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Home My WebLink About20171304 Ver 1_Shoreline Stabilization_20171012JNIIIIVU83d b3ldiU jjr 401 /Unvnb CNdl-8N3C ' 1lOZ T cvfno(f C13/\I303 t4 al 77Z_1 *-k,7 1`9 /7 7,1 �-Oew 14 JA/ -� ' , /-,-v��. oma? 4/ r a s� sus© r rQ (s �� _lip, ofd b0 £ L 1 to Z 91oYf��-� a'711 rdf 22 fib f yr fj :)lt,=,L 'lN (r/AP(Z State of North Carolina Department of Environment and Natural Resources D-W,,'R Division of Water Resources later Resources 15A NCAC 02H .0500 —Water Quality CertifKation, Shoreline Stabilization Dkisim of 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 1. Applicant Information. f 15A NCAC 02H .0502(a)] 1. Owner Information Name: Mailing Telephone Number:0 E-mail Address: 2. Agent/ Contact Person Information Fax Number: A signed and dated copy of the Agent Authorization letter (a form can be downloaded here: htta://www.saw.usace.army.mil/Portals/59/docslregulatory/reedocs/Permits/SAMPLE AGENT AUTH ORi7ATION FORM.ndf) must be attached if the Agent has signed this application form. Name: Company Affiliation: Mailing Address: Telephone Number: Fax Number: E-mail Address: Person to receive the Certification Approval: II. Project Information MA NCAC 02H .0502(x) & (b)1 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 dearin& structures (buildings, retaining walls, docks, impervious surfaces, FORM: SSGP 30-2013 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 property1(/where work is to be conducted) County: �� Ly Nearest Town: L Subdivision name or site address (include phase/lot number): Z5�-- L5"J D r ✓) s J o nj , Lo -r" --Af- P Directions to site - please include road names and numbers, landmarks, etc.: Fo uoeJ t4 o- Z4 -2-7 7`oc") ,twi> L..-�- W r/L-6teY, U-Y�51- b61; P,eC- C?44f-1 eJ Ak i --DG E -7-aIeA! SIG1�7-- AnIT-/% /Akl--_ >//-/¢.e-Yje-D_ e",0 A0m/)Z�s T//,n1 /r-T'O/YT0 to ✓ E- � - /e "✓ eat ucYe(fn d&5degre A -1--P' Long' u a (decimal degrees) 5. Describe the existing land use or condition of the site at the time of this application (residential, undeveloped, etc.): 6. Property size (acres): t) . S-% 5� A C 7. Lake/-river/ocean adjacent to property:N� 8. Describe proposed work (include discussion as to how hardening of shoreline has been @voided, or why it is necessary): le z5 --- X 15 T/i1/ Jy 1 ALI) s M Ll_ erlc {: e -P A -A1.-:71 m v 1.c 9. Will work be conducted from land? Q--- 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: 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: %G X Z — 3 Z 0 -50 je-T', 1- 1200 S. r SJ a%r� Cam 12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and 13ro O 50 feet landward to be impacted (number of trees, for instance): Al 0 -die i��S s • F P6-'M0V6-1 Owner/Agent's SignatureUSA NCAC 02H --.0502(f)) Date Agent's signature is valid only if an authorization letter from the owner is provided. FORM: SSGP 10-2013 Page 2 of 3 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 structures such as buildings, retaining walls, docks, etc. 5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation 6. 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