20201014 Ver 1_Shoreline Stabilization_20200731

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Lx� State of North Carolina
Department of Environment and Natural Resources
Water Resources
ENVIRONMENTAL DUALITY
Division of Water Resources
15A NCAC 02H .0500 — WaterQuality Certification, Shoreline Stabilization
Shoreline Stabilization Application Form
FORM: SSGP 02-2017
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 ;� �'� dv
A. Applicant Information [15A NCAC 02H .0502(a)] ' �k � (
1. Owner Information✓- � � (�
Name: BENTHOS LLC (JEREMY PURBRICK)
Mailing Address: 1950 YELLOW FORK TRL EAST
NEBO NC 28761
Telephone Number: 919-740-2961 Fax Number:
E-mail Address:
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.savv.usace.armv.mil/Portals/59/docs/reeulatorv/re�docs/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: [e-mail]
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 propos d 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 cond
County: MCDOWELL Nearest Tow NEBO
Lake/ river/ ocean adjacent to property: DAMES
Property size (acres):
Subdivision name or site address (include phase/lot number): 1780 LOT 192
Directions to site -please include road names and nu bers, landmarks, etc.:
FROM MORGANTON TAKE HWY 126 / TL ON CARBON DR / TR ONTO YELLOW FORK
PERTY
Latitude (in decimal degrees) 35.74155
5. Describe the existing land use or condition of the
(residential, undeveloped, etc.): VACANT 1A
6. Describe proposed work (include discussion as to
avoided, or why it is necessary):
HEIGHT WILL BE 10'
de (decimal degrees) 81.90555
at the time of this application
hardening of shoreline' has been
ABILIZATION
7. Will work be conducted from land? ❑ i From water?
8. Total amount of impacts below the normal pool lake bevel /Normal Water Level
Permanent impacts (including all excavation, backfill, jrip rap, retaining walls, etc.) in square feet:
6' X 258' = 1548 SO 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:
4' X 258' = 1032 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): 4 TREES LESS THAN 6" AND
6 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

11. Signatu
� �
Owner/Agent's Signa re' [15A CAC 02 .0502(f)1 � Dat
Agent's signature is valid only if an authorization lett�r 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
Lake
(At Full Pond/ Normal Water Lever
Full Pond/ f`�ormal 'Water Level
Shoreline
i-�s��iea
�a n View
FORM: SSGP 02-2017 Page 3 of 3

TO: NORTH CAROLINA DIVISION OF WA
1 GIVE CARISSA PARKER, OF BENNICK EN'l
PERMISSION TO .SIGN AS MY AGENT ON MY
SHORELINE STABILIZATION.
SIGNATURE (S)
DATE � `� �'�-�
RESOURCES
ISES, LLC.,
CAT(ON FOR'

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Benthos LLC - 1780 192
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BENTHOS LLC
1780 lot 192
2070 Yellow Fork Trl W
Latitude: 35.74155 N
Longitude: 81.90555 W
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