20201159 Ver 1_Shoreline Stabilization_20200904

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State of North Carona
Department of Environment and Natural Resources
Division of Water Resources
Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
ENVIRONMENTAL QUALITY FORM: SSGP 02-2017
Shoreline Stabilization Application Form
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 RECEIVED
Raleigh, NC 27699-1617 Raleigh, NC 27604
A. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name:
Mailing Address:
Telephone Number:
E-mail Address:
ROBERT & SHIRLEY NORDBLOM
19 ANCHOR COVE CT
BLUFFTON SC 29910
978-337-6038 Fax Number:
2. Agent/ Contact Person Information
SEP 0 4 2020
NCDEQ/DWR/NPDES
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:
htto://www.saw.usace.armv.mil/Portals/59/docs/reizuIatorv/reedocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf)
Name:
CARISSA PARKER
Company Affiliation:
BENNICK ENTERPRISES, LLC.
Mailing Address:
7836 HWY 70 EAST
NEBO NC 28761
Telephone Number:
828-659-1000 Fax Number: 828-659-1001
E-mail Address:
CARISSA(@BEN NICKGRADING.COM
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

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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: MCDOWELL Nearest Town: NEBO
Lake/ river/ ocean adjacent to property: JAMES
Property size (acres): 1.5
Subdivision name or site address (include phase/lot number): OLD WILDLIFE CLUB 5
2008 OLD WILDLIFE CLUB DR
Directions to site - please include road names and numbers, landmarks, etc.:
FROM MORGANTON TAKE HWY 126 / TR ONTO WILDLIFE RD / TR ONTO OLD WILDLIFE
CLUB DR TO PROPERTY
Latitude (in decimal degrees) 35.74686 Longitude (decimal degrees) 81.91841
S. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): VACANT WOODED LOT
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): 200' SHORELINE STABILIZATION BY BARGE,
HEIGHT WILL BE 5'
7. Will work be conducted from land? ❑ 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:
3' X 200' = 600 SQ FT
Temporary impacts in square feet:
NO TEMP IMPACT
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:
2' X 200' = 400 SQ FT
Temporary impacts (temporary clearing, construction corridor) in square feet:
NO TEMP IMPACT
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): 6 TREES LESS THAN 6" AND
4 TREES GREATER THAN 6" WILL BE REMOVED TO COMPLETE THIS PROJECT. THEY WILL BE
REPLACED INCH FOR INCH WITH TREES TOTALING THE SAME DIAMETER. ANY REMAINING
DISTURBED AREA WILL HAVE MULCH APPLIED TO IT
FORM: SSGP 02-2017 Page 2 of 3

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11. Sign
21 ^ZD
o ent's Si re CAC 0 .0502(f)1 Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
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
La ke
{At Full Pond/ Normal Water Level)
Full Pond/ Normal Water Level
Shoreline
oil w;�dr,� c��
;0 5
Plan View
I 1 �
3��ou
FORM: SSGP 02-2017 Page 3 of 3

ROBERT & SHIRLEY NORDBLOM
LAKE JAM ES
OLD WILDLIFE CLUB / 5
TO: NORTH CAROLINA DIVISION OF WATER RESOURCES
I GIVE CARISSA PARKER, OF BENNICK ENTERPRISES, LLC.,
PERMISSION TO SIGN AS MY AGENT ON MY APPLICATION FOR
SHORELINE STABILIZATION.
SIGNAtuAtirk

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ROBERT & SHIRLEY NORDBLOM
OLD WILDLIFE CLUB LOT 5

Nordblom - OWC 5
Latitude: 35.74686 N
Longitude: 81.91841 W Nrr �-
6,
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Pisgah NationalPdiest
Lake James
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