20190638 Ver 1_Shoreline Stabilization_20190510

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Water Resources 1SA NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
ENVIRONMENTAL QUALITY FORM: SSGP 02-2017
Shoreline Stabilization Application Form 2 0 1 9 0 6 3 8
Three copies of the application (including attachments) and the application fee should be sent to:
If sending via US Postal Service If sendin via delivery service (UPS, FedEx, etc.)
Karen Higgins s
DWR — 401 & Buffer Permitting Branch —�401&ffer Permitting Branch
1617 Mail Service Center Street
Raleigh, NC 27699-1617 Raleigh, NC 27604
A. Applicant Information [15A NCAC 02H .0502(a)]
1
Owner Information^ �
Name:
Mailing Address
Telephone Number:
E-mail Address:
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C'&r Ics(i ► #'J C 0,52-1 k
-S'? 25 Fax Number:
2. Agent/ Contact Person Information
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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:
httD://www.saw.usace.armv.mil/Portals/59/docs/reaulatory/regdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf) I ^_
Name:o� Grr (li�SiCJ(� Ct s
Company Affiliation:
Mailing Address: 1 519 G4ji'((0006k 0
Telephone Number: Fax Number:
E-mail Address: 't &,QZ WincWeafv. • nek-
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 Paee 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 oftheproperty (where work is to be conducted)
County: / 4"d500" -e y Nearest Town:
Lake/ river/ ocean adjacent to property: /7 /< E D,
//
Property size (acres): ` 2 a c,R c -S ci
Subdivision name or site address (include phase/lot number):
1,grW_ oc_x
Directions to site - please include 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.): l
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): }d- t,✓oOaQ So4r../'o'll IPC%%Limit-1kT
7. Will work be conducted from land? 0/ 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:
Temporary impacts in square feet:
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:
3 .C.1 v/ q r/_ 4/2 D so
Temporary impacts (temporary clearing, construction corridor) in square
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): 5&V e: kxi 5/++a. / /
11. Sigqgfure /
Owner/Agent's Signature` [15A NCAC 02H .0502(f)l Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 02-2017 Paee 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
La ke
(At Full Pond/ Normal Water Level)
Ri V ;20.p
-3
Full Pond/ Normal Water Lev
'-`horeone
2 ft. x 150 ft.
additional clearing �.
H necessary
Plan View
/ 4e0 IZ¢
Z1.2 o al l
-zrn 104 L� n
/qtr/ 11 f G( CDN
Lake
(At Full Pond/ Normal Water Levey
Existing Dock
/30 ft. 7 f
Riprap
3 ftx 150ft
' Below full pond/ NWL
4kx150f,
-Above full pond/ NWL
FORM: SSGP 02-2017 Paee 3 of 4

V,
1Q
La ke
(At Full Pond/ Normal Water Leyte
© � ttDJJ !
oho o °
Side View
0 0°
5
3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing
if necessary
Existing bank
10 ft. bank `V
height D�iz
Q�OQ
Side Vi LE
FORM: SSGP 02-2017 Paee 4 of 4
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3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing
if necessary
Existing bank
10 ft. bank `V
height D�iz
Q�OQ
Side Vi LE
FORM: SSGP 02-2017 Paee 4 of 4

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