20140945 Ver 1_Shoreline Stabilization_20140904

®� �0 9 4 5
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Dl� v s notl of Water Resources
FORM: SSGP 10 -2013
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 ,,r.
1617 Mail Service Center D
Raleigh, NC 27699 -1617 SEP 0 4-2014
I. Applicant Information [15A NCAC 02H .0502(a)] " �'� WAL
1. Owner Information
Name: Donald R. & Gaither B. DeLuca
Mailing Address: 980 East Gulf Drive
Sanibel, FL 33957
Telephone Number: 239.322.6583 Fax Number: 239.275.5148
E -mail Address: ddeluca(@rlrllc.com
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http:Hwww.saw.usace army mil/ Portals /59 /docs /regulatory /reedocs /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: Fax Number:
E -mail Address:
Person to receive the Certification Approval: Owner
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 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: Jackson Nearest Town: Cashier
Subdivision name or site address (include phase /lot number): Lot 17, Stillpoint
96 Stillpoint Lane Glenville NC 28736
Directions to site - please include road names and numbers, landmarks, etc.: From
Cashiers take Route 107 N to 1155; right turn onto Lakeside Circle Drive,
left turn onto Still Point
Latitude (in decimal degrees) 35.18356 Longitude (decimal degrees) 83.091788
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): residential, developed
6. Property size (acres): 0.78 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): massive erosion causing us to stabilize shoreline
with stack stone and rip rap
9. Will work be conducted from land? ❑ From water? ❑d
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:
450 sq ft
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: 450 sq ft
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 disturbance,
no brush or tree removal required
7 c
er /Agent's Sig
it's signature is
* [15A NCAC 02H .0502(f)]
1.3,1_
Date
if an authorization letter from the owner is provided.
FORM: SSGP 10 -2013 Page 2 of 3

Fall Pond/
Normal Water Level
SI
La ke
(At Full Pond/ Normal Water Level)
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

$ R
o
cl
H ��8a
_ —4 r
o �
m b En
m
o C)
an
S� 3 � §• °"°B m NTH 9 d
YOU d
ks F 1a§ >g� I via �m
k °a
Tit
b'n
4, ^�
S `� (� d \ 0Cfi1'MVy nmrgy�Nf
co
on
�W4
log
� c �
y � � � > Q. � $TbF y�d�p • N Z

t � �,'rl
�' d
,
x
+: Ft
♦�
�
,` A 5
. �:
� '
x
�
w�
,� /
�
�
�
h,� /
� „� f
�
•''i
�
- .
,,
�. �
•- '
E r
'll � :.'�:,", 1�.. �,r� n �
,...� ;� "� a .,. � ak .a,

�i
� y
4'
ig4C-<
?RDFILE VIEW
0I I
/-5b +-
G NOR-
�'� �trP -� t�R YSf�eK uhf �.�-� YeFT)EID
w