20181087 Ver 1_Shoreline Stabilization_20180807

State of North Carolina
Department 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
401 & Buffer Permitting Unit 2 0 1 8 1 0 8 7
1617 Mail Service Center
Raleigh, NC 27699-1617
I. Applicant Informatior
1. Owner Information
Name: 1W4-
Mailing Address:
AUG u 7 2018 10
`'j%� - ATER RESaURCE
2 O RFER RERIu11TT11
SZ"/ Z -/-Z 13n
0�1IS /X 751/9
Telephone Number: Z72 597 29Z`l Fax Number:
E-mail Address:
2. Agent/ Contact Person In ormation
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http://www.saw.usace.army.miI/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: Cf /&
Company Affiliation:
Mailing Address: /Z� /D 7
Ce) *227 tiC 2072 3
Telephone Number: "2Z 2025 Fax Number:
E-mail Address: Z3"
Person to receive the Certification Approval:
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 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: Jack -Sal Nearest Town: %LLCG�SEG �
Subdivision name or site address (include phase/lot number):
Directions to site - please include road names and numbers, landmarks, etc.: 4W
__4I0,l/en _7�_ 4�.e 4,✓!:25- .�c�SEaeG�
G -D iZ) z5ae
Latitude (in decimal degrees) .Z330s3 Longitude (decimal degrees) —S-3, 0.301
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): ��SLiri�,yL
6. Property size (acres): 5 Z w
7. Lake/ river/ ocean adjacent to property: G��E
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): SMM 42-2,17J_- J
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:
25-0
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:
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):
Z__ Z /LzS /�,�d%l�'ell- 3E�D 6i7a_4 J ��✓ P
31yw-a
Owner/ nt's Signature [15A 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

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO.
PLAN NO. PARCEL ID: 75-U6 ^ 2�/- 6Z 213
STREET ADDRESS: .5S03 X.ZDG - 41C
Please print:
Property Owner:%�%�lr , j a,E�i� L Ath26 GSL �D /l/ /07 ;e�
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Gf% Gas of *7
(Contractor / Agent) (Name of consulting firm) �C
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
Telephone: ! 72 ��j �? 222 V
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Auth ized Signature
Authorized Signature
Date: '�/ �' Date: '-�w- &

Full Pond/
Normal Water Level
�''''
Shoreline
Lake
(At Full Pond/ Normal Water Level)
162 5TH 40Ck-
I-Nf `X -'z>
CV57ZYC ��(J
.I"d6C0!5-SS
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

k
t!

ice` \ ,�i � �� �.�

I CEDAR
CLIFF
�+ _LAKE BEAR
LAKE
LA— LOI
15 zJwss^N \/Y,q i
eJ 00358• W \/ ✓✓✓
VICINITY MAP J SITE
(NOT TO 5CALE)
Q.
B E A R
A/
LAKE 461'.
�4�qRi �f - ; � ��_
INv:_� - -4_r{Arli'� I r \ T �_ y
'Y'f _ of 1wK� - - /'-___—� %
2802.0 J7 ` \ EOGE �!'_l �'
I "
it r `,
_ _ - .i i��_ - _ _ - _ ©rw+v //' i
Jr
- __ ' mKrf � 1;. �_ r' 44.•x' 11 I/ 1�` _ ]$00.5-__� �_--�-J' � \ _ _-• I rr,♦�, "/ /
_ r v
r `
$lamE
zr e�
i i I if WET ipl' ].9 ` , \ d - / �:: `• ' �/
,
.,
Cj—
LURE INLET ,
„
,
' `v
" - r
TOP: 2801.5' ..-_ �. ,� .' WOODEN
71.
' 111 i,1i ',��yy___.�. / ( FLOATMG
�V-^i /
lib 25reii•..'�E I ! I /f,/ ` dt\ INV
wrooD
ARBOR �
BOUNDARY LINE
TAKEN FROM f
/ r PB 14, PAGE 859
TAKEN FROM LAK E
BOUNDARY LINE \ "�
.+o.vk
/ PB 14, PAGE 859 \ d �'S `
—� WATERTRONICS�
PUMP
PIN 7586-91-6329
MAG BEAR LAKE
DB 1982, PAGE 444 j
PB 14, PAGE 859
i
I BENCHMARK
Topographic Survey forI TOP OF #5 REBAR FOUND WITH'EHA' CAP
MAG BEAR LAKE
ELEV.= 2,569.B2' (APPROXIMATE NGVD 1929)
LAKE CLUB SHORE STABILIZATION
Being on a portion of PIN 7586-91.6329
as described in Deed Book 1982, Page 444 I
and shown in Plat Book 14, Page 859
River Township, Jackson County, N.C. I
Date: 11-24-2014 Drawn By: M. Edgerton I
Job#: 13171 Checked By: B. Brown
Robert C. Brown, PLSTREE LEGEND:
I
Ed Holmes & Associates Land Surveyors, PA
y HIC =HICKORY
200 Ridgefield Court, Suite 215, Asheville, NC 28806 SW = SOURWOOD #5 RUNEBAR I i�
MAP =MAPLE FOD
828.225.6562 Company#C-2806 BIR =BIRCH WCAPAEn HOLMES
40' 0' 40' 80' POP = POPLAR CIATED ''
LOC =LOCUST & ASSOS VV
HEM =HEMLOCK L A N D i II x V E Y ,I x- 1 e
WAL = WALNUT
SCALE 1" = 40' DWG#: C14-119 PN = PINE
NOTES
I, Robert C. Brawn, certify that this map was drawn under my supervision from an
` This is a topographic survey only, boundary information obtained from plat
actual survey made under my supervision using traditional field procedures; that the
recorded in Plat Book 14, Page 859.
boundaries not surveyed are dearly Indicated by dashed lines as drawn from
information found m deed books as shown; that the topographic survey was
performed at the 95 percent confidence level to meet Federal Geographic Data
' This survey was prepared without benefit of abstract title and matters of title
Committee Standards ((21 NCAC 56.1606 (3)9b))1
should be referred to an atlomey-alaaw.
Witness my signature, License Number, and Seal
This suns ma be subject Y Y to a8 m
' right"ll-way, easements, reservations and
restrictions, written and unwritten, recorded and unrecorded.
this 24th Day of November AD., 2016 �suxuy4j
' The certification shown hereon is not a certification of title. zoning or
N.C. Professional Land SurvepF Qy
freedom from encumbrances.
Robert C. Brown, PLS 7 447 .SEAL T S
License a 2748 = L-2748
' No underground utilities were located. Call 1-800-6324949 before digging.
' This property is oriented to the North Carolina Grid (North American Datum
$
of 1983) by global positioning system methods and utilizing North Carolina
Geodetic Monuments: •Big Ridge' and •Tuckasegee'
Asn.as ..
u
' All distances shown hereon are North Carolina Grid distances.
s
' Aft elevations shove hereon am appro>amate NGVD 1929 elevations.
• The combined grid factor used is: 0.9997300.
' Contour interval is 2'.
I CEDAR
CLIFF
�+ _LAKE BEAR
LAKE
LA— LOI
15 zJwss^N \/Y,q i
eJ 00358• W \/ ✓✓✓
VICINITY MAP J SITE
(NOT TO 5CALE)
Q.
B E A R
A/
LAKE 461'.
�4�qRi �f - ; � ��_
INv:_� - -4_r{Arli'� I r \ T �_ y
'Y'f _ of 1wK� - - /'-___—� %
2802.0 J7 ` \ EOGE �!'_l �'
I "
it r `,
_ _ - .i i��_ - _ _ - _ ©rw+v //' i
Jr
- __ ' mKrf � 1;. �_ r' 44.•x' 11 I/ 1�` _ ]$00.5-__� �_--�-J' � \ _ _-• I rr,♦�, "/ /
_ r v
r `
$lamE
zr e�
i i I if WET ipl' ].9 ` , \ d - / �:: `• ' �/
,
.,
Cj—
LURE INLET ,
„
,
' `v
" - r
TOP: 2801.5' ..-_ �. ,� .' WOODEN
71.
' 111 i,1i ',��yy___.�. / ( FLOATMG
�V-^i /
lib 25reii•..'�E I ! I /f,/ ` dt\ INV
wrooD
ARBOR �
BOUNDARY LINE
TAKEN FROM f
/ r PB 14, PAGE 859
TAKEN FROM LAK E
BOUNDARY LINE \ "�
.+o.vk
/ PB 14, PAGE 859 \ d �'S `
—� WATERTRONICS�
PUMP
PIN 7586-91-6329
MAG BEAR LAKE
DB 1982, PAGE 444 j
PB 14, PAGE 859
i
I BENCHMARK
Topographic Survey forI TOP OF #5 REBAR FOUND WITH'EHA' CAP
MAG BEAR LAKE
ELEV.= 2,569.B2' (APPROXIMATE NGVD 1929)
LAKE CLUB SHORE STABILIZATION
Being on a portion of PIN 7586-91.6329
as described in Deed Book 1982, Page 444 I
and shown in Plat Book 14, Page 859
River Township, Jackson County, N.C. I
Date: 11-24-2014 Drawn By: M. Edgerton I
Job#: 13171 Checked By: B. Brown
Robert C. Brown, PLSTREE LEGEND:
I
Ed Holmes & Associates Land Surveyors, PA
y HIC =HICKORY
200 Ridgefield Court, Suite 215, Asheville, NC 28806 SW = SOURWOOD #5 RUNEBAR I i�
MAP =MAPLE FOD
828.225.6562 Company#C-2806 BIR =BIRCH WCAPAEn HOLMES
40' 0' 40' 80' POP = POPLAR CIATED ''
LOC =LOCUST & ASSOS VV
HEM =HEMLOCK L A N D i II x V E Y ,I x- 1 e
WAL = WALNUT
SCALE 1" = 40' DWG#: C14-119 PN = PINE