20190029 Ver 1_Shoreline Stabilization_20190103

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 28
PLAN NO. c 125 PARCEL ID: 34297
STREET ADDRESS: Lake Shore Rd. S Denver NC O 2 9
Please print: Je�,o,�-r ♦ '(�owt�1 A4µT k1
Property owner: I I K
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Michael Wetter of Landcrafters Sitework & Development
(Contractor / Agent) (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):
1—)eRY8—F 15416- 37 7oyy7 Cahw,+..j • ASr43urz.J
Telephone: 703 " (p2 ' Z`i%O VA • 201`{7
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
ji 3'4
46--,
Au riz Signature
Date: / Z - 7-.7 —18
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Authorized Signature
Date:

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'' State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
ENVIRONMENTAL QUALITY FORM' SSGP 02-2017
Shoreline Stabilization Application Form
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
A. Applicant Information [15A NCAC 02H .0502(a)l
1. Owner Information
Name: Merk Homebuilding, LLC
Mailing Address: 5112 Pelican Point Dr. Denver NC 28037
Telephone Number: Fax Number:
E-mail Address:
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:
htta://www.saw.usace.army.mil/Portals/59/docs/regulatory/reizdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.Pdf)
Name: Michael Wetter
Company Affiliation: Landcrafters Sitework & Development
Mailing Address: PO Box 3965 Mooresville NC 28117
Telephone Number: 704-433-9947 Fax Number:
E-mail Address: [e-mail]
B. Project Information [15A NCAC 02H .0502(a) & (b)l
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 Page 1 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: Lincoln Nearest Town: Denver
Lake/ river/ ocean adjacent to property: Norman
Property size (acres): •44 AC
Subdivision name or site address (include phase/lot number):
Westport Subdivision - Lot 28
Directions to site - please include road names and numbers, landmarks, etc.:
NC16 to Fairfield Forest Rd/ R on Fairfield Forest Rd / R onto Barker/ R on Lake Shore Rd./
Property on left
Latitude (in decimal degrees) 35.506076 Longitude (decimal degrees) -80.979609
S. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Vacant Lot
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Stabilization of existing shoreline using rip rap
7. Will work be conducted from land? ® 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:
180 SF
Temporary impacts in square feet:
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:
0 SF
Temporary impacts (temporary clearing, construction corridor) in square feet:
900 SF
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): Natural grass typical of vacant lot
11. Si natur
O er/Agents Signature (1 CAC 02H .0502(f)l 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
(Full Pond/ Normal Water Le
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Shoreline
Plan View
Full Pond/ Normal
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AMPLE
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FORM: SSGP 02-2017 Page 3 of 4

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 a
height ge
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FORM: SSGP 02-2017
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