20181646 Ver 1_Shoreline Stabilization_20181203

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State of North Carolina
Department of Environment and Natural Resources
Division of Water ResourceA_
Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
ENVIRONMENTAL QUALITY FORM: SSGP 02-2017
Shoreline Stabilization Application Form 2 0 1 8 1 6 46
Three copies of the application (including attachments) and the application fee should be sent to:
If sending via US Postal Service If sending via delivery service (UPS, FedEx, etc.)
Karen Higgins Karen Higgins
DWR — 401 & Buffer Permitting Branch DWR — 401 & Buffer Permitting Branch
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC 27699-1617 Raleigh, NC 27604
A. Applicant Information [15A NCAC 02H .0502(a)] LCQ)-
OW
1. Owner Information D
o s 2018
Name: yJ J0At3
Mailing Address: 13"Z5 , � ' RESOURCES
cllcz_ n�O f'L 22 G,�/, FER PERMITTING
Telephone Number: 7-5,()7 6t -'l 066/ .Falx Number: 44
E-mail Address: �✓1�2/irJnrUc �l���J- y„may, /. �,�;,,
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter must be attached if the Agent has
signed this application form. (A form can be downloaded here:
http //www.saw.usace.army.mii/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTHORIZ
Name:^'>��'
Company Affiliation:
Mailing Address:
Telephone Number
E-mail Address:
G32
U Fax Number: /'to
2
B. 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, buildings, retaining walls, docks, impervious surfaces, 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.
FORM: SSGP 02-2017 Page 1 of 3

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: C SO/✓ Nearest Town:
Lake/ river/ ocean adjacent to property: 654P Z-0-6
Property size (acres): ! /5 em -
Subdivision name or site address (include phase/lot number):
65>4% %d!vl�_ /sl /o% 6 6 Z
Drops to site - please inclu road names and nu be s, landmarks, etc.:
Latitude (in decimal degrees) 3S" 12 p Longitude (decimal degrees)—S`�3g,�?
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): �� ESi ��tiTI>0L
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): �i '� GL � S%WA LG.ZZ47272X/ 64 5--
Azo
=Azo IVa° Z '. SXD� 0-IM14115- _rlc/ M -la I)Ir Af2ld:
7. Will work be conducted from land? E?__ From water? ❑
8. Total amount of impacts below the normal pool lake level/ Normal Water Level
Permanent impacts (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
/OvU s—Ld f/C"-
Temporary impacts in square feet:
660 S (2
9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet
land -ward
Permanent impacts (including back fill, excavation, rip rap, retaining walls, etc.) in square feet:
266�U sty ��
Temporary impacts (temporary clearing, construction corridor) in square feet:
10. 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):
11. Signature
Owner/Agent's Signatur " A NCAC 02H .0502(f)] Date
*Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 02-2017 Page 2 of 4

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 662 PLAN NO.
PARCEL ID: 7596 -12 — 224
STREET ADDRESS: (—a7 662 _Sa4i/a1.51%X6'A1C
Please print:
Property Owner:
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
(Contractor / Agent) (Name of consulting firm)
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):
Z3 *S` . j�� Z-'Y4-etg�-&ylLly4eo
Telephone: "� U 7 b z t) /
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature
Date: r(�T
Authorized Signature
Date: /� /-(-v 4/ �D

12. Please approximately sketch the following information on this plan and provide dimensions for
each item:
a. All proposed vegetation clearing
b. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
c. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
d. Location of any proposed structures such as buildings, retaining walls, docks, etc.
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
Full Pond/ Normal Water
Shoreline
Plan View
La ke
(At Full Pond/ Normal Water Level)
&J -S- AtP,
202,v
5/x2& g �✓ u-��a�J
S" z 24-t" ? AJyr4AWL c44AT1q,
W/U.5 Micr,ro,o
A C.CFSS.
LOT 662-
Lake
6z
Lake
(At Full fond/ Normal Water Level(
Existing Dock
/ 30k x 7 fl
E AMP E
Plan View
FORM: SSGP 02-2017 Page 3 of 4
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err
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clear'-
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Plan View
FORM: SSGP 02-2017 Page 3 of 4

X/ REFI Y �
Ep'')GO
Y
AIK
Lake
(At Full Pc nd/ Normal Water Level
Side View
U-
3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing
'if necessary
Existing bank
10 ft. bank a
height Oh¢
°1
Side Vi
FORM: SSGP 02-2017
Page 4 of 4

Jones
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VICINITY MAP
SCALE, IINCH - 2000 FEET
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LOT 661
4
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TOPOGRAPHIC SURVEY
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POP6BEAR LAKE RESERVE
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0 CANADA TOWNSHIP
JACKSON COUNTY
fT1 X2564 BEAR LAKE NORTH CAROLINA
HIC
S 11'35'51" E
2. 31.37' NOTES:
14 HMc 1. ALL BOUNDARY INFORMATION SHOWN PER RECORD
X 2• PLAT BY OTHERS.
j• 2552.9
2. THIS MAP IS CERTIFIED TO REPRESENT THE RESULTS
s 7 xiseiaD DC52'S OF A TOPOGRAPHIC SURVEY ONLY.
X I S 25'05'24" E DOCK REPRODUCTIONS ILLUSTRATING PROPOSED DESIGN,
21.42' MODIFICATIONS OR REVISIONS BY OTHERS ARE NOT
57
AUTHORIZED, ENDORSED, OR APPROVED BY
X8 65X94.7 3e?o0a PROPe01VRTy ECIIVE a LEGEND: &COMPANY, P.A..
9 25 7 X
X 14.81R S
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= CABLE TV
= CORRUGATED METAL PIPE
X22689 S 76•� JL/� =CPP = CORRUGATED PLASTIC PIPE
X28 5.p7 X256&t
zs 64.4 38" 2571. 6 $ 04g,. „�, DBL = DOUBLE
X •POP 5 03 ❑ E BOX =ELECTRIC BOX
es x2675'2 24 .B x257 14•P 2572$ 9 IC CL S /I L • LBF =IRON BAR FOUND
'P 2 CBI 14 •POP DBL 12•HIC X 6477, BENCHMARK: SPIKE SET INV =INVERT
zsa2.o S8 X25716 64 22" IN 18" POPLAR • IPF = IRON PIPE FOUND
4 • A NS = NAIL SET
X2 76 2271. 6 E ELEVATION = 2579.00'
IMUM TBA �. 7 1 X14`P 61 25722 G,'62 (SCALED) OHW =OVERHEAD WIRES
BEAR LAKE CTUR x2D•P 1 2577. 3 569.7 ❑ PH BOX =PHONE BOX
GUIDED 5 P 14 1 7 A 2573.7 B HIG
25841 X2569.1 T = TOP OF BANK
. 'PDP TW = TOP OF WALL
8
4 POP
24-'R TRI =TRIPLE
\\ X 5x i I WM = WATER METER
\\ X25 7. IX 2567.5
xe I BIR =BIRCH MAP =MAPLE
TT. 23973 5 B zs S 11'27'49" W CO = CHESTNUT OAK POP = POPLAR
X2 227 D �R 27.19' GUM = BLACK GUM RO = RED OAK
R M HEM = HEMLOCK SW = SOURWOOD
259 5. I
2585.8 6 BOR.9X 7 7 HIC = HICKORY WO = WHITE OAK
T
Ba. 2577,8 LOC =LOCUST WP = WH TE PINE
T 259. x B6.4 X25 .2 6'BIN
2595.1 TREE SPECIES ABBREVIATION PRECEDED BY TRUNK
z 7 e 25 PS 1�� DIAMETER IN INCHES.
1594..9. X T 3.2
2593.9 X 59 6 X 8•B 'BIR DECIDUOUS TREE CONIFEROUS TREE
2593.3
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25B .9
261.
X257 .�
u :7.' : SCALE: 1 INCH = 20 FEET
G . _ E69{. E ,g
252 x257 9GJ CONTOUR INTERVAL: 2 FOOT
e 2511.x" 316•. IR
1D. DATE: OCTOECR 15, 2018 DRAWING NO. 6184
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12 • aiR; REVISIONS:
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77.5 I 4i ERIC A. IORENZEN, PL 0. J647 DATE:
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CAT41 C9
2628.4 I / 'U0' I, ERIC A LORENZEN, CERTIFY THAT THIS PROJECT WAS COMPLETED PREPARED BY
VILI I / UNDER MY DIRECT AND RESPONSIBLE CHARGE FROM AN ACTUALSURVEY
/ MADE UNDER MY SUPERVISION, THAT THIS GROUND SURVEY WAS PERFORMED SYLVESTER 8L COMPANY, PA ,
AT THE 95 PERCENT LEVEL (2 SIGMA) TO MEET FEDERAL GEOGRAPHIC DATA
25' / COMMITTEE STANDARDS. THAT THE HORIZONTAL ACCURACY IS 1:7500 AND
THAT THE VERTICAL ACCURACY IS 1 FOOT AND THAT THE ORIGINAL DATA
I WAS OBTAINED ON OCTOBER 12. 2018. THAT THE SURVEY WAS COMPLETED ON SURVEYING • PLANNING
OCTOBER 15, 201&, THAT CONTOURS SHOWN AS [BROKEN LINES] MAY NOT MEET
THE STATED STANDARD, AND ALL ELEVATIONS ARE BASED ON A SCALED P.O. BOX 1596 - 8 CHESTNUT SQUARE TEL [phone]
' ELEVATION FROM JACKSON COUNTY OS WEBSITE. CASHIERS. NORTH CAROLINA 28717 FAX [phone]
61 t54 LL