20141136 Ver 1_Shoreline Stabilization_20141029

20141 1 36
State of North Carolina
DWR Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Sh in! StrllbiffLa
Division of Water Resources F
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
1617 Mail Service Center
Raleigh, NC 27699 -1617
I. Applicant Information [ >A_NCAC U2H ,0502(a)j
1. Owner Information
Name: _)Oki)
Mailing Address:
53 %G DDSs 14aar�Y j4JaA A-A
�MH
OCT 2 9 2014 I
DENR • VVAI °tn RESOURCES
Telephone Number: Y(q kR 1 5'7 9.4 Fax Number:
E -mail Address: )�� ,�� 1t(�q I�h� •C v��
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,MLI /Portals /591docs r fator regdocs/Permits1SAMPLE AGENT AUTH
ORIZATIO_ N _FORM.pd`) must be attached if the Agent has signed this application form.
Name: Tdk y-t 12. ('3�Xk U 1 �� G),^
Company Affiliation:
Mailing Address: ) ^BE�I Gl S 2c� ��S /irIY" 4t2:::�
Telephone Number: V061 d2 y 5751' Fax Number:
E -mail Address: rn��� ����Y� e-0- 013, cam'►
Person to receive the Certification Approval: _T ©Arl Ay (,4X- U i wvl
I1. Project Information [' 5A NCAC 02H .0502(a) & (b)l
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 Nearest Town ��IG+riU:ti�
Subdivision name or site address (include phase /lot number). -&4 -cr 1214A
Directions to site/- please include road names and numbers, landmarks, etc 0 ?
j4- ( WiJ
Latitude (in decimal degrees) 35 ° (,k - f- Longitude (decimal degrees) — 3 13 IA
5 Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.)
6. Property size (acres)`
7 Lake/ river/ ocean adjacent to property
8 Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary) 4v,-e- i S A N y S,.•,f /'
FW : ._ _
C Ff 7 ti/� 5 t_o"e / � J, ^ r c7 �r
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.
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: 3c'a 5 r{ F4-
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 d�
f vied' Kvc/c,
�wnel /Agent's Signature* (15A`NCAC 02H 0502(f)l Date
'Agent's signature is valid only if an authorization letter from the owner is provided
FORM SSGP 10 -2013 Page 2 of 3

Lake
(At Full Pond/ Normal Water Level)
Full Pond/ -IN) I- ,r�o�`
Norm ater Level ')tk
an am BMW Um am W'M ow a"
Shoreline 1'cl�rw,
c�"(�1.e�IS %�tuG Erfh
9 tact
Please approximately sketch the following information on this plan (provide dimensions for each
item, such os 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

Ej -� G l 6S C/k.,j
i
1
J�

Page I of 1
()., 4

Page 1 of 1
httns- / /nel- attach.vmail.comlus.fl259. mail. vahoo .com /va/securedownload ?mid =2 0 0 1 2... 9/4/2014

2-
Am

Jul. 7. 2011c' 7:37PM LANDMARK REALTY GROUP No.95461 =P' I
GAY" 4 .0101 If0w, IR , W'Af'r '11A1' rtlS VAF 1145 .0"IrN 0~0 NY S /IP£RWWAi fnOh LN 4CrNAL
.:4A1'L'• VI/£ I.YALR IfY .ILPfRM•s /t1N ,NAY /NB dAN4.P Oi %'L OS'Vp0' AA CAL CULAYrrp BY LAr /l4P4f: I'
F , n OCIAIM184'2 19 &Z$,v r//A// / 30110 A//A 1 I /4Y •J/ /T NAP WA-0 P047AA-R� 0 I// Acev DANCE
%A C S. it - JO Ay 4VeArVEP. (r•TN6S! //Y flkll) ANO SFAA r /JIS PAY OF SISAL. �
fv%q,l&A L' 1451
.• o AL'cJSrcnEP LANs UR VlYOR % t •IlJ1 \\ �`
JYAre O/ NO//rM 4ANOLINA
dOvJlr: Of JABor"O
/. CAROL lf. /1BYSON. ROTARY PUSLIO , IN ANO nm mars0ACOVNrr. NOnr)f 040OLI11A,00 RE'BBOr Off. M eR�
S!'Ar,pr '6AT (/AVIV /f, BRrIO //, JR.•PBBJO/JALLr APP"9f0 06fOPS 1(6 r / //$ DAY A //O B61N0
SIPORN 44KNOr/LERSL TIk4Y rA�1' follevo1NC C,(ATii /C6rC WAS eirecorto OY ( / /R. B'/TNESB t'Y /+ r O
nANP Axn seat rRls ._!Q. Ter Of.. _. _ .�_.. 4.c...t�� A r coWmsslnR (7 ; y0Y Aft p '1
p jOUH L � G
JrATI 0A NORM, OAROLV/A 41 �, {,(*
tdvRr, of J6Gx,�01J �� ,a ,`� OU
/,�• 9.
r1/f :)Rr7400 CERTIFICATES OP 00110 /I dprS01J1 oft 4Rr1 SUAVErOR, 4Rp J1,s
PARRS Y 097'9! /n, NOTARY /10^10 'ARC C14'Rfer /20 ry pE 0 or , YN /S /NJrRON.f11r aw
PA6SFA):L• FJR RACISrRAF10b' A110 RECOnOfP IN /'11;.7 OFF/ AIN P/.AT CA0/1/er
GAY OF
left
tN
7
V� O
z 1(/F O. m. o. �
CORP
71 1 r
N/F AM. 0. CORP X Z�, £
TT.QO b/ P.
r
� 9
s
0
I
ill
in
tr r .
0 i
M �
C �
o_ '
�—E /PO
S1,90
W
m
o
n
O
lz
A
O
C
1�
s
, � N
y
iO
V
1
.1
not
.t
1,
0.84 AC.
/. MALONey /.
w ro 1 SURVEY Me. 88 -12.5f
I / L I
f o �
DWELLINO 11
1�� 90�g1' 20,00
I r 6/R
E /.,A
{1 A
1 `\� /� 1
C2,11
000, '
g'i ba Cot?#
!P LAT
FOR
/ i�
s
I _
DDrNIBI PROPERTr ID ALL- OF THE LAND& TRAjle- ROn C. ®nd Mei b W. �� �O�t
FURR60 TO 40HN K. STO6911911,ETVK Dr0ECO PROPERTY I.00ATEG IN TATER KNOB SUBDIVISION
6 E6011060 IN OEBO 6001( 4701 P6. 933, JACKSON
COUNTY RZOISTRY:- ._ „�•w HAMBURO TWP.. JACKSON CO., NORTH CAROLINA

-
I IV
This map is prepared for mventory of real property within Jackson County. ft is GOMPIlfid from recorded deeds, plats, and public data
Jackson County or any County rapresenbdive assumes no kWI responsibility for th* contents of this map- Printed:Aug 2 20141