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Home My WebLink About20171257 Ver 1_Shoreline Stabilization_201710042 0 1 7 1 2 5 7 State of North Carolina _D "+ Department of Environment and Natural Resources Division of Water Resources W' Division of Water Resources ISA NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization FORM: SSGP 10-2013 Shoreline Stabilization Application Form Four 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, PJC 27699-1617 F1 I. Applicant Information [ 7 i t_.r=,C 12 H .O5Q2' !] 1. Owner Information ` Name: /C /Y/Y4J /ti�iq'-'1/ OCT 042017 Mailing Address: X 0 44 fL e z to�� iS.;cR� iL`C Z 7S'y I Telephone Number; 0 y Fax Number: _ E-mail Address: �/ 4,0w•'�i�w� s'� �y�¢/�6 a c, 2. Agent/ Contact Person Information A signed and dated copy of the Agent Authorization letter (a form can be downloaded here: c_,3i?ATION FORM,.pdr) must be attached if the Agent has signed this application form. Name: Company Affiliation: Mailing Address: Telephone Number: E-mail Address: Person to receive the Certification Approval: Fax Number: II. Project Information [ 3 i\K '_ ] 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 4 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, Ishovel handle, etc.) 4. Location of the property (where work is to be conducted) County:iC'�,v `� r;,• ,t� Nearest Town: 13 4 � d Subdivision name or site address (include phase/lot number): 4 Directions to site - please include road names and numbers, landmarks, etc.: %ss f��(A•RJ rare' r�RMc� /ter � v •�/ s�+4w.v�" f� � <'. s'T�/'S� �'Krs A10LSE's' 0/1" L PFT 5. Describe the existing land use or condition of the site at the time of this application (residential, undeveloped, etc.): ,!✓Si J) —�i✓7`"igL 6. Property size (acres): le----�R 7. Lake/ river/ ocean adjacent to property: C .4,(C 8. Describe proposed work (include discussion as to how hardening of shoreline has been S avoided, or why it is necessary): 9. Will work be conducted from land? Yt'S From water? 10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.) below` he 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: „? � X 13 J. -5- 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): (I 1tSS_. riii r Owner/Agent's Signat re' [1 = ! _ ,C Date 'Agent's signature is valid only if an authorization letter from the owner is provided. FORM: SSGP 10-2013 Page 2 of 3 I Provide four (4) copies of -the application and supporting information (maps, drawings, etc.), as well as the appropriate application fee (see below), to the Division of Water Resources, 401 & Buffer Permitting Unit, 1650 Mail Service Center, Raleigh, NC 27699-1650. Ap licant Information [f Owner Information: Please provide complete and accurate contact information ❑ Agent Information: Per 15 A i jC,'AC 0,,_,H 0502 , an agent may be given signatory authority for the owner/applicant if a signed and dated copy of an Agent Authorization letter is included with the application. (A sample form may be found at c3zOi"V; C2!~CiOs Si Q:'t"rnitS/SAC1,/jfi'i_C AGENT AU T HORIZA iC1P ��0Pvi.p II. Pro ect Information [ Vicinity/ Site Map: Some type of site map so that someone unfamiliar with the area can locate your project. A county map or USGS topographic map indicating the project location is usually sufficient. [� Site Plan: A site plan showing the location of the shoreline, location of the impacts to the shoreline and/or lake bottom and the location and any vegetated areas that will be impacted. In most cases the site plans do not have to be professionally prepared. However, if you intend to conduct hydraulic dredging, professionally prepared drawings will likely be required for the spoil structures. See example below. [� Photograph of shoreline to be impacted/ disturbed [/7 Description of property and existing features on and near the site Description of project and impacts/ disturbance proposed III. Signature LvJ Per 15A, CAC uL i . ?502 , the application shall be considered a "valid application" only if it bears the signature of a responsible officer of the company, municipal official, partner or owner. This signature certifies that the applicant has title to the property, has been authorized by the owner to apply for certification or is a public entity and has the power of eminent domain. IV. A plication Fee [7The application must be accompanied by the appropriate application fee (checks made out to the NC Division of Water Resources). The application fee is as follows (pursuant to G.3 1.43-215". 3 D): ➢ $240.00 for impacts to lake (below normal water level) of less than 1 acre ➢ $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre INSTRUCTIONS FOR APPLICATION SSGP307980 08-13 & SUPPORTING DOCUMENTATION Page 2 of 3 State of North Carolina DWR Department of Environment and Natural Resources Division of Water Resources Division of Water Resources 1SA NCAC 02H .OSOO — Water Quality Certification Instructions for Application FORM SSGP 10-2013 (Shoreline Stabilization 401 WQC to accompany USACE GP30, GP79, or GP80) Instructions for Shoreline Stabilization Application When to use this form —This application form should be used to apply for a 401 Water Quality Certification to impact: Description U.S. Army Corps of Engineers (USACE) Permit Federal Energy Regulatory Commission (FERC) regulated lake shore or bottom GP30 Tennessee Valley Authority (TVA) 'regulated lake shore or bottom GP30 Local government regulated lake shore or bottom GP30 USACE Reservoir owned/regulated lake shore or bottom GP79 Private lake shore or bottom GP80 When this form should not be used —This application form cannot be used for wetland or stream impacts. This information does not apply to landowners within the twenty coastal counties that are affected by Division of Coastal Management (CAMA) rules. For more information — If you have been advised that you require a 401 Water Quality Certification, and would like more information about: ➢ The application process: ��Lt� a a�.r _��;�� -�'Vta ➢ How to download an application form: f-r1tp ➢ Application fees: i.ttp-. ' por aI.Ecden 3,L If you are unable to download this !information or application, please call (919) 807-6300 to request an application with instructions. Please note — Not all imparts require written authorization from DWR. This may include the construction of docks or boathouses if there is no dredging or filling involved (other than the pilings). For more information, fl.,Ci .LL�71 E please visit the following website: ii j✓UP" ai_i!t �!501.,_�. f-a='dlii.1_illi.`,�I_a(_�S¢t3:''P_Ja,s �0 am:,1\/ How to apply — When submitting an application to DWR, please use the following instructions as a checklist in order to ensure aR required items are submitted. Adherence to these instructions will help facilitate a quicker review time and reduce the amount of requested additional information. INSTRUCTIONS FOR APPLICATION SSGP307980 08-13 & SUPPORTING DOCUMENTATION Page 1 of 3 p� fB racy - LAKE ROYALE---- 9el akeRo ale Pro'perty Royale �. Owner's Association, Inc. , 50 Tar River Basin_ Riparian Buffer G- \ ``, s 5.2.,5.2.,_ rte.r L.-�.f ,.fj i William R. Dickerson, et ux -B,. 133 P. .4 f �.� t 15 ,- -_:1'703 Rovert W. Vangroafeiland, ` r✓ 4Da� of u x �\ Aww �y� Full Pond/ Normal Water Level La ke (At Full Pond/ Normal Water Level) je J;S J � _y 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 strctures 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 The River Golf & Country Club AS http://community link.comlmaps/fmnklincountN7nc/lakeroyalenc/ma... Click on a section of the map for an enlarged view. Select The First Letter Of A Street Name AIBI�IQIEIFIGIHI!IjIKILIMIN IoIQIPIRISITINIy WI Points of Interest awl AC Ej 1 01'-' 10/l/2017,8-.47 AM I! 040 s "ti .7..