absorption. All existing soil erosion control systems and drains will be maintained.
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Vd gle Maps 308 Lake Point Ln
Lake Point Community- Belews Creek NC
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308 Lake Point Ln
Belews Creek, NC 27009

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