20181634 Ver 1_Shoreline Stabilization_20181128

State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, S4oreli a§tubi ' tion
Division of Water Resources 01;
M V
Shoreline Stabilization Application Form
20181634
Three copies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center'°
�D
Raleigh, NC 27699-1617 POU 2 2018 E
I. Applicant Information [15A NCAC 02H .0502(a)] DEQ-wATF-3? ,.�
401 &B EER PP
1. Owner Information
Name: Mark Ritter
Mailing Address: 682 Adams Point Drive Garner NC 27529
Telephone Number: 984-2
E-mail Address:
2. Agent/ Contact Person Information
2163 Fax Number: NA
ir41e-r 1,1c>�--7Y_ -, e- , � , A i!1r
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http://www.saw.usace.armV.miI/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:
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

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: McDowell Nearest Town: Marion
Subdivision name or site address (include phase/lot number): The Peninsula Lot 83
51 Whisoerina Pine Trail Nebo NC 28761
Directions to site - please include road names and numbers, landmarks, etc.: JOKIZIP7 mer
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Latitude (in decimal degrees) 35.749943 Longitude (decimal degrees) -8173419
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.):
6. Property size (acres): 1.56 ACRES
7. Lake/ river/ ocean adjacent to property:
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): lGO ✓ �/ .7r~ i 4�A .&/A
9. Will wort be conYucted from land? ❑ From water? [Z4-�
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:
I` X 1-6o, = -4C)Z>
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: 5 %� loo I �-(`fU
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): �% JJ�K�.
e 5 `g n (0'/
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Owner/Ag is Signature* [15A NCAC 02H .0502(f)] Date
'Agent's si nature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

Full Pond/
Normal Water Level
Shoreline
La ke
(At Full Pond/ Normal Water Level)
?e is u 114
0� � R'5
xiv_y�
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

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