20180673 Ver 1_Shoreline Stabilization_20180517

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 apall
should be sent to:
If sending via US Postal Service nding via delivery service (UPS, dEx, 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 Informa
Name:
Mailing Address:
Telephone Number:
E-mail Address:
CTlq— iiuto
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/regdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf)
Name: r= 2 n M rwi n
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Fax Number:
B. 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, 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.
FORM: SSGP 02-2017 Page 1 of 3
$1

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: D vc,py-\ Nearest Town:
Lake/ river/ ocean adjacent to property:1�
Property size (acres): 0 Q 0,0 &"�)
Subdivision name or site address (include phase/lot number): ll-�k 1 heti
Directions to site - please include road names and numbers, landmarks, etc.:
Latitude (in decimal degrees)
Longitude (decimal degrees) ?
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): ?-1 w. I z e _ .Ovy1e
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): e T>eC-M'A- Y"Q,-AQA . f'�
i �, f �M
7. Will work be conducted from land? u."-5, From water? ❑
8. Total amount of impacts below the normal pool lake level / Normal Water Level
(►� "RJ 46
Permanent impacts(includ}iing all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
Temporary impacts in square feet:
9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet
land -ward
nt impacts (including back fill, excavation, rip rap, retaining walls, etc.) in square flet:
.a 1. •V;< Z A. Z``i u.J
4-
Temporary impacts) (temporary clearing, construction corridor) in square feet: � area` rQE*
-�►,r_ t;� a0 4,'� ---L)' rr"at-k, t 4o (,v" were_ J?gLr� a-
::�_ � -Vo-� A'a Ca" -W -eA kak�_ aAAk'bt41A , 1
10. Please describe the vegetation above the normal pool lake level/ Normal Water Level and 50
feet landward to bye ' pacted (number of trees, for instance):
-� we►-ao 5m4(lar -Nw,� '' �ex--Q.grewwJe�d + s- wy
11. Sign re Ned Ictk� c/
Ow gent's Signature* [15A NCAC 02H .O502(f)) Date
`Agent's signature is valid only if an authorization letter from the owner is provided.
ttske-.s
Ae. SO'fmark
t -
FORM: SSGP 02-2017 Page 2 of 4

NOT FOR LEGAL USE
Legend
E-911 Addresses
Easements
— Conservation
-- Easement
Utility
+ — All Other
300
5/14/2018 NOT FOR LEGAL USE
N
A
Feet
0 30 60 90 120
0 0.006 0.012 0.018 0.024
Miles

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
Full Pond/ Normal Water
Shoreline
Plan View
Lake
(At Full Pond/ Normal Water Level)
Lake
(At Full Pond/ Normal Water Level)
Existing Dock
30 ftx7ft
' 3fta150h
Below full pond/ NW,
Full Pond/ Normal Water Level _
�horeiIne
4ftXi50ft
Riprap Above full pond/ NWL
2 ft. z 150 ft.
adTtional clearing
if necessary
Plan eWE�CAMPI�E
FORM: SSGP 02-2017 Page 3 of 4

FORM: SSGP 02-2017 Page 4 of 4

N U I F U K L t G A L U J t
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oncard ChurcA
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Legend
Town -36K
CountyBoundary_Line-36K
County
Town sh ips_36K
• Fac it ity SitePoi nt-36 K
<all other values>
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OTrv�ii;
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Person County GIS, NCDOT, Person County GIS, City of Roxboro
5/11/1U16 NU I F UK LLt3A L USt
N
A
Feet
0 2,200 4,400 6,600 8,800
0 0.4 0.8 1.2 1.6
Miles

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Gmail - 164 Heron Cove Drive in Leasburg, NC - Hyco Lake Bank Stabilization - James ... Page 1 of 1
G("n ' James Freeland <[e-mail]>
164 Heron Cove Drive in Leasburg, NC - Hyco Lake Bank Stabilization -
James Freeland
1 message
Sullivan, Roscoe L III CIV (US) <Roscoe. L. [e-mail]. mil> Wed, May 16, 2018 at
12:55 PM
To: James Freeland <[e-mail]>
Cc: "Goss, Stephanie" <[e-mail]>
Mr. Freeland,
Thank you for the information you submitted regarding shoreline stabilization on Hyco Lake at the above
referenced property. Your activity, described as rip rap stabilization of approximately 300 linear feet of
shoreline, fits the description of Department of Army, Wilmington District, Corps of Engineers General
Permit 198200030 (GP 30) as long as the work was done in compliance with GP 30 Special Conditions
and General Conditions.
Note, however, that you must also receive approval from the NC Division of Water Resources (NCDWR).
Please see the Shoreline Stabilization Form and Help Document (updated September 2013) at the
following NCDWR website:
http://deq. nc.gov/about/divisions/water-resources/water-resources-permits/wastewater-branch/401-
wetlands-buffer-permits/401-application-forms-help-documents
Stephanie Goss (cc'd above) is currently the appropriate NCDWR contact for those requirements. Her
phone number is 919-791-4200.
If you have any questions related to Corps of Engineers requirements please let me know. Thank you for
your time and coordination.
Sincerely,
Ross
Ross Sullivan, PWS, ISA Certified Arborist
Regulatory Specialist
Raleigh Regulatory Field Office
U.S. Army Corps of Engineers - Wilmington District
Wake Forest, North Carolina 27587
Office #: 919-554-4884. Ext. 25
Email: [e-mail]
We would appreciate your feedback on how we are performing our duties. Our automated Customer
Service Survey is located at: http://corpsmapu.usace.army.mil/cm_apex/f?p=136:4:0
Thank you for taking the time to visit this site and complete the survey.
n RGP30-2016-12-23.pdf
761 K
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