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Home My WebLink About20171461 Ver 1_Shoreline Stabilization_20171114.1 State of North Carolina Department of Environment and Natural Resources Division of Water Resources \ 15A NCAC 02H .0500 -Water Quality Certification, Shoreline Stabilization FORM: SSCP 10-2013 Shoreline Stabilization Application Form Three copies of the application (including attachments) and the application fee should be sent to: 1. Division of Water Resources 401 & Buffer Permitting Unit 1617 Mail Service Center Raleigh, NC 27699-1617 ) 1 4 6 1 Applicant Information 1`15A NCAC 02H .0502(a)] Owner Information Name: Mailing Address: 50�, 11115Y Ify4 oGC�L��IC� D ov1A2UN D -WA-M—RRESOURCES BUFFER PERMITTING -1 Telephone Number: .5Z " � t� Fax Number: E-mail Address: 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: Jam' Company Affiliation: Mailing Address: - !-'�- D 0 Telephone Number: j92,9- Z.26 Z0y%Fax Number: FZe-Z�3— 1Z6 0 E-mail Address: co rvn Person to receive the C ification Approval: 4_7_,0%�! ,f��c 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 01 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: _J etc +�So�(,� Nearest Town: i Subdivision name or site address (include phase/lot number) - 5 :� umber): 5:� Zg,:7 z 3 Directions to site - please include road names and numbers, landmarks, etc.: rr�V? �l /� ' fit,�� /Dt /'-/ TD Al /(13OZ r✓ %b f/ooP.Ev,' div 2-7To Ty oT e2-,'rJ A?Ty /-� Latitude (in decimal degrees) S-61 / Longitude (decimal degrees) S. Describe the existing land use or condition .of the site at th time of this application (residential, undeveloped, etc.): ��1 6. Property size (acres): 0/02 !f -f�g— 7. Lake/ river/ ocean adjacent to property: G l& N ir��ll� S. Describe proposed work (include discussion as to h"/ow hardening of shoreline has been avoided, or why it is necessary): r�e>/V'7�f"yC�t 's4i 1�J %–O Ij2��-' 9. Will work be conducted from land? ❑ 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: �3 , 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: -S Q r 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):�f2� 469wl r- //mss ffN® A1i1✓I-WUL k�6*;o�T�4/-) /, - OKA�-v -- 77111s /7- 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. FORM: SSGP 10-2013 Page 2 of 3 1, JOHN W JUMS, CERTIFY TN4T THIS PLAT WAS ORAVW MWM AN ACTUAL SURIEY MAD! `.J Cf.RTIROATQ OR APPROVAL FOR R1C01101N0 UNDER MY SUPERMEeK OV. THAT THE SURVEY la OF AN ISTNAE O PARCEL OF LAND OOROn N DEED BOON TON, PAGE SH AND OWS NOT CREATE ANEW STRICT OR CHANGE AN I CnTMY 11Mi THE PLAT iNOWN HEREON OOM/LICS MM TNb EKNTNO SMW- THAT THE MADO OF PRINCEON AS CN.CULATO IS I : MMS; THAT THIS WA Rrury v Ar THE PAT ORDINANCE AND IS APPROVED FOR Fur wAs PRaAReo N ACCOMANC/ Wall as. A.ro M AMENDED. nTTNns MY oaaNAL VICINITY MAP .. Ree=NE N Me ReoISTu of D®Da oFPvcc EO/diLlRe, LMEIISB NUMRM ANO SEAL "NS ETN DAY OP JNN4 TNT. o NO SCALE DATE WATERSNEDADAMESTRATOR ,R.,PFLLp' NOOJ: TNR PROPEIrYNI LOCATED LNTNN A PIASUC WATER S LAND SURVlYDR I. STA W SUPPLY HAnIRSHED. OEV.LOFMpTRQSTATCIION MAYAPPLY. X STATE OF NORTH CAROLINA, COUNTY OF JACKSON SITE STATE OF NORTH CAROLNA, COUNrY Op JACKSON THE MASS- CEAWIOATES OP JOHN W. ANN$, PROFESSIONAL LAND SURVEYOR, AND SNE COUNTY OIYMR! Aq C.RTMIlD TO IQ COMQGi. L RENEW opp m OPJAOKSoNCoUNTY, CCRiMY THAT THIS INSTRUAWNCT WAS PRESENTS POR REOSMAr/0N ANO RECORD.. IN THE PUT TO VANCH flES CERHRCATION 12 AFFIXED MEETS ALL STATUTORY R#cW#EUWMFS FOR RECORDING. PLAT CABINET Ar SLIOR .MIS DAYOP 4� AT OCLOCK M., ,AD P nVICW OpRCG OAR $JJ. '1f REGISTER OF DaEOS ,/ fMfxllMx fY SPQbTVE'E / nlww.r uaalfaxr � C AlRTi• xrf•u�f•w aW LOT S] A • OI N1r°o LOT S JAMlA N..LOOD000D ,{A{ JAMES O. WILLIAMSON /AOA ,61TIxx. T�tMtrr. LOT5 i •. ".. ,,. t 0.99 ACRES / I t ~ ^••, .3 ` ` ". "" "" p4 / Rei q x CAB. • EL..1.e 1" m 30' ♦• IxM Nle ter,. AA. xf. 3 .^ P w b LOCATION SURVEY OF / ^�• �• „ lrle AN EXISTING PARCEL " "°° H ••` •" „rr8 �•, K., „„ PREPARED Fan /, h• '� ° M I ! _ i r , RICHARD & QUIN BRISCOE •'�° "••- "`�'°"°° ^�„ ', ' I ; LOT 5, 0.99 ACRES, SUMMERHILL S/D k LAKE FROM CURRENT OWNER LOT. OLENWLLE My- MUST T'TQAT, »' •• DOUGLAS A. SAMPSEL, 1096-261 11141148' HAMBURG TOWNSHIP, JACKSON COUNTY, NC. aT;iiiD, W % F° rrxm B P.II NOTES: ux OOIMI MAY 31, 2017 1. PROPERTY SUNECT TO ALL RIGHT OF WAYS, EAnMnTS, RESTRICTIONS AND AORnMEWS OF RECORD OR THAT , d CORNERSTONE SURVEYING, PM M .C. EXIST E GROUND.Cr[ S• MG COORDINATE COMPUTATIGN METHOD1244 FA/RWEW RD., SYL VA, VC. E. Deep 10ai STATES LOT 15 SUBJECT . m +m waL ZIP 28779, PH. 8281586-5782 SETBACK =60 77ON21 THAT HAS 891M REVISED ro WT LICENSE # C-1881 � Lpl pjW _ 6a -z a F -I (' ?df p /px v1z--1z-eo-r- ✓E��sr.�s /Ila 70, J-3 4n?%) 6- 5;�/OOW4 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. S. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation 6. Location of construction access corridors N FORM: SSGP 10-2013 Page 3 of 3 i it I n' e __ ��, , �' �� Y`�` , ��. r �.,3-.-r -rte -�"-�-.-�- � �C -= F _� �r y .. ._ .`Y � �.a"� _--� � - - -- --- � _ _ -_ zm L '11'�j;