The URL can be used to link to this page

Home My WebLink About20190408 Ver 1_Shoreline Stabilization_20190401State 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 r9��® Raleigh, NC 27699-1617 Raleigh, NC 27604 �tL' i� A. Applicant Information 115A NCAC 02H .0502(a)I 1. Owner Name: Mailing Telephone Number: 4�Z,?%/S/�,? Fax Number: E-mail Address: 2. Agent/ Contact Person Information WOW 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/regdocs/Permits/SAMPLE AGENT AUTHORIZ ATION FORM.pdf) Name: Company Affiliation: Mailing Address: Telephone Number: Fax Number: E-mail Address: 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 Page 1 of 3 �J 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 here work is to be conducted) County: 112Z Nearest Town: AWG Lake/ river/ ocean adjacent to property: Property size (acres): Subdivision name or si70/7077': (includ/_ase/i umber): Directions to site - please inciu "d name§Ahofimbers, landmarks, etc.: Latitude (in decimal degrees)2S a Longitude (decimal degrees) YO G/ 5. Describe the existing land use or condi . n of th at the time of this application (residential, undeveloped, etc.): r " 6. Describe proposed work (include or vbv it is IF 1 7. Will work be conducted from land? how hardening of shoreline has been From water? ❑ 8. Total amount of impacts (below the normal pool lake level / Normal Water Level Permanent inlpacts_Oncluding all excavation, backfill, rip rap, retaining walls, etc.) in square feet: Temporary impacts insquare feet: 9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet land -ward Permanent impacts (incitiding back fill, excavation, rip rap, retaining walls, etc.) in square feet: Temporary imp4ets (temporary clearing, construction corridor) in square feet: 10. Please describe the vegetation above the normal pool lake level/ NoTial Water Lyvqand 50 feet landward to be impacted (nWhber of trees, pr instance): 11. Signature Owner/Agent's Signature (15A NCAC 02H .0502(fll Date Agent's signature is valid only if an authorization letter from the owner is provided. FORM: SSCP 02-2017 Page 2 of 4 f 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 Lake (At Full Pond/ Normal Water Level) Full Pond/ Normal Water Level OW111111Mi s Shoreline Plan View FORM: SSGP 02-2017 Lake lac F,d1 Pad! Normal Nacer Level) Existing Dock 30 hath 3 ft. ISO ft 8elav U Pad! M'OL Full Pond/ Normal Water Level v- Shoreline » aha 158ft Riprap above its P.% NM 2It. z IW ft addband cleaft �y I b necessary �„� E AMPLE Plan View Page 3 of 4 (At Ful 1 Y / . Lake Il No mal wa m � c �T E Z Ln Side View0 U - 10 ft. bank Side Vi FORM: SSCP 02-2017 3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing if necessary Existing bank AMPLE Page 4 of 4 LAIC SHORE 0R. NOTES, 1 BOUNDARY PREDICATED ON EXISTING BERRY HILL DR. MONUMENTATION FOUND IN THE FIELD. 2 AREA COMPUTED BY COORDINATE COMPUTATION, SITE 3 PROPERTY IS NOT LOCATED IN A FLOOD HAZARD AREA. BERRY HILL DR. 4 THIS PROPERTY IS IN A COUNTY WHICH VICINTY MAP REGULATES THE SUBDIVIDING OF LAND. not to scale 5 THIS IS A SURVEY OF AN EXISTING PARCEL OF LAND. LEGEND: • EIP — EMITING IRON PW (As Described) O SIP — SET IRON PIN (1/2' IRON REBAR) CM — CONCRETE MONUMENT NPS — NO POINT SEr PROPERTY IJNE --- ADJACENT PROPERTY UNE (NOT SURVEYED) -- RIGHT OF WAY POWER UNE I, George W. Simpson, certify that this map was drown from an actual survey S = T E P I— A IV Y OF made under my supervision, that the�y�' �9'r T Lsr� PROPERTY OF ; C _ _ L_ I T T I E error of closure as calculated by �,'�r'e LOT IN NORWOOD T1rp., STANLY Ca, NC q4��'-�N latitudes and do ppaortures is 1:10.000+• ��•,.•• •••„ �� e, that the boundahes not surveyed are •., N THE ORy OF NORWOOD ON BERRY HILL DRIVE 50' R/W �+ FSS / shown as broken lines, and tfie angd®r�?•QO Off, •. �. ! Q NOUSE N0. IN BLOCK ►q. _ ON MPP OF TILLERY BEACH error was seconds per tum.:Z).' '.�9 MAP RECOMFD IN BOOK 1 . PG 214 . DEED RECORDED IN m ; SEAL ; 2= o L-3497 = O; SURVE,r FOR:W E S J O Y" E R -�yy F �= F \ LOT 536 \ __ 4Fl. � >. URNS •�` SIP \ p q \ 8604 Nd, L-3491 v1 4 Prafeewonal Surv%vr 191 O> 2 Z O— •4 O O O \ a g1'ly ,g5 DUKE ENERGY \ Lt ERE F 4 1/2" IRON ROD LOT 535 0 \ tip- Cao [� CP&L PIPE moo' �R`Oool \ LAKE TILLERY a `� '° A. •9 -o_ o. \ C q ��` r`flci y� h•Vv . � � LOT 534 P CPe1rL PIPE oo s� 0.14 ACRES DB 1108/PG 696 Ok \ \ � g9• 9,py S� \ 1/2 -IRON ROD LOT 533 \ LEGEND: • EIP — EMITING IRON PW (As Described) O SIP — SET IRON PIN (1/2' IRON REBAR) CM — CONCRETE MONUMENT NPS — NO POINT SEr PROPERTY IJNE --- ADJACENT PROPERTY UNE (NOT SURVEYED) -- RIGHT OF WAY POWER UNE I, George W. Simpson, certify that this map was drown from an actual survey S = T E P I— A IV Y OF made under my supervision, that the�y�' �9'r T Lsr� PROPERTY OF ; C _ _ L_ I T T I E error of closure as calculated by �,'�r'e LOT IN NORWOOD T1rp., STANLY Ca, NC q4��'-�N latitudes and do ppaortures is 1:10.000+• ��•,.•• •••„ �� e, that the boundahes not surveyed are •., N THE ORy OF NORWOOD ON BERRY HILL DRIVE 50' R/W �+ FSS / shown as broken lines, and tfie angd®r�?•QO Off, •. �. ! Q NOUSE N0. IN BLOCK ►q. _ ON MPP OF TILLERY BEACH error was seconds per tum.:Z).' '.�9 MAP RECOMFD IN BOOK 1 . PG 214 . DEED RECORDED IN m ; SEAL ; 2= Boon 1108 PG 696 _ aFFICE OF THE REd5TER of DEEDS L-3497 = O; SURVE,r FOR:W E S J O Y" E R -�yy F �= SCAM1" - 30' DATE FEB. 12. 2019 =_it`�•�3uilvtitJ �r�� SME N Fr __ 4Fl. URNS •�` 50 25 0 3D so SIMPSON SURVEYING / E3 ]30X 1413 L-3491 MT. GILEAD, NC 27306 Prafeewonal Surv%vr 191 O> 2 Z O— •4 O O O FIT F , ROGFRS.nwn Its