20211683 Ver 1_Shoreline Stabilization_20211118

Submission Form
I. Applicant Information [15A NCAC 02H .0502(a)]
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all
mandatory questions are answered.
Primary Contact Email *
Owner Information:
Name: *
Email: *
Phone Number: *
Mailing Address:*
Name:
Email:
Phone Number:*
Mailing Address:*
[e-mail]
Please provide an email address for payment and requests for more information here.
Peter J Jarvinen
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
260 Tahala Trail
Address Line 2
City
Cullowhee
Postal / Zip Code
28723
Constance L Jarvinen
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
260 Tahala Trail
Address Line 2
City
Cullowhee
Postal / Zip Code
28723
Is there an agent working on the project?* Yes
No
State / Province / Region
NC
Country
Jackson
State / Province / Region
NC
Country
Jackson

Agent/Consultant Information
Name: *
Bob Martin
Company Affiliation: *
Bob'sDocks/Seawall Co
Email: *
[e-mail]
Phone Number:*
[phone]
(xxx)xxx-xxxx
Mailing Address: *
Street Address
PO Box 304
Address Line 2
City
Glenville
Postal / Zip Code
28736
A signed and dated copy of the Agent Authorization letter:
SAMPLE—AGENT—AUTHORIZATION—F...
35.2KB
(2).pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: * Jarvinen Seawall
State / Province / Region
NC
Country
United States
If your project has a formal name please use this. If your project does not have a formal name, please identify your project
by the owner name and proposed activity (Jones Property Access Road, Smith Guest House, etc.) List in parentheses
any other names that have been used to identify the project in the past.
1. Provide 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.*
Upload File
- Look up address
Property Address Lookup: * Street Address
260 Tahala Trail
Address Line 2
City
State / Province / Region
Cullowhee
NC
Postal / Zip Code
Country
28723
Jackson
Latitude: * 35.192088 Longitude: *-83.173303
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 elevations, and construction access corridors. You may use the diagram under
section 12.normal pool lake level/normal water level*
Seawall Sketch Scan 0110.pdf 268.82KB
260 Survey.pdf 22.09KB
Please use the diagram at the link below:

https:Hedocs.deq.nc.gov/WaterResources/O/edoc/616616/ShoreIine%20Layout.docx
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale of some sort- a yard
stick, shovel handle, etc.)*
shoreline photos 11-16-2021.pdf 170.83KB
4. Location of the property (where work is to be conducted)
Nearest Town: * Cullowhee
County: * Jackson
Lake/ river/ ocean adjacent to Lake Glenville
property:
Subdivisions name or site address: * Woudes Mountain-Tahala Shores I -Lot 38
Include phase/lot number
Directions to site: *
From the intersection of Pine Creek Road and North Norton/ turn onto
North Norton from Pine Creek Road and take a left onto Woods Mountain
Trail, continue on Woods Mountain Trail about 1.1 miles and take a left
onto Tahala Trail.
We are at the end of the road on the right just before going into the cul de
sac.
Please include road names and numbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:
Residential Home Site
Residential, undeveloped, etc.
6. Property Size 1.00+-
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
We would like to build a stacked stone seawall to stabilize our shoreline
and keep it from washing away into the lake.
8. How will the work be done?* From Land
From Water
9. Total amount of disturbance below the normal pool lake level/ normal water level: *
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
570 sq'
square feet
10. Total amount of disturbance above the normal pool lake level/ normal water level and 50 feet land-
ward: *
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
570 sq'
square feet
11. 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)
Minimal brush and bushes/ 1 tree leaning
Sketch: Seawall Sketch Scan _0110.pdf 268.82KB

Application Fee:
Once the application has been accepted. You will need to send a corresponding fee in with the appropriate DWR#. The
application fee is as follows (pursuant to G.S. 143-215.3D):
0 $240.00 for impacts to lake (below normal water level) of less than 1 acre
0 $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:
o I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the best
of my knowledge and belief
o I, the project proponent, hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time.
o I agree that submission of this Shoreline Stabilization online form is a "transaction" subject to Chapter 66, Article 40 of
the NC General Statutes (the "Uniform Electronic Transactions Act');
o I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act');
0 1 understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
o I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:* Peter J Jarvinen
Signature:
Submittal Date: 11/16/2021

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20211683 Version: *
Select Reviewer:*
Select Reviewing Office:
Has payment been received?*
What amount is owed?*
Kaylie Yankura:eads\kyankura
Asheville Regional Office - [phone]
No Payment Needed
Fee Received
• Need Fee - send electronic notification
• $240.00
$570.00

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO: 38
STREET ADDRESS:
260 Tahala Trail
Cullowhee NC 28723
Please print:
PLAN NO: 20201468 V 1
Property Owner: Peter 3 Jarvinen
Property Owner: Constance L Jarvinen
PARCEL ID: Lot 38 Tahala
Shores Unit 1
The undersigned, registered property owners of the above noted property, do herebyauthorize
Bob Martin , of Bob's Docks/Seawall Co
(Contractor/Agent) (Name 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 Owners Address (if different than property above):
Telephone: [phone] [phone]
We hereby certify the above information submitted in this application is true and accurate tothe
best of our knowledge.
Peter J Jarvinen
Authorized Signature
11-15-2021
Date
Constance L Jarvinen
Authorized Signature
11-15-2021
Date

AGENT AUTHORIZATION FORM

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