20181234 Ver 1_Shoreline Stabilization_20180906

1
Water Resources
ENVIRONMENTAL QUALITY
2 p j g ti 2 3 4 State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 —Water Quality Certification, Shoreline Stabilization
FORM: SSGP 02-2017
SID Shoreline Stabilization Application Form
1h�e co 'res of the application (including attachments) and the application fee should be sent to:
/ If sending via US Postal Service If sending via delivery service (UPS, FedEx, etc.)
Karen Higgins Karen Higgins
DWR- - -
1617 �
Raleigi
A. Applicant h
1. Owner I
Name:
Mailing
i o 4-fto rl)Je A90,0<_
Telephone Number: `309 gfV %2 QL Fax Number: A -VA
E-mail Address: ow vn ku (I Q_Vun'f'n�, I. eem
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.miI/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf)
Name: A -VA
Company Affiliation: A)LA
Mailing Address: Aa
Telephone Number: W/A Fax Number: AMA
E-mail Address: 01A
B. Project Information [15A NCAC 02H .0502(a) & (b
%X! 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.
tZ 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

8. 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: 514tnllev Nearest Town: Alt,r6u-- rLet
Lake/ river/ ocean adjacent to property: 1,.ke- 2'11ef w
Property size (acres):AnroK8:Z j4r•e_s
Subdivision name or site address (include phase/lot number): T &tV 1-C 17'e- 4ES-&-4
ODqq�r,gil if6err�e,�--a81116
Directions to site - please include road names and numbers, landmarks, etc.:
f1 h
I
Me a $e S 1,0e Tri. r760 s e ; s &.7 f1t a rho * f -L-#- aV4-A .-c X640t.
Latitude (in decimal degrees) 56".36ohis Longitude (decimal degrees)
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.):
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, orwhyit is necessary): A re—h is n!eA w fb re-ol'or--o-
7. Will work be conducted from land? r� From water?
8. Total amount of impacts below the normal pool lake level / Normal Water Level
o rL
Permanent impacts (including all excavation, backfill, riip rap, retaining walls, etc.) in square feet: r1
JI Cbi. �54�+ ��t�¢. Qrt>�'.� �eru1� (pQ
Temporary impacts in square feet:
N/►9
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:
71,e- ares. fl'e LZM11 1.5;!(" 614-K11104 r -SI,
Temporary impacts (temporary clearing, construction corridor) in square feet:
U 1A
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): IUo tre eS oc &U6!,
tA ; ll ice_ %0QC- 1}'
Signature
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 02-2017 Page 2 of 4

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
E►'c,le s
AUa z°3i�
Co�stro�f:w, �a rt�a.�
E e.�cJa.,Q.Q
Full Pond/ Normal Water
Shoreline
Plan View
Lake
{At F
K;E-L' 4'�
9V. $4: a.clL
e�Q
(r.$i, kiLe-4 i
�oG4�KilL e� IV,�
"Ut
FORM: SSGP 02-2017 Page 3 of 4

Lake
t Full Pond/ Normal Water
1,61
111.4
I '3` o
Side View
10 ft. bank
Side Vi
0
0
3 ft. below full pond water level 4 ft, above full pond water level 2 ft. additional clearing
if necessary
Existing bank
FORM: SSGP 02-2017 Page 4 of 4

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