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Home My WebLink About20190409 Ver 1_Shoreline Stabilization_20190401State of North Carolina Department of Environment and Natural Resources Division of Water Resources 14,'ater• Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization LNVIRONNENTAL 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 ' 1 I11 A Raleigh, NC 27699-1617 Raleigh, NC 27604 .lL A. Applicant Information (15A NCAC 02H.0502((a)] 1. Owner Information Name: Mailing Address: Telephone Number: a7.S^7 Fax Number: _ E-mail Address: � / e- 2. sIill�� 2. Agent/ Contact Person Information $� $-A 1® — V 1 0 44 08 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: http://www saw usace army mil/Portals/59/docs/regulatory/reedocs/Permits/SAMPLE AGENT AUTHORIZ ATION FORM.pdf) Name: Company Affiliation: Mailing Address: Telephone Number: E-mail Address: Fax Number: B. Project Information 115A NCAC 02H .0502(a) & (b)j 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 props 04where work is to be conducted) County: Nearest Town: 44 ewf Zt, Lake/ river/ ocean adjacent to property: Property size (acres): Z-2 r Subdivision name or site addnclude phase/lot number): A l/e"i^ TCA6,01 Directions to site - please include road etc.: Latitude (in decimal degreesJ&�Longitude (decimal degrees) ��•O�Yy�d S. Describe the existing land use or cond n of theatxhe ti9ne of this application (residential, undeveloped, etc.): �,C 6. Describe proposed work (include 7. Will work be conducted from land? 011*"— From water? ❑ 8. Total amount of impacts below the normal pool lake level / Normal Water Level PermarV impactssjncluding all ex tion, backfill, rip rap, retaining walls, etc.) in square feet: Temporary impacts in sgyAre feet: 9. Total amount of impacts above the normal pool lake level / Normal Wafter Level and 50 feet land -ward Permanent impacts (infiuding back fill, lavation, rip rap, retaining walls, etc.) in square feet: 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 (nyn)ber of treesorj: 11. Signature Owner/Agent's Signature f 15 NCAC 02H .0502(f)1 Date Agent's signature is valid only if an authorization letter from the owner is provided. FORM: SSCP 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 Level Shoreline Plan View FORM: SSGP 02-2017 Lake (At Full Pond/ Normal Water Level) l/ le i Full Pond/ Normal Water let Shoreline 2 h.x150h. ad6tiorul clearing I ' If rucessary Plan View Lake IN NA fund/ wo.rw ware, Lerch Riprap Existing Dock /30 ft a 7 f 3 h.150h 8rbm I -D pad/ NWL Ohhte�150h Above pmd/ NWL Page 3 of 4 �I 3 � a� J Lae o, (At Full Pond/ Normal Water L ) M 'S iv c E `- O O Z Side View LL 10 ft. bank Side Vi 3' G lal.7 `°` 3 IL below full pond water Levet 4 ft. above full pond water level 2 fL adcbdonal clearvC necessary Existing bank !am FORM: SSGP 02-2017 Page 4 of 4 mm -9m C s 3 :f ice_ r t 7 }`moi ,A$ r / { r Wow 0, u+ 0 SnE 50520 WOOD DLXX STRAND LN. DR. MALLARD LN. VICINTY MAP not to scale NOTES - I BOUNDARY PREDICATED ON EXISTING NONUENTATION FOUND IN THE FIELD. 2 AREA COMPUTED BY COORDINATE COMPUTATITM 3 PROPERTY IS NOT LOCATED IN A FLOOD HAZARD AREA ACCORDING TD 'FDD FLOOD MAP . 4 THIS PROPERTY IS IN A COUNTY WHICH REGULATES THE SUBDIVIDING OF LAND. 5 THIS IS A SURVEY AN EXISTING PARCEL OF LAND EIP/CAP (51411 LOT 20 N 16'15'50"E DS 1536/PG 303 LOT 28 25.3r PLAT BOOK 1/PG 191 JOINT OWNERS N 10 43b9"W SEE DB 802/PG 25514'56' qP/CAP (51410) TRACT II SEE DB 1611/PG 442 OP/CAP S 8734 -9'E 10$53' SEA - PARCEL 2 �'S SEA-WALL 2� v LOT 19 o BOAT -HSE J 0.13 ACRES TWO STORY < IL g DOCK CONC. BRICK DWELLINGa LAKE RIS N T1LLE1 EIP/CAP EDUKE NERGY J p PER LOT 18 w DB 802/PG 225 EIP/CAP (51409) PLAT BOOK 1/PG 191 I 1 • �µ 05., .,��rJQp�FS.Si�y�2•f m� a Q SP - E10STING IRON LIN As Deecnbsa Z: o CM -sir NRON Pw i/z�� uzoN REaAR�j 9 ry L-34gi Q Co - MPS - CONCRETE NPs � a>�, -'yp �_: 2 m w — -- — ADJACENT PROPERLY UNE (NOT SURVEYED) � '...•,•,,,,,..• POWERUY WAY UNE�!�BURN�..•`, 4 George W cortify, that Hes C O N E Y A N C E P- A Tsna OF map was drawn Trom an acbapl survey FWPWY OF: ..J A " E ED A A T Z rnado umler ray auperviaom that the tar IN w rte[ TIP. STANLY O0. Nr. error of d�odmes as ovkubted by e.es..t.rP, N 1W CRY OF ALBEMARLE ON WOOD DUCK LN. (PRNATE) gft baud mry Is y Oro' •%`,Lj%A CAR * wm rn m acac Na _ ON W OF RIVER HAVEN afaem broker tines (F1tOM DEEDS AS a SSS! • O '' N aloe I Ps 191 tIEID R®oeOED N and HNr angular error was ._ Off; .. 1611 Pip 442 - Ora# OF INE nOpb7FR of oEi�s Q 9 Pale �COTT St STEAWR =Vsum 1' 40' peg JAN. 22, 2018 O? -3491 says: N FWr 20 0 40 tD SIMPSON SURVEYING �suoi , ' P.OT. . BOX 1413 L-34N7I ratotsaas c910> E220C 4000 27306 Imd FILE 1 WDUCK50.DVG