20051861 Ver 2_Shoreline Stabilization_20180102

,� D� \� � State of North Carolina
ODepartment of Environment and Natural Resources
DWR Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division 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 "I G
401 & Buffer Permitting Unit J� C`
1617 Mail Service Center V\
Raleigh, NC 27699-1617 T
I. Applicant Information 1`15A NCAC 02H .0502(a)]
1. Owner Information
Name: Rnit'-&T1�jJLyf R
Mailing Address: ag 5 '; AV, -V) i_ rJ Rn
r
Telephone Number: Fax Number:
E-mail Address:
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
httD://www.saw.usace.armv.mil/Portals/59/docs/re,gulato_ry/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: HU AuR i BkaSa J
Company Affiliation: ZRyS.-J n _- xLK i A.16
Mailing Address: '352 b W to -7 nJ
�Lf0L11".L! NC.
Telephone Number: Fax Number: 281 7Y 3 0 337
E-mail Address: _ rrAI - k: '-)m
Person to receive the Certification Approval: Hubs R7 J A)
II. Project Information [15A NCAC 02H .0502(a) & (b)]
1. Attach a vicinity map (i.e. street map) dearly 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 3

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: TA iK sp N Nearest Town: i L N V IL LL
Subdivision name or site address (include phase/lot number):
38a IB►" C-111Lowrifi. tjC .,kq, I A �
Directions to site - please include road names and numbers, landmarks, etc.: rje krc„j &p, Ybg M;
�t1Rni iiQV nal-jjiLw Mi"WPA WAij gl6 m,L it, 1.:ka ofACQ P_AAPit )t1r ,itj .4#KT,c)Nio
Fg&I-!,J 1*1usT lal , if t Q 3 J 9-1401: Wit A9ISS f 1 a2: 3990 U) V11- L &I" '
Latitude (in decimal degrees) 35, t % a t 5 5• Longitude (decimal degrees)_�3
S. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): gg,51 Rf,IrjAL
6. Property size (acres): , 67 Ac_p..ti
7. Lake/ river/ ocean adjacent to property: 4.A Kf. cli-1 ayicit;
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): e&PRitt cqQ ANA) L,&l aagic. AA;A Rc"4 DAR.5 aNa
.?AV RA9 Tc"Oving-i 5-rAi-'illi.jm-,�i Cwi.Nf FI.I�HiR iRoSio�
9. Will work be conducted from land? ❑ From Water? [`'r
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:
X00 K2 k,,A LL 6 0oP' Z RI FRAP f -c+0 1,,00 Fr
z.
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: !Y0 K W'+ 20o r'r cmc k CI LL t�f�a X00 FT 2
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): p;EAn �T�TMpS �c1
SmAl.. ILLI 5 3 to 44 -rRfr • ; rt i=.,k P (75 I.2 R12&r-s
Owner/Agent's Signature' 15 NCAC 02H .0502(f)] Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

Full Pond/
Normal Water
Sho
�'reline ''
3` x Zoo
epvt,OSR wort
Lake
(At full Pond/ Normal Water level)
to
3$O WlLDCttNI$S "TRAIL
Z i A Zcx�I
Ba�LpiR Wri4-L
3' x 200
VA? R.nP 5 ►k"'V-
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ftx 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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Robert Lee Culver
2855 Arden Road
Atlanta, GA 30327
Cell# 404-597-9862
[e-mail]
Lake Glenville Address:
380 Wilderness Trail
Cullowhee, NC 28723
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