20140009 Ver 1_Shoreline Stabilization_20131220

�I
DWR
2®140009
State of North Carolina
Department of Environment and Natural Resouroes
DWon of WSW Resources
Dh N nA NCAC 02H .0500 - Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10.2013
Shoreline Stabilization Application Form
Four copies of the application (including attachments) and the application fee should be sent to:
Division of Water Resources
401 & Buffer Permitting Unit - .,�
1650 Mail Service Center 1
T _
i 7
Raleigh, NC 27699 -1650
A. D"'202013
I• Applicant Information LISA NCAC 02H .05021ail '" D NR -aye
1. Owner Information w d8 u fry
Mailing Address: c Al.
Telephone Number:
E -mail Address: oA 5l Fax Numbek r
: S
� ,r/r,�, ,,,►...fir,.. , ^ca„/v �< ri►rY;
2. Agent/ Contact Person Information '
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
httpJLwww,SaW6Usace.armV .mil /Portals/59 /de siro.ulatorv/regdocs /permits /SAMPLE AGENT AUTH
ORIZATION FORM odf) must be attached if the Agent has signed this application form.
Name: ?'/J J C-1 Z/ Zv
Company Affiliation:
Mailing Address: -
Telephone Number: 4�R -0A& 02 - Fax Number: �7fr- _ S3- 5 222
E -mail Address: Pit S , -73 ,� GoZ Lam"
Person to receive the Certification Approval:
II. Project Information 115A NCAC 02H 0502(a) & Ibil
1. Attach a viclnky 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 i of 4

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: rk•..o.y Nearest Town:
Subdivision name or site address (include phase /lot number):
A-004 .LID /v
Directions to site - please include road names and numbers, landmarks, etc.:
Lw
S. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): &91W&d=L
6. Property size (acres): 966
7. Lake/ river/ ocean adjacent to property:
S. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): STAB 1_n�'Z
9. Will work be conducted from land? 21*- From water? El
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:
A—W S' � neo-
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: 41A) -!AwAe ' AFET
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):
— IXA t ` Art ge 6eeg e„kkg/ &44g4-.
e- -mil .112 C 13
Owner /Agent's S nature 115A NCAC 02H .0502(f)1 Date
Agent's signature* valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013
Page 2 of 3

A
Full Pond/
NormNVIS �e re MISS
e
C(. t. ..j
AAA
Lake
(At Full Pond /Non al Water Level)
5 2W AV
71 8
�A/11-+QOL AXK)
COA60AICT7.0V
Accas CatZooe
a a a a a
A*717,e1aL Luc
,484e FcL AW
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.
S. 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

SAMPLE AGENT AUTHORIZATION FORM
PROPSM L IM DESCFWl7ON:
MjN
LOT NO. PLAN NO. PARCEL M.
STREET ADDRESS:
75- E?6 -'6- - 1i5'. �?1�
�er-LA .,1G' OL '&P tl , ✓G
Please prim
Property Owner: i s
Property Owner: -A ,,Pg A
The undersigned, registered pert/ owners of the above noted property, do hereby aut oriae
(Contractor I Agent) (name of Consulting firm) GGC
to act an my behalf and tabs all actions necessary for the processing, Wmnm and rce of
this permit or m "ll atbn and any and all standard and special conditions attached.
Property Owner's Address (if difrerent Von property above):
wit A/• Avy ttok4 Fuo:=
We hereby certify the above inbmdon submitted to 11115 applicatkm is true and accurate to th
best of our lmmk dge.
Datm &L

l5 & R O W

LEGEND
These standard symbols will
be
found in the drawing
O
Rebar Found
•
#4 Rebar Set
O
Utilities
A
Point Not Set
•
Nail Found
•
Magnail Set
0
Pipe Found
o
Concrete Monument Found
B
Crimped Pipe Found
Q
Tree (Diameter in inches)
0
Aluminum Monument Found
r
Angle Iron Found
— —
Right of Way Line
Moore and Jahnke
Creek
Utility Lines
x —
Fence
_
Building Wall
Gravel Road
Paved Road
Dashed Lines not Surveyed
I
,.p'� -NIA CA!Q 11,+'
BEAT. r'
f L-4266
G► 4b OF
Nantahala Power and Light
Bear Lake
1 /
of 20' 40' 60'
NC 281
N Site v
a
v
o �
W E v 3
z
Shook Cove Road
ForesIn-
Lake
S
From PC 12 SI 962
106
B and B Landing Ent LLC
1665/770
S
60.
�T�)+
e \
There are no recoverable horizontal control
monuments within 2000 feet of this property
Vicinity Map (not to scale)
This plat is of an existing parcel or parcels and does
not create a new street or change an existing street
1. Clark Lipkin, certify that this plat was drawn
under my supervision from an actual survey made
under my supervision (deed description recorded
in book 1559, page 248)
and that the error of closure as calculated by
coordinate computation is less than 1 5000 and that
this map was prepared in accordance with GS 47 -30
as amended Witness my original signature, licence
number and seal this 28th day of August, 2009
- - - - - -- - -- — --------- - - - - --
Professional Land Surveyor L -4268
State of North Carolina, County of Jackson
I, ---------------------- - - - - -- Review officer
of Jackson County, certify that the plat to
which this certification is affixed meets all
statutory requirements for recording
------------------ - - - - -- Date
Review Officer Date
State of North Carolina. County of Jackson
The foregoing certificates of Clark Lipkin,
Professional Land Surveyor L -4266, are
certified to be correct This instrument
was presented for registration and recorded
in this office in plat cabinet---- slide - - --
This - - -- day of ------ - - -.at - - - - -o clock- -
20 - --
Register of Deeds
Certificate of Approval for Recording
I certify that the plat shown hereon complies with
the Watershed Protection Ordinance and is approved
for recording in the Register of Deeds office
Date Watershed Administrator
NOTICE This property is located within a Public
Water Supply Watershed— development restrictions may
apply
As —Built Map
for
James H.
Moore Jr.
Karen A Jahnke
Drawing #
ate Surveyed
Lot # 105
994 AB
5122108
Bear Lake Reserve
Sheet 1 of 1
Re8 28 09ate
River
Township
Scale
Jackson County
1 „_201
Clark Lipkin, PLS
Surveying.
North Carolina
Lipkin Land Inc.
51 East Rogers Road
The owner at the time of survey 13
Cullowhee, NC 28723
(828) 293 -3030
Moore and Jahnke