20191440 Ver 1_Shoreline Stabilization_20191021

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State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilizati
Division of W Resources FORM: SSGP 10-20h, Ott
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resources
401 & Buffer Permitting Unit RECEiN'°"a
1617 Mail Service Center
0LT 21 2 019
Raleigh, NC 27699-1617
Wetsr Resources
I. Applicant Information [15A NCAC 02H .0502(a)] P"tthg S®ctiw
1. Owner Information
Name: LORRAINE B. FREY
Mailing Address: 653 SUMMER HILL ROAD
CULLOWHEE, NC 28723
Telephone Number: 828-743-2603 Fax Number:
E-mail Address: [e-mail]
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/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name:
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Person to receive the Certification Approval:
Fax Number:
II. 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, structures (buildings, retaining walls, docks, impervious surfaces,
FORM: SSGP 10-2013 Page 1 of 3

etc.), 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.
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: JACKSON
Nearest Town: GLENVILLE-CASHIERS
Subdivision name or site address (include phase/lot number):
SUMMER HILL Lot 4
Directions to site''please include road names and numbers, landmarks, etc.: SC
Rt. 207 to Norton Road. Travel Norton and loin North Norton to Lloyd Hooper Road.
Follow.,same to entry gates to Summer Hill. Gate open on week days. Gate code available
by calling on'bfb phone to Frey residence. They will "buzz" entry. Alternatively, a special
code can be given for limited use by calling ahead to Frey residence (239-634-7907, 828-
43-2603 or 239-433-0448
Latitude (in decimal degrees) 35.169167 Longitude (decimal degrees) 33.152500
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): RESIDENTIAL
6. Property size (acres): 1 ACRE
7. Lake/ river/ ocean adjacent to property: GLENVILLE LAKE
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): 066 �InC t uyhc)�N GL1 I .tot ,
i-,( Ct l
9. Will work be conducted from land? ❑ 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:
'5b S G • �T
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres: § S O � . f-
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):
FORM: SSGP 10-2013 Page 2 of 3

Owner/Agent's Signature* [15 NCA H .0502 f Date
`Agent's signature is valid only if an at orization letter from the owner is provided.
- Fz�
(At Full Pond/Normal Water Level)
pS--I
6
Full Pond/
Normal Water Level ...
Shoreline c
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.
5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
FORM: SSGP 10-2013 Page 3 of 3

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