20191200 Ver 1_Shoreline Stabilization_20190910

State of North Carolina
Department of Environment and Natural Resources
Division Tat,"esources
fV DWLsion of Water Resources 15A NCAC 02H .0500 —Water Quality Certification, Shore ' Stabilii10
�v - FORM: SSG 13
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Shoreline Stabilization Application Form 2 0 9 1 2 00
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Three copies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resources co? „
401 & Buffer Permitting Unit ` 1
1617 Mail Service Center 0 i
Raleigh, NC 27699-1617 �Cf
Applicant Information [15A NCAC 02H .0502(a)]
1 r)wnar Infnrmntinn
Name:
Mailing
01 -
Telephone Number: Fax Number: `--�
E-mail Address: anA4,0, CCA1-Cn S s K -)C
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http://www.saw.usace.army.mil/Portals/59/docs/regulatorvlregdocs/Permits/SAMPLE AGENT AU
THORIZATION FORM.0f) must be attached if the Agent has signed this application form.
Name: a'o `j - %T-fwo
Company Affiliation:
Mailing Address: 5z7
vi -((e ��Ud 3
Telephone Number: q cA4 —5-793 4J7 Fax Number -
E -mail Address: -ft' c111,11 . IAJ ''DEN /DWR
Person to receive the Certification Approval: 0 2014
Water Resources
II. Project Information [15A NCAC 02H .0502(a) & (b)] Perrnitking Section
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, structures (buildings, retaining walls, docks, impervious
surfaces, etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Level
FORM: SSGP 10-2013 Page 1 of 3

elevations, and construction access corridors. You may use the diagram provided at
the end of this application form.
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),
County: �aCi e'er Nearest Town: cc6k(e i- N�
Subdivision name or site address (include phase/lot number):
r'v-w --17�l \ -i t& 1 wrA ,l (itSVlle i C Lg 1 i
Directions to site - please include road names and numbers, landmarks, etc.:
��'► -A-a6 , Le -F- cry k rrtt- L)2� D Vic
Latitude (in decimal
Longitude (decimal degrees) : "
5. Describe the existing land use or condition of the site at the time of this
application (residential;..undeveloped, etc.). �S. 4V4� a
Property size (acres) - -d
7. Lake/ river/ ocean adjacent to property: t-AVIL 65dc
8. Describe proposed work (include discussion as to how hardening of shoreline has
been avoided, or why it is necessary): Lb -9 IN(( b,� IV --h 64t-ej--S-kk! �
9. Will work be conducted from la d? a From water?
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining
walls, etc.) below the normal pool lake level/ Normal Water Level in square feet or acres:
50
� V
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool take level/ Normal Water Level and 50 feet land -ward"
in square feet or acres: SO /v--�/

12. 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):-Yt
gorm;
5
FIMUM,
ne
Please approximately sketch the: following information on -this plan (provide dimensions for each
item, such as 10 ft x 100 ft)*:
1. All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
3. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
4. Location of any proposed structures such as buildings, retaining walls, docks, etc.
FORM: SSGP 10-2013
Page 3 of 4

S. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevatio
6. Location of construction access corridor � !��'""
irk

8/28/2019
1325 New Trillium Way - Google Maps
+GOP')& Maps 1325 New Trillium Way
Imagery 02019 Google, Imagery 02019 Maxar Technologies, Map data 02019 50 ft =, _, .._w ,..;[
1325 New Trillium Way
Cashiers, NC 28717
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