20190010 Ver 1_Shoreline Stabilization_20181228

State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water os® Imi
15A NCAC 02H.0500 — Water Quality Certification, Shoreline S ization
Division of Water Resources FORM: SSGP 10-2013��!
Shoreline Stabilization Application Form 2 0 1 9 0 0 1 0
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
Raleigh, NC 27699-1617 �S
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information _
Name: / M ci i HY 7 ►::�q JJ I<-'—
Mailing
<
Mailing Address:
E R--7-L.i< v c. hH'E,
s-.2- L U
Telephone Number: en7P ­42_� -ZZy`j Fax Number:
E-mail Address: 44 1,,, -OS2-7C \/aitc;oyc-c
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
httn://www.saw.usace.armv.mil/Portals/59/docs/reRulatory/re2docs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: N '2:/J Y J F--X5--,4tj
Company Affiliation:
Mailing Address: /2 L- nT /-'arc
` —A 1L4
Telephone Number: 6-76-42 j-_2 Zy_ Fax Number: —
E-mail Address: 4rcA,rd:�,,Q57Z7 6L VcA oc>>. o c m
Person to receive the Certification Approval:
II. Project Information [15A NCAC 02H,0502a) &_(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 ofd property (where work is to be conducted) /1
County: . Nearest Town:
Subdivision name or site address (include phase/lot number): S)R vN,
231- W Y51 �E1ANr u CUWmN C, IIC 2-2723 �o7 / 9 d1VT7 1
Directions to site - please include road names and numbers, landmarks, etc.:
/Yo2rH A/c z7ou kb -ha A o� > a C) } J _to G_kE us,ya,eE D2
v
'2--3:1 WAy s )� LA "E_
Latitude (in decimal degrees) 316 • 14MUOZ 6 Longitude (decimal degrees) 00 0 /13O�
5. Describe the existing land use or condition of the site attthe time of this application
(residential, undeveloped, etc.): r" _ 5� ��;i 'Qr .yEf�ooe'd
6. Property size (acres): !. -1 �
7. Lake/ river/ ocean adjacent to property: AKC GLENV/L/_L-"
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): ►Se m m v E z �t� h i 4 k �'%c � Sean 5e0VU-1
16-V FiirEg- Wr-AyE 7W
9. Will work be conducted from land? From water? ❑
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:
/0 M TooneS iN,'I( �,e_ r'emve-A '+ r\ %P)Iar'ZJ I e"A Orlc_
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: %7'Z X2.25 - zzs"N -A, 5,�cu P -r—' Ma6ii
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): tn o r aSS
24c* e 5 Av I,,a 41'Orm sa, / SOr.
Winer/Agent's Sign
Agent's signature is t
Date
only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

Full Pond/
Normal Water Level
Shoreline
-1 {� 9,c— WL e. 14 —e 7Q 0
F« Eric
5itt:�rZ9 �1 A se—
La ke
(At Full Pond/ Normal Water Level)
cC'.)
�)— 2-5' -
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ftx 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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Full Pond/
Normal Water Level
Shoreline
[--1 )19V- Woe;,
Lake
(At Full Pond/ Normal Water Level)
Please approximately sketch the following information on this plan (provide dimensions foreach
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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