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Home My WebLink About20190519 Ver 1_Shoreline Stabilization_20190422-2 Water Resources LNVIRONMLNIAL OUAUIY State of North Carolina Department of Environment and Natural Resources 0 1 9 0 5 1 9 Division of Water Resources 15A NCAC 02H .0500 — Water Quality C�fication, Shoreline Stabilization A®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)] 1. Owner lydormation , i Name: _ �C yP31 Mailing Address: Telephone Number:��\O �`\�\ 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: http://www.saw.usace.armv mil/Portals/59/docs/regulatoryZresdocs/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 X1.3. Attach a photograph of the shoreline r / 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 Nearest Town\ Lake/ river/ ocean adjacent to property: Property size (acres): ! \-N Subdivision n me or site address (include phase/lot number) SQ_� �aq Directiogs t site-�Iease rclude road es a d nb s Ian rks etc.:`� ' Latitude (in decimal degrees)35.� %pk' Longitude (decimal degrees)g� 5. Describe the existing land use ocondition of the site at the time of this application (residential, undeveloped, etc.):1� 6. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or why it is necessary): /7d G dJL+,, � ��c7 i<•h�..S lvu `�% �,,� d �c,r�(�-t L �- l/>°. -y: c .�-( ce.�.'t�.� L•ro - f-r�t, 7. Will work be conducted from land? 0�� Y A 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: 'C� i Temporary impacts in square feet: S j 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: / S— CL_ Temporary impacts (temporary clearing, construction corridor) in square feet: ChM - — .1.1 ^S SJ i -C� ^4 ; k c ) 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*M -C-- — S' �1r �_ r PT -11 11. Signature O r/ s Signature' (15A NCAC 02H 0502(fll Date `Agent's signature is valid only if an authorization letter from the owner is provided. FORM: SSGP 02-2017 Page 2 of 4 Full Pond/ Plan 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 PlPvatlnn La ke Full Pond/ Normal Water 'Ihorei"ne 2 ft. ■ 150 ft. adt�nonw'I.4q • it necawv Lake lAt roll Pond/ Nornyl Existing Dock ift■1S0ft Belor hM Poed/ NWl . 4 �ft.150ft Abmv full land/ NWl EXAMPLI E Plan View FORM: SSGP 02-2017 Page 3 of 4 i Side View U- 3 h. below full pond water level Existing bank 10 ft. bank Wr PIK ter. Lipeei 4 ft, above full Pond water level 2 ft. additional clearing . 'if necessary FORM: SSGP 02-2017 Page 4 of 4 SAMPLE AGENT AUTHORIZATION FORM PROPERTY LEGAL DESCRIPTION: LOT NO. Wy-\ - PLAN NO. PARCEL ID: STREET ADDRESS:�� Please print: \ Property Owner: Property Owner: The undersigned, registered property owners of the above noted property, do hereby authorize of (Contractor / gent) (Na a 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 �� We hereby certify the above Information submitted in this application Is true and accurate to the best of our knowledge Authorized Signature Date: Authorized Signature Date: 4/7/1019 17030 Green Dolphin Ln - Google Maps 17030 Green Dolphin Ln U OOOgx Jeep Rain fr. ��Uslt4l Norman 0 Ell c— cannyy —b Go gle N,n� oil Map data @2019 Google 2000 ft 17030 Green Dolphin Ln Cornelius, NC 28031 ^1 You visited 6 days ago Photos https://www.google.com/maps/place/17030+Green+Dol phi n+Ln,+Comel i us,+NC+2803 1/@35.4644044,-80.9247291,14z/data=!4m5!3m4! 1 sOx8856ae93Of9fb91d:0... 1/1 l �ti.ra.�✓ 1• t. .R. a ��iti Y. •t ' h - ai - b .t N: I •..i .li i.` f � IV AM ' +� t�,' � '1'��l'��'?�' S.; r may"•, +'lY �,�� : � ;,�,.1}�" �y�,h � M IJiY' ia�jya. A � s1'I,MMI,��•~ K � dli. 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