20190945 Ver 1_Shoreline Stabilization_20190716

20190945
State of North Carolina
Department of Environment and Natural Resources
Divi ' of Water Resources
Water- Resources 15A NCAC 02H .0500 — Water Quality Certificatiol h
LNVIRONM LNIAL OVAL'- Stabilization
SS6p---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 ICAC 02H .0502(a)1
I. Owner Information
Name: Z_;�' \_1-rZS'=�.�� k'_ 0 -4 --
Mailing Address:
L1
Telephone Number %11 �_ �� \ _,�-Fikx 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 army mil/Portals/59/docs/reeulatory/reedoa/PermitslSAMPLE AGENT AUTHORIZ
ATION FORM.2df)
Name:
Company Affiliation: \--° '�
Mailing Address: \�,
Telephone Numb •�\b\�� •� `=Fax Number:
E-mail Address: v -C ��-� c\�.�,�
B. roject Information [15A 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
Pagel 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 property (where work is to be conducted)
Nearest Town:
(_-Lake/ river/ ocean adjacent to property: \'�,""�
Property size (acres):
Subdivision name name or site address (include phase/lot number):
irectiQns to site - please include road names and numbers, landmarks, etc.:
Latitude (in decimal degreiocj � Longitude (decimal degrees) t�-�
5. Describe the existing land use or dition of the ite at the time of this application
(residential, undeveloped, etc.):
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): �'r�r l `s f✓x; , r, LS �2.t P �, wL w�l
S IZG `tom .
7. Will work be conducted from land? [r__�' 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:
/7Y 5 . !--; .
Temporary impacts in square feet:
U
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:
ti—
Temporary impacts (temporary clearing, construction corridor) in square feet:
L 57 ' F - l - A,J (��� t Z /21c ' 1 J ! � A- 7e, cS h,
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): E6 ,-� S> r. RL -s I1 -C s
11. Signature
Owner/Agent's Signature' U1 A NCAC 02H .0502ifil Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 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
Full Pond/ NorMW Watt I
�hon�ne �
2 h.: 150k
addowAo deu4y
Y nece+wr
Plan View
FORM: SSGP 02-2017 `
La ke
(At Full Pond/ Normal Water Level)
L LA -0
C5- c"L-.e 9 I
Lake
{A1 Fal 7-d/ Ncrnyl W. Irrll
Existing Dock
/ 300.7h
h
VNWL
h
UNWL
Page 3 of 4

C
Side View CL
10 ft. bank
3 ft. below full pond water level
Existing bank
pli
4 ft, above full pond water level 2 ft. additional clearing
•if necessary
FORM: SSGP 02-2017
Page 4 of 4

7/8/2019
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