20140837 Ver 1_Shoreline Stabilization_20140805

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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 Stabilization
lIslon of Water Resources FORM: sSGP 10 -2013
Shoreline Stabilization 11 944 am
Three copies of the application (including attachments) and the applicatio I�
to:
Division of Water Resources AUG U ) 2014
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699 -1617
Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: Peter J. Klich
Mailing Address: 10 Dogwood Trail
Suite A
DeBary, FL 32713
Telephone Number: 386.668.1315 Fax Number: None
E -mail Address: Petrofl @aol.com
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 AUT
HORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: Peter J. Klich
Company Affiliation:
Property Owner
Mailing Address:
10 Dogwood Trail
Suite A
DeBam FL 32713
Telephone Number:
386.668.1315 Fax Number: None
E -mail Address:
Petrofl @aol.com
Person to receive the
Certification Approval: Peter J. Klich
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, 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
Subdivision name or site address (include phase /lot number):
38 Levi Rd. Glenville NC 28736
Directions to site - please include road names and numbers, landmarks, etc.: From
Cashiers take Hwy 107 into Glenville, left onto Knob Hill Rd which will turn from paved to
shale, bear left at fork and then turn left onto Levi Rd (hair pin turn), lot is iust after turn
and has a white permit box near left property line
Latitude o deamal,degrees) 35.164892 Longitude oecimal degrees) - 83.1x30300
5. Describe the existing land use or condition of the site at'thertime of this
application (residential, undeveloped, etc.): Residential, Undeveloped
6. Property size (acres): .43 Acres
7 Lake/ river/ ocean adjacent to property: Lake Glenville
8 Describe proposed work (include discussion as to how hardening of shoreline has
been avoided, or why it is necessary): Install new seawall to,stop rapid and continuing
erosion of property; approximately 6' tall x 80' in length
9. 'Will work be conducted from land ?)�XXX 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:
Approximately 400 square feet -
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: Approximately 800 square feet
FORM: SSGP 10 -2013 Page 2 of 4

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): Minimal Vegetation to
be impacted approximately 5 trees and small vegetation where wall will be installed.
ner /Agent's Sign e' [15A NCAC 02H .0502(f)) Date
Agent's signature is valid only if on authorization letter from the owner is provided.
Full Pond/
formal Water Level
Shoreline
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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: 6'x80' =480 S.F.
2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
3'x80' =240 S.F.
3. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
FORM: SSGP 10 -2013 Page 3 of 4

6'x80' =480 S.F.
4. location of any proposed structures such as buildings, retaining walls, docks, etc.: Dock and
Rama is 520 S.F. Total.
S. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
None
6. Location of construction access corridors: In center of lot approximately 12' wide x 30'
lone.
FORM SSGP 10 -2013 Page 4.of 4

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