20190028 Ver 1_Shoreline Stabilization_20190103

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Water Resources 15A NCAC 02H .0500 -Water Quality Certification, Shoreline Stabilizatiorl
E.IV I ROW' EN r A LOUnL IT r FORM: SSGP 02-204ID
Shoreline Stabilization Application Form 2 0 1 9 0 0 2 8
Three copies 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 - 401 & Buffer Permitting Branch DWR - 401 & Buffer Permitting Branch
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC 27699-1617 Raleigh, NC 27604 J_
A. Applicant Information [15A NCAC 02H .0502(a)] ` ✓%��
1. Owner Information
Name: (c r 54iWnA4-n S
Mailing Address: Szvr ter`
IiIL�Gv�Uj if.� ZB� DZ
Telephone Number: 7- Soy - 7�7`i� Fax Number:
E-mail Address: Vnew i 01) & 4/0-1)/"'o
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:
httr)://www.saw.usace.armv.mil/Portals/59/docs/reRulatory/reRdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM. df)
Name: IYLT)4i If�r3?is7�c-
Company Affiliation: G✓ STT i .)EJ
J
Mailing Address: _7".S (/%`dvt 64y 5F
ltlG/CiiL/ jig[
Telephone Number: f Z6 -3i7 - 2 3-1 Fax Number: 9ZS - �7 49V�
'f 1
E-mail Address: �' S� �tSs : afc•s ir�c L4rN
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 Pagel of 3

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: gyg' �&' Nearest Town: t�461.203;C-
Lake/ river/ ocean adjacent to property: 10&'t / ir/7a�dlrsf
Property size (acres): /, 2¢ o=fu'
Subdivision name or site address (include phase/lot number): f'VX1')1✓IS;—
It) L �-g
Directions to site - please include road names and numbers, landmarks, etc.: sr C'11h
vd 6W/
eh
ftt i 7vT f L e^1� /Ll�y l /�,� I;wy �, -/ 6.�f
i%G 07• At � T�� cYr �t�i �ir%'y � )V.Z �
Latitude (in decimal degrees) 7W,89 Longitude (decimal degrees) — �'/ 67//M
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, or why it is necessary): &,'Ol`5z Ivo �S.s�tfCin �-
7. Will work be conducted from land? P From water? ❑
8. Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent impacts (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
/ Zo s� 1611i/- 12j4p
Temporary impacts in square feet:
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:
34'6
Temporary impacts (temporary clearing, construction corridor) in square feet:
�Sc� Sf C'c'7'l S'/ vwC •�ti- C� G �L.2r t�Jc"y'
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):
%7*/- N n ZJ 600t Ir
11. Signatur
Owner/A is 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 i ava1 aipvitinn
Full Pond/ Normal Water Lei
m. » 1® Iii IMI
Shoreline
Plan View
J
Ai: r'l� ; rc~GC C�ytitt
I
FORM: SSGP 02-2017 Page 3 of 4
Lake
JAI: Full Pond/ Normal Water Leveq
ming Dock
-
30 ha7h -
3 ft x 150 Ft
Full Pond/ Normal Water Level
Below full pond/ NWL
7horeTne
Ripra p
4 ft x Iso N
2ft. a150 f1
Above full pond/ N WL
addlrional clearing
'if necessary
E
AMP
E
Plan View
FORM: SSGP 02-2017 Page 3 of 4

t � r u
3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing
If necessary
Existing bank
10 ft. bank
IjA
FORM: SSGP 02-2017
Page 4 of 4

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DEESCC+R�IPTION:
LOT NO. . � b PLAN NO. PARCEL ID:
STREET ADDRESS: 10-7 14W, -eve eymvCZG y
rLc01je tit Zi3(vrZ
Please print:
Property Owner.
Property Owner:
1,11,424 ac -C
444 t -v 5'kw w►c'v -C
The undersigned, registered property owners of the above noted property, do hereby authorize
(Contractor / ent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, Issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
9 314 Gyaad-"& 7. e, 131 W, HJ*.r w Cr',L . z 3'/78'
Telephone:
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Autivrized Signature
Date: / q &P"—' % '5
hi rized Signature
Date: I!q 1= - '

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BEACON
RIDGE DRIVE
' L. K11: RIIODMS's
40
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/� I< MAIN FLOOR 1
JBASEMENT ",
/ SEPTIC REPAIR AREA \
/ TOO.�VV 1058
BOSW 1052
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SO1N %V/ 10801054
— TO 1062
1056
TOW/ri1LOv66
SEPTIC FIELD\ BO 1059
\BOW 1062 e0
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\ N W 104
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BOW yy068 /
TO 1076 C
831072 /\
T61.7
Br 1076
TOW 1040
BOW 1030
TOW 1042
BOW 1038
TOW 1046
BOW 1038
ipq"�' eu- Pz1 —
TOW 1048
BOW 1042
TOW 1046
BOW 1036
GRADING & DRAINAGE PLAN
SCALE: 1'=20'
Pf r a to --v
Q NOTES THIS SHEET:
1. ALL PRECAST DRAINAGE STRUCTURES SHALL MEET MATERIAL REQUIREMENTS OF
ASTM C789 AND C850, LATEST REVISIONS.
2. ALL PRECAST DRAINAGE STRUCTURES SHALL BE INSTALLED IN ACCORDANCE WITH
AASHITO DMSKIN 11 SECTION 27, AND MANUFACTURERS SPECIFICATIONS.
S. THE PRECAST SUPPLIER/MANUFACTURER SHALL BE RESPONSIBLE FOR THE
STRUCTURAL DESIGN OF THE STRUCTURE. GENERAL CONTRACTOR IS
RESPONSIBLE FOR PROVIDING SHOP DRAWINGS AND DESIGN CALCULATIONS,
SUIGNED AND TO THE ENGBYA UCENSED STRUCTURAL ENGINEER) FROM THE
4. DRAINAGE STRUCTURES SHALL BE CONSTRUCTED IN ACCORDANCE WITH THE
CURRENT NORTH CAROLINA DEPARTMENT OF HIGHWAYS AND TRANSPORTATION
DESIGN STANDARDS.
5. UNDERGROUND FACILITIES, STRUCTURES AND UTILITIES HAVE BEEN PLOTTED
FROM AVAILABLE SURVEYS AND RECORDS, AND THEREFORE THEIR LOCATION
MUST BE CONSIDERED APPROXIMATE ONLY. THERE MAY BE OTHERS, THE
EXISTENCE OF WHICH IS PRESENTLY NOT KNOWN. CONTRACTOR SHALL VERIFY
LOCATION OF ALL UTILITIES AT .HIS OWN INITIATIVE AND EXPENSE.
B. THE CONTRACTOR SHALL COORDINATE FINISHED PAVEMENT GRADES WITH
ELEVATIONS AND LOCATIONS OF EXISTING ROADS AND STREETS.
7. NO WORK SHALL COMMENCE ON SITE UNTIL A LAND DISTURBING PERMIT IS
ISSUED BY THE APPROPRIATE AGENCY.
8. LENGTHS OF LINES INDICATED ON THE DRAWING FOR UTILITY SYSTEMS ARE
APPROXIMATE ONLY. IT SHALL BE THE CONTRACTOR'S RESPONSIBILITY FOR
DETERMINING THE EXACT AMOUNT OF PIPING REQUIRED TO FURNISH A
COMPLETE WORKING SYSTEM IN ACCORDANCE WITH THE INTENT OF THE
DRAWINGS.
9. DIMENSIONS AND COORDINATES SHOWN AT CURB ARE TO FACE OF CURB.
COORDINATES SHOWN AT CURB INLETS ARE AT CENTER OF CURB INLET. SPOT
ELEVATIONS SHOWN AT CURB INLETS ARE AT TOP OF CURB. SPOT ELEVATIONS
SHOWN ON DROP INLETS ARE AT TOP OF INLETS.
10. FINISH CONTOURS SHOWN ARE TO TOP OF TOPSOIL, TOP OF PAVEMENT, TOP OF
SIDEWALK, ETC. CONTRACTOR SHALL PROVIDE GRADE TO SUBGRADE ELEVATION
REQUIRED. PAVEMENT SECTIONS AND SIDEWALK SECTIONS ARE PROVIDED FOR
REFERENCE ONLY.
11. PROVIDE POSITIVE DRAINAGE AT ALL GRADED AREAS. PROVIDE UNIFORM
(STRAIGHT) GRADE BETWEEN SPOT ELEVATIONS, FINISH CONTOURS, TOP OF
INLETS, ETC.
12. FOR CONTINUATION OF ROOF DRAINAGE SEE SHEET P1.04
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