20190362 Ver 1_Shoreline Stabilization_20190320

State of North Carolina
DW
Depprtment of Environment and Natural Resources
Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee oPA1
15
to:
Division of Water Resources
401 & Buffer Permitting Unit 2 0 1 90 3 62
1617 Mail Service Center
Raleigh, NC 27699-1617 ��'�41 \r�
1. Applicant Information [15A NCAC 02H .0502(a)] Ax
1. Owner Information
Name: �A ��_r SA1-1S &u- Y I LUST
Mailing Address: I 061 cr'r'a/� Eb!�( di i�JT L rJ
f1i
Telephone Numbea CvuFax Number:
E-mail Address: -L_Shd,� (°✓ 0, � 0) 6 Mel r'z AA
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http://www.saw.usace.army mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: 'Q1I-v:1n "VI, Ai A.1 I i I NP / ' i /-4,A,- i -TW,
Company Affiliation:
Mailing Address:
M be, i,'/ / k N C: -JE )17
Telephone Numbc:"7L�'7.5 �� ? Fax Number:
E-mail Address: r- w C-C,y
Person to receive the Certification pproval:
II. Project Information [15A NCAC 02H .0502(a) & (b)]
I. 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.
I 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: 'C It G Nearest Town: (!Ofj l FLY LZS
Subdivision name or site address (include phase/lot number): U)% it
`l S Ek Lf I fin au 7 -
Directions
Directions to site - please include road names and numbers, landmarks, etc.:
Latitude (in decimal degrees) S 9 (f jo -7 el y Longitude (decimal degrees)— 'j Q , 3 T
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.):
6. Property size (acres):
7. Lake/ river/ ocean adjacent to property: N b" A-nl l c.(-%2tiJn /.(
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why ,why it is In-�ecessary): p I� 'N
T� S f''a►rCl,rit; b v'J
9. Will work be conducted from land? ❑ From water? ®�� �L ,� LOX)
G�z
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etcf
below the normal pool lake level/ Normal Water Level in square feet or acres:
-C�_VAIL
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:
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):
ignature* ( A NCAC 02H .0502(f►j Date
'Age'�Oionatur, is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013
Page 2 of 3

Full Pony
Normal W'atte
Shorelin
La ke
(At Full Pond/ Normal Water Level)
V
s
N-0 12L=M&VQ)
1 �-tA-L DISruP L-2-A�i
T
) N 6- L, ON 67 Z i t
e,WA-r6C_ Q- b a- C
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
I 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

Project Name/address: °I ��,, ,� f L/%J
/Co nty:A LC k_L-€i (PC
Owner IC.r SA;t✓ i '" (,(2 �� ;�. -
Print -�
Contractor/agent:
Print /
Signature
application is a violation of the Buffer Rule. Site specific work should be provided in
The approval is for the purpose and design described in your application. Impacts not indicated in the
the
02H .0506 and 15A NCAC 02B .0243(8)] application. [15A NCAC
Trees are not allowed to be removed from Zone 1 of the Buffer (within 30 ft of the full pond elevation), unless
approved. Exception, those trees that are severely undermined along the immediate shoreline can be removed.
Minimal shaping and sloping along the immediate shoreline is allowed. 115A NCAC 02B.0243(6)]
Benching, grading in the buffer is not allowed. Excessive disturbance of ground cover. [15A NCAC 02B.0243 (6)]
Beaches, impervious patios, impervious walkways, etc. are not allowed in the buffer unless specifically approved
by the Division. There are limitation on size for decks. [15A NCAC 02B.0243(4) and (6)]
Work to be conducted from land must indicate an access and indicate any trees that are to be removed. The
work corridor should be described. The approved access corridor shall be restored. Staging, spoil, construction
material must be outside the buffer. [15A NCAC 02H .0502 and 15A NCAC 02B .0243 (4), (6), (8)]
Stormwater cannot be piped or channeled for direct discharge to the lake. All constructed stormwater
discharges must be at the natural elevation and discharged prior to entering the buffer directed as diffuse or
sheet flow at non-erosive velocities to the lake. USA NCAC 02B .0243(5), (6)]
Acknowledgement of Notification
hereby state that I have been informed of
the Riparian Buffer Rule. Any work conducted in the buffer, not specifically stated in theapplication aand appr
by the Division of Water Resources (DWR), is a violation and subject to enforcement. Due diligence will beoved
taken such that the construction will be built within substantial compliance and intent of the 401 Water
Quality Certification and Buffer Rules, the a .peed pll n(s) and specification (s), and other supporting
materials. //

I _ ►/1 Ir.G SA -Li Sia to?q r e a 7 , GIVE
LAKE NORMAN DREDGING INC. AUTHORIZATION TO OBTAIN THE NECESSARY
INFORMATION FOR STABILIZATION AND DREDGED PERMITS.
DATE: 3+ �j 1 �

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From TAMARA HAGER [e-mail]
Subject Janice Salisbury pits
Date Mar 7, 2019 at 12:22:26 PM
To TAMARA HAGERager(«)lakepermit.com

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Marshall Steam Station to 5156 Glenwood St, Drive 4.9 miles, 9 min
Go, gle Maps Sherrills Ford, NC 28673
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Map data @2019 Google 1 mi
Marshall Steam Station
8320 NC -150, Sherrills Ford, NC 28673
t 1. Head south toward NC -150 E
0.2 mi
ro. 2. Turn right onto NC -150 W
1.7 mi
41 3. Turn left onto Slanting Bridge Rd 2.0 mi
-*1 4. Turn left onto Keistlers Store Road
0.3 mi
,*1 5. Turn left onto Mountain Shore Dr
0.4 mi
*1 6. Turn left onto Glenwood St
f)Destination will be on the right
0.2 mi
5156 Glenwood St
Sherrills Ford, NC 28673
These directions are for planning purposes only.
You may find that construction projects, traffic,