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Home My WebLink About20181481 Ver 1_Shoreline Stabilization_20181029State of North Carolina Department of Environment and Natural Resources DWR Division of Water Resources Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization FORM: SSGP 10-2013 Shoreline Stabilization Application Form Three copies of the application (including attachments) and the application fee should be sent to: � &A Division of Water Resources 401 & Buffer Permitting Unit 1617 Mail Service Center Raleigh, NC 27699-1617 2 0 1 8 1 4 8 1 Applicant Information [15A NCAC 02H .0502(a)] 1. Owner Information Name: Q -t- 144(-, Mailing Address: 20 11 g DAAt<:�,S ,c_ ikIDC E D2 Co2NE'[ I US � ZOO ) OCTR 9 12 0 W RE 2 s 201e 10 Telephone Number: Fax Number: E-mail Address: .5,11k Ll ` . Cb (V1_1 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: Company Affiliation: Mailing Address: Telephone Number: Fax Number: E-mail Address: Person to receive the Certification Approval: _ If. 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 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:Mf C4=L&11,jRU,2c, Nearest Town: Co a-fV EL.► US Subdivision name or site address (include phase/lot number): CiZow- 14(i(30 L Directions to site - please include road names and numbers, landmarks, etc.: Cx1'i zTS o GQ l,ieXS�r -r(-> -T'bCzn*--krE Crirto4gF-L 2-5 )QS _0i) TW k.E A a -144-y o S[�+�n�� A7r �'Ca� ! L� o n CW->LAJA t Latitude (in decimal degrees) 3S°Z9� StiF 000 --Ti+ Longitude (decimal degrees) aQ 52� `tZ' 1N eS'� 5. Describe the existing land use or condition of the site at the time of this application (residential, undeveloped, etc.): (Lc;;Fs , de„ Air- I ;Sus -y- rvgZgb -B &2cAce 6. Property size (acres): 7. Lake/ river/ ocean adjacent to property: I_fV 4g5- t�i(5a-ryNA ) 8. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or why it is necessary): :J� t o6T ism E `21 A 2 -ft -P i tj T+k e su PJ f sd m � fb 1� ► tV 5f kpt,�cPS 9. Will work be conducted from land? From water? ❑ F)s 6CP0y%.'t 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- W, c-'--- PCS'- 'isoSA) n Li244374- to _�,pr-Pk+J%n % c saNy QQPLPC4e AOCA`-, 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: "0AJla 1 -un PI*c-jUe- S7ov) 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): No n t=7 ZZZ(, /W Owner/Agent's Signature` [15A NCAC 02H .0502(f)] id J2 Z- /?..GI � Date `Agent's signature is valid only if an authorization letter from the owner is provided. FORM: SSGP 10-2013 Page 2 of 3 La ke (At Full Pond/Normal Water Level) Full Pond/ Normal Water Level ''''' Shoreline 36 �- 30 cz: QIP cL Ip 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. Location of construction access corridors FORM: SSGP 10-2013 Page 3 of 3 2,P RA -e V P rOYL- I t-\ 1e" 1 f 444,&- WA%f&�s C -2L —IL-1 ►u' -t J -PsF,--P ..!ip -r*4 ► s A c1 ac'-' n'0 &f%i 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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