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Home My WebLink About20171021 Ver 1_Shoreline Stabilization_201708153- State of North Carolina Department of Environment and Natural Resources 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 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 Raleigh, NC 27699-1617 Raleigh, NC 27604 A. Applicant Information [15A NCAC 02H .0502(a)] 1. Owner Information �n Name: ('-!I r,�J;ZcF7? J�a Mailing Address: J7 Z- KI L -(r 4/c- ,2-7 t Telephone Number. c)0'3 Fax Number: E-mail Address:iQ2: �cr-?' 2, J40)--7 ti 11✓�- f` Ly.�7 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: httr)://www.saw.usace.armv.mil/Portals/59/docs/reeulatory/reedocs/Permits/SAMPLE AGENT AUTHORIZ ATION FORM.pdf) Name: Company Affiliation: Mailing Address: Telephone Number: E-mail Address: Fax Number: B. Project Information [15A NCAC 02H .0502(a) & (b)] 1 401 & BUFFER PEF 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, 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) n County: T14 VK L i,.Vl Nearest Town: Lake/ river/ ocean adjacent to property: /12.0 Property size (acres): A' Lt -5; Subdivision name or site address (include phase/lot number): 1--o T Directions to site - please include road names and numbers, landmarks, etc.: E I Cr�frr4 ,rj �' L k - - - --- Latitude (in decimal degrees) 3569 7Z 3j ongitude (decimal degrees)''" c4� C3 L S. Describe the existing land use or condition of the site at the time of this application (residential, undeveloped, etc.): G 5 i D /i- L 6. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or why it is necessary):/i/�' �'✓-��.�-lrnL/,�1�r"c C� . 7. Will work be conducted from land? ® From water? ❑ 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: r� " x Y", ' = // 0 sem. )--r7-, 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, eexcavationnn,%rip rap, retaining walls, etc.) in square feet: 1 Temporary impacts (temporary clearing, construction corridor) in square feet: 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): �^_� A'045 C'r7 v` 11. Signature Owner/Agent's Signature' [15A NCAC 02H .0502(f)] �— Date 'Agent's signature is valid only if an authorization letter from the owner is provided. 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. e. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation Lake (At Full Pond/ Normal Water Level) L1 C- �y Full Pond/ Normal WateriLevel 0 16 `""� � . _ = _ — Shoreline,01 Wo b Plan View Lake (At Full Pooh/ N -I Water Level) Existing Dock /30@.7(1 E AMP E Plan View uuu�r�r♦��r�� ♦�rr••�r••r•ri• r��r�rr r••♦ T— E AMP E Plan View 3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing 'if necessa Existing bank 10 ft. bank `V height I Latitude and Longitude Finder on Map Get Coordinates Page 1 of 3 2JLatLong. n(tt Home Address to Lat Long Lat Long to Address Lat Long to DMS DMS to Decimal Degrees Latest Places Country List Add Place Lat Long to UTM +LatLong @latlong_net Get Latitude and Longitude To make a search, use the name of a place, city, state, or address, or click the location on the map to find lat long coordinates. I!> Place Name 381 sagamore dr louisburg, nc usa Add the country code for better results. 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