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Home My WebLink About20190279 Ver 1_Shoreline Stabilization_20190304SAMPLE AGENT AUTHORIZATION FORM PROPERTY LEGAL DESCRIPTION: r � I ass • • • • ' ► ►_ - -` .AL Please print: Property Owner: Property Owner: Rze sk-e-OLO-U-CP 2 0 1 go 2 T 9 The undersigned, registered property owners of the above noted property, do hereby authorize (Contractor gen (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): Telephone: 2D `( L, S ( - 30 ? ( We hereby certify the above information submitted in this application is true and accurate to the best of our knowledge. Authorized Signature Authorized Signature Date: /��' Date:�1 �C�i N 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 LNVIRONMLN I AL OUAL!IY 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 (]5A NCAC 02H 0502(a)I Owner Information Name: (i/r dA iZ,)bpi s4e/�11e.� Mailing Address: —3 l c1 S- �� (_g ,� A)e , Alc-Z k 3'-L) Telephone Number: 70 ci- GSI - 3021 Fax Number: E-mail Address: 2. ggent/ Contact Person Information VA 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: http://www.saw.usace army mil/Portals/59fdocs/regulatoryZregdocs/Permits/SAMPLE AGENT AUTHORIZ ATION FORM.pdf) t Name: 4 •t') l" Company Affiliation: fir, F'If k'+-� ` -e-- � C.` Mailing Address: 09 W 6A-If-4c,,,1�,.4_ A.,,e- Telephone Number: ?-�` � - Fax Number: E-mail Address: 1-4 lid', 62 /V 7tC vn -+,17`-t e --- B. ,roject 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 Page 1 of 3 V3. 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�� Nearest Town7L-rc \� Lake/ river/ ocean adjacent to property: Property size (acres): 'r�� o d s Subdivision name or site ddress (include phase/lot number): _ M Directions t s to -pleas' einclude road names and numbers, landmarks, etc.: Latitude (in decimal degrees'"\ Longitude (decimal degrees)' 5. Describe the existing land use or condition of the site at the time of this application (residential, undeveloped, etc.): —CL -1-0 r a eK tib 6. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or why it is necessary): j'ke,,<- 0 P_eg&,, &e 12Ae �,,{ �,,�g,)d„ s G✓ L /% o.. Win _ '{SCJ�,v,S r ' G(SSt 6� (Ztl1 ILV r 7. Will work be conducted from land? [L� From water? USJ. 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: �(sz s 3 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 a14 sI;- moi excavation, rip rap, retaining walls, etc.) in square feet: 2Y —C_(ssr 1 Temporary impacts (temporary clearing, construction corridor) in square feet: 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): A/,a '7 -rt r S C s s A 11 Signature O er/Agent's S' re' [15A NCAC 0211 0502(f)1 Date Agent's sig ture 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 Pxravarinn nr ,4,-,4–;-- -1- - -- 4—sttrs LJCIVVN Me rule rona/ Normal Water Level elevation La ke (At Full Pond/ Normal Water Level) Full Pond/ Normal Water Level Shoreline_.(6p- Plan View Full pond/ Normal Water Leo .— -- �Zene` 2ft x150 h. additk.W nearing • if necessary Plan View Lake (At FWI pad! NanWi Wafer 1-1I Riprap Existing Dock 30 it. l Y. 3 h: 150 h aebw MI voted/ NWL 7-4h7l50Ta" xh Above"pad/ NWL AMPLE FORM: SSGP 02-2017 Page 3 of 4 I (At Full Pond/ Side View 3 ft. below full pond water level Existing bank 10 ft. bank 4 ft. above full pond water level Z ft. additional clearing *If necessary +wlaw N-��M[ mA— r.•. FORM: SSGP 02-2017 Page 4 of 4 tv '�'iAOV iV7' A wl n IIA M vm 1 0 , TA t 2/25/2019 Go gle Maps 8526 Burley St The Boat Rack Fence It Q Terrell Baptist Chwch 1 -all No*mm, p Touchtess Boat Covers `I M Iro 8526 Burley St - Google Maps 0 Mountain Creek Marina D �9M y l,. �oBoat Rack Manna "O,v —a 0 ' Shoreline Construction 18526 Burley Street Association P e ) Management Solutions laris Stean, M;iy (:,crk Mountain Creek Go gle Mager Creek lake Norman Electric Q < 1•J Map data ©2019 Google 1000 ft t r 8526 Burley St Terrell, NC 28682 IV You visited 2 months ago https://www.google.comlmaps/placel8526+Burley+St,+Terrell,+NC+28682/@35.5675677,-80.9786405,15ztdata=!4m5!3m4! 1 sOx8856ad47d82f b625:Ox5e29fe63dd5... 1/1