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Home My WebLink About20180552 Ver 1_Shoreline Stabilization_201804172 0 1 8 0 5 5 2 State of North Carolina Departm nt J'Xr Lment 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 Karen Higgins DWR - 401 Et Buffer Permitting Branch 1617 Mail Service Center Raleigh, NC 27699-1617 If sending via delivery service (UPS, FedEx, etc.) Karen Higgins DWR - 401 Et Buffer Permitt 512 N. Salisbury Street Raleigh, NC 27604 A. Applicant Information [15A NCAC 02H .0502(a)] Owner Information Name: i "t Z)S tci si Mailing Address: 3 -TI (>-;, Sti; X02 ,1 C ,) 7'3'i3 Telephone Number: S)3,6 Fax Number: q E-mail Address: 14%r -v- P > i . L %Y) 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: http:// www. saw. usace.armv. mil/Portals/59/docs/regulatory/reQdocs/ Permits/ SAMPLE AGENT AUTHORIZATION FORM.pdf) Name: Y-�z.1L wi5- Company Affiliation: Mailing Address: 1'\ ,L y Telephone Number: E-mail Address: Fax Number: B. Project Information [15A NCAC 02H .0502(a) Et (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, buildings, retaining walls, docks, impervious surfaces, rip FORM: SSGP 02-2017 Page 1 of 3 Provide three (3) 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, 1617 Mail Service Center, Raleigh, NC 27699-1617. Applicant Information Owner Information: Please provide complete and accurate contact information Agent Information: Per 15A NCAC 02H .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 http://www.saw.usace.army.miI/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTHORIZATION FORM.pdf) Project 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 I tion 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. Z]-10hiotograph of shoreline to be impacted/ disturbed description of property (including location information and [at/long coordinates) and existing features on and near the site Description of project and impacts/ disturbance proposed III. Signature Q',Der 15A NCAC 02H .0502 , 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. Atatilopn Fee lication 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.S. 143-215.3D): ➢ $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 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: i rKOfLt Nearest Town: Si�ACXA ake river/ ocean adjacent to property: Mr -O LA140 Property size (acres): Subdivision name or site address (include phase/lot number): Yklk C'O-TTotS h- Tot \4"Jo2 , OtO ('Vi5PAVI&10 f 0P- &)L PI Directions to site - please include road names and numbers, landmarks, etc.: k_#rn T-A4q S7 TygA LEFT CiAla SY-ILAZy. LJW c?4r C_ugo�ryJ (Lj *_%"I onl" Q16 W°w Ppk°fid7'Y PQM 0'� T1Ii L Latitude (in decimal degrees) qUL o t Longitude (decimal degrees) igS6790 5. Describe the existing land use or condition of the site at the time of this application (residential, undeveloped, etc.): t3t06 0-.PAuf-o 6. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or why it is necessary): R -Ir KiP Q� &40,li W,4i To C<)147*o . ir�_uS�04 7. Will work be conducted from land? `I iS From water? t� o 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: 050 SF 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, excavation, rip rap, retaining walls, etc.) in square feet: ► C' cc S F Temporary impacts (temporary clearing, construction corridor) in square feet: %_� 104, k FORM: SSGP 02-2017 Page 2 of 5 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): Gly �-sS 11. Signature�r� 4-3-1 Owner/Agent's Signature' [15A NCAC 02H .0502(f)1 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 Lake (At Full Pond/ Normal Water Level) ,` 4 L. `- �oAD t' ull Pond/ Normal Water Leve Shoreline �,qP Plan View Level elevation FORM: SSGP 02-2017 Page 3 of 5 'a C- 0 Side View FORM: SSGP 02-2017 Page 4 of 5 Lake (At Full Pond/ Normal Water Level) Existing Dock 30 fl7ft 3ftx 150 ft Below full pond/ NWL Full Pond/ Normal Water Level "'Ihoreone -- _ aft;15oft Riprap Above full pond/ NWL 1 ft. x 150 ft. additional clearing • H necessary EXAMPLE Plan View FORM: SSGP 02-2017 Page 4 of 5 EXAMPLE La ke (At Full Pond/ Normal Water Level) 00 Dock 30ftx7ft Excavated Area 25 ft x 150 ft Full Pond/ Rip Rap • - - 3ftx150ft Normal Water Level - • • - Below full pond/ NWL -urs-=.�_ Shoreline • Rip Rap • 3ftx150ft Cleared Area Above full pond/ NWL 8ftx150ft ' Lot A Existing 5 ft 10 ft / / Proposed Additional clearing 5 f INSTRUCTIONS FOR APPLICATION SSGP307980 08-13 & SUPPORTING DOCUMENTATION Page 3 of 3 FORM: SSGP 02-2017 Page 5 of 5 �, 1 � � , i `�,� ,• , i ' c ti �� ,r`r 9 w+tl+� i j� i�' "� 1 - j' q I r Y� ,"� `yam °°`d •r.� � ''- 1 ;�' ''" ` `'• x' � � `�-` ` I l ,.. ", - ,,.%'��..' _ tY r I /}r f : a Not yl Wr d '... _ y. k �eL r lov,•�;,; max? i i � ��lIII�l�.tIIIAD�Mi1 i►•000/ A06 - 1 i k9m :t7 77 -Ly4, a- 4 n 4 �t �' Hy(,�O LAKEcruises.s� . entertaining times on Hyeo. The fishing is great and Bassett ryiy yak „4 a, . •..x your mate will enjoy the sunset When the sun Collinsville TOUR THE LAKE goes down thins ret quiet. 1f you are still looking Martinsville Blairs South Boston for action, you will find evening cruisers, dock parties Axton W lco>ni( t,> flyco bake where �x-c enjoy henotncna� and people floating at "New Fwater ork City", the hot t Spencer - skrzng, �� iheboaiding, cruising and ishtn with 25 discharge. Whether �:ou choose to live here or just get Dariville ' billion ga ons cif w ater. Sorrc sailors, becu,:�;�° rh;: lake a weekend place, come on in, the water's fine and Alto" „ has reliti� r'y small fingers with rt s abound, there there are memories to be made, Pelham Provii H �e,r Lake �r co are vert% fcgd rc<ts that you can cauh. wind. l_,ucicv for Eden ► nyrnt bs us, I-Irco off `rs tl)e smoothest water around. Wt-elle "GREAT TURKEY BUZZARD" 311 sr to PaYek Rutin , s0111e tamilie� arc producing future professional skiers Wentwortht.�l '� and % ak b{)tf de, s, others are lust building family 1-Tyco. Lake means "great turkey buzzard" and was r:ladison , - Leesburg ..Roxboro > memories ataa� from the hustle. and bustle of city life. ' constructed in the earl 1960's b Carolina Power. S y oan fr,,,=r Reidsville `� lav 1-1 co offs rs a sense. of community, comradeship and - and Li Company (now Duke Energy) as a coolin cooling ,se a common theme of fun-in-the-sun on the lake. reservoir for their. steam electr..- generating plant. Q - ag Timberlake 62 Hurde MiRs The lake covers over 3,750 ac--cis, has 120 miles of is$ ca.� On the drive here, you will find scenic country driving shoreline and has three main tributaries North Hvco Haw River state Park Sc,mmerfietd � �� ` Rougemont hrc,u h the rollinghills of Northern North Carolina. Creek South Nyco Creek and Cobbs Creek. HS-co '�• flak Ridge , sol "Xicc: vou're here, you will find good neighbors that allows permanent boat docks and the owners lease ` Qsz Bohemia become skiing partners and good friends. If skiing or the land below the 420 line from the Person Caswell yarn awn y Greedy ,sr bearding sounds like work to you, there are still mane Lake Authority. _. 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