20181308 Ver 1_Shoreline Stabilization_20180925

201 81308
State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
DlviSlan of WAt@r R@*aurclr3 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
Shoreline Stabilization Application form
Three copies of the applica kni' `attachments) and the application fee should be sent
to:
Division of Water Resources p /;ZL
401 & Buffer Permitting Unit L5 v D
1617 Mail Service CenterSEP 2 5 2018
Raleigh, NC 27699-1617 1 [j
1. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information \
Name: 1`� No� cu.y ��Sc ?"i 0-n CJ
A (
Mailing Address: 157 S F
Telephone Number: � 0- 7i3- "744 - Number:
E-mail Address: `'Save lSzw--� (CL Q-0 ( oW) J C_01.c6W­'
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.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:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address.
Person to receive the Certification Approval:
11. Project Information 115A 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: q G lc Sv V,\ Nearest Town: r f 1 S
Subdivision name or site address" "(inclu;de' phase/lot number): C
Directions to site -please include road names and numbers, landmarks, etc.:
,r I-j� SC � - M S
mrd I I I �� � r
Latitude (in decimal degrees) } Y/ Longitude (decimal degrees)
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): C - f' L i i 0-y l C,\
6. Property size (acres): \ , 1 � f
7. take/ river/ ocean adjacent to property: Com,
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
9. Will work be conducted from land?E] 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:
35e sq., �;�
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake level/ Ngrmal Water Level and 50 feet land ward in
square feet or acres: L)0 �;G
12. Please describe the vegetation above the normal pool take level/ Normal Water Level and
50 feet landward to be impacted (number of trees, for instance): UR��
' I Sg4p11
0 �- c -e- ve � ` r ow
a;AA.-c
Owner/Agent's Signature* 115A 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/Norrm@l WOW L@v@I)
ty��ris afro►'�
Q�P3, A5D
Full Pond/
Norrnauvwuo`
Shorelln W� �j,1}µret I
�kv0 al6eo, j
Li
P
a rk CL69�je-
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ft x 100ft)*:
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

NORTH
NORTON ROAi NOR i ON ROAD
b
R
cc0
2
LOCATION MAP
i CHA90RA - DB 846 - PG 356 i
(D3
N 4 REBAR FOUND
# 4 REBAR FOUND
tt 4 REBAR FOUND�•`6,,LOt ay 1.1 I t_ ACRES
@31 V5E 13
(TIE); a 4 REBAR FOUND
4
o � SOT T �i._.: �234.2,, POINT IST SET 4
o • r r, � 1 17•x, S
SHED c�
L-4
I ' IP FOUND
% LOVE(FORkERLY BOOKER - 08 838 - PG 470) 3
A
MUMOVKu IVWr4Zfl1'NAVIIJVri WUMIT~ IM UAMUNA
AUGUST 22, 1997 SCALE 1' . 50'
#971169 -DATE OF SURVEY -AUGUST 87-FB#DC
PREPAREb BY
W. EDWARD HALLI.S.
HIGHWAY 107,SOUTH-P.O.BOX 2004 .
CASHIERS,NORTH CAROLINA
TEL. [phone]
CARO4
2 9
L-2876
ti
• "OWARD gyp%
3110 CONTOUR(NPL DATUM) IS THE PROPERTY LINE
LAKE GLENVILLE - THORPE RESERVOIR
aaafMvFj .i
1 certify that the pM >
,arothe 1NStershed Pto>
of
is approved fot
Deeds OtfI'*e. `
Date Mier A
"OTICc- this f fG .
Public Wdw
{

Jackson County, NC - GoNaps//��
`�' U �,�_-❑®' �� 7Fi"�.,ti X71
Select WD: General ♦,
Active Layer. Tax Pameks
Map Layers Search Tools Map Toob
Quick Report R -1h Exiracl Data
s fts1d71flO
S'
139 PM
4x � 9n8/2018

Joe
m

FULL POND
or
_ {.ea -I^
NORMAL SUMMERTIME
S-rosila
TOP ERODE© ESCARPMENT
�� ��� s l"►p,re,ir he.
END OF LAKE 8E) •- *I ---••• TUE OF BANK
BASK HEJ D 11VAi"ION
FOR SNORE ELIN STABILrrATION AC" ES
MAY. 199.9