20141141 Ver 1_Shoreline Stabilization_20141030

2 0 1 4 1 1 4
State of North Carolina
DWR Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
M:_ SSGP 10 -2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699 -1617
Applicant Information [15A NCAC 02H .0502(a))
Owner Information e
Name: ',j�,a2j � L '�h Av e n) L1G1
Mailing Address:
Telephone Number:
E -mail Address:
OCT
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�ijS23 6,e, &'fax Number: 4{aY �W? k6C13
iy OMA-A Q fi- oLk-�-M&Vk �C-4-JQ% S t (,>M
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 /dots /regulatory /regdocs /Permits /SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: Lki"\A)FMC; 414 /Ue�-,J Mast
Company Affiliation:
Mailing Address: rte`
Telephone Number: V& '�f Yid G 1-'17 Fax Number: 1/6!Z
E -mail Address: MG J -V, , �) " 0-1�m - 49 �#DV4­
Person to receive the Certification Approval: l/L��GF. A)e-,.di i e-+ 1
II. Project Information [15A NCAC 02H .0502(a) & (b)J
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: 7,CkLI�'m,\ Nearest Town:
Subdivision name or site address (include phase /lot number):
5(ay- 35 b -i +Q �L i 1
Directions to site -please include road names and numbers, landmarks, etc.:
3(;7 �oc��S vii _cy
Latitude (in decimal degrees) 3 S ����� Longitude (decimal degrees) "��' 15-
/ � %d,
PL_ 0(_-
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): P-6 t' 66i aka
6. Property size (acres): k A
7. Lake/ river/ ocean adjacent to property: �i l
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): 5(,V (;ice LX-6k, 15 Ov ')LY P'd`n
�
Gt:1/� Gf�O�r'' v� �- � �5�c.<< <ak-: o�, OE So � 5ec t, � \ �of"AA� �,u.
t
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:
-/5�0 5 Q F�-
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__"_452 Pt
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): _ t-)y`
43
Owner gent's Signature' [15A NCAC 02H .0502(f)j Date
'Agent's signature is valid only if an authorization fetter from the owner is provided.
FORM: SSGP 10 -2013 Page 2 of 3

Full 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

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found in the drawing.
C
Rebar Found
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#4 Rebar Set
❑
Utilities
L\
Point Not Set
a
Nail Found
9127111
Magnail Set
O
Pipe Found
0
Concrete Monument Set
Emil
Crimped Pipe Found
Jackson County
Tree (Diameter in inches)
—
Stone Pointe
Easement Line
- --
Creek
Lane
Utility Lines
z
Fence
License #C-2654
Building Wall
Gravel Road
Paved Road
Dashed Lines
not Surveyed
10
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From PC 13 Sl 7110
Retaining
0
Newman
996/342
6" Hemlock Stump
4k
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e0��y, 3110' Contour (NPL Datum)
sB, is the Boundary Line
371.91,—
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7.91'S 80^00'53" E
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9 0�9 X83
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Access
Gutter is 0.5' p 7
ut�t S
Southeast of line ease 14 5,2" E
�e�t
are$ 89 31,
--16" Oak, hacked and painted blue
Gas Pipeline (exposed) � � "`,_,`° Edge of Clearing
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j o=n t Easement for 0rivewa�`.,,.
Pell' 544/328
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1.18 ACRES
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L4266
N 87°37'28" E
30.08'
Dock
1 j Lake Glenville
4
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41.47'
N 87°10'05" E
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Date po'Ote
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There are no recoverable horizontal control
monuments within 2000 feet of this property.
S 86"39'00" E
19.53'
This plat is of an existing parcel or parcels and does
not create a new street or change an existing street.
I, Clark Lipkin, certify that this plat was drawn
under my supervision from an actual survey made
under my supervision (deed dc=scription recorded
in book 1848, page 217)
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 G.S. 47-30
as amended. Witness my original signature, licence
number and seal this 27th day of September, 2011.
Professional Land Surveyor L-4266
20.31'
S 85054'34" E
(Tie)
g�
01'
1�0�� US 64
Vicinity Map (not to scale)
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.
45 , ' ez�
Dateshed Administrator
NOTICE: This pr y is located within a Public
Water Supply Watershed -development restrictions may
apply.
State of North Carolina; County of Jackson.
The foregoing pert 6s 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 0f , A,at I = -s'clock_
n:
Register of Deeds
Certificate of Approval for Recording
I certify that the_ plat shown hereon complies
with the Subdivision and Mountain and Hillside
Development Ordinance. and is approved
for recording inIZ
er ofDeeds Office
ate P g Director or Designee
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.
G. &
Review Officer Date
Plat
for
Keith Heal Properties, LLC
Pine Creek Rd
ate Surveyed
Lot # 1
Woudes Mtn Trail
8/8/11
Stonepointe
Sheet 1 of 1
Revision Date
a
Site
9127111
0
Hamburg
o
Strawberry Hill Rd
Scale
Z
Jackson County
1 00=30"
f=30"
—
Stone Pointe
North Carolina
Lipkin Land Surveying, Inc.
51 East Rogers Road
Lane
o
z
Keith Real Properties, LLC
License #C-2654
Z
g�
01'
1�0�� US 64
Vicinity Map (not to scale)
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.
45 , ' ez�
Dateshed Administrator
NOTICE: This pr y is located within a Public
Water Supply Watershed -development restrictions may
apply.
State of North Carolina; County of Jackson.
The foregoing pert 6s 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 0f , A,at I = -s'clock_
n:
Register of Deeds
Certificate of Approval for Recording
I certify that the_ plat shown hereon complies
with the Subdivision and Mountain and Hillside
Development Ordinance. and is approved
for recording inIZ
er ofDeeds Office
ate P g Director or Designee
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.
G. &
Review Officer Date
Plat
for
Keith Heal Properties, LLC
Drawing #
ate Surveyed
Lot # 1
1317-1
8/8/11
Stonepointe
Sheet 1 of 1
Revision Date
9127111
Hamburg
Township
Scale
Jackson County
1 00=30"
f=30"
Clark Lipkin, PLS
North Carolina
Lipkin Land Surveying, Inc.
51 East Rogers Road
The owner at the time of survey is
Cullowhee, NC 28723
[phone]
Keith Real Properties, LLC
License #C-2654