20210276 Ver 1_Shoreline Stabilization_20210323

Submission Form
Pre -Filing Meeting Information
Before submitting this form please ensure you have submitted the Pre -Filing Meeting Request Form as we will not be able
to accept your application without this important first step. The Pre -Filing Meeting Request Form is used in accordance
with 40 C.F.R. Section 121.4(a) "At least 30 days prior to submitting a certification request, the project proponent shall
request a pre -filing meeting with the certifying agency" and in accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5)
all certification requests shall include documentation that a pre -filing meeting request was submitted to the certifying
authority at least 30 days prior to submitting the certification request. Click here to read more information on when this
form is needed prior to application submission or here to viewthe form.
Attach documentation of Pre -Filing Meeting Request here:
pre file.pdf 933.89KB
Pre -fling Meeting or Request Date 2/10/2021
ID# 20210276 Version 1
I. Applicant Information [15A NCAC 02H .0502(a)]
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all
mandatory questions are answered.
Primary Contact Email * [e-mail]
Rease provide an err -ail address for payrrent and requests for pure infornation here.
Owner Information:
Name: *
Glen Kope & Carolyn Sullivan
Email: *
[e-mail]
Phone Number:*
[phone]
(xxx)xxx-xxxx
Mailing Address:*
Street Address
1945 Yellow Fork Trail
Address Line 2
City
State / Frovince / Region
Nebo
NC
Fbstal / Zip Code
Country
28761
USA

Is there an agent working on the F Yes
project?* r No
Agent/Consultant Information
Name: *
Carissa Parker
Company Affiliation: *
Bennick Grading
Email:*
[e-mail]
Phone Number:*
[phone]
(XXX)XXX-XXXX
Address:*
Street Address
7836 US Hwy 70 East
Address Line 2
City
Nebo
Fbstal / Zip Code
28761
Asigned and dated copy of the Agent Authorization letter:*
auth letter.pdf 263.53KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* 1780 168
State / Province / Region
NC
Country
USA
If your project has a formal name please use this. If your project does not hake a formal name, please identify your project by
the owner name and proposed activity (Jones Property Access Road, Smith Guest House, etc.) List in parentheses any
other names that have been used to identify the project in the past.
1. Provide 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.*
r Upload File
r Lookup address
Property Address Lookup:*
Latitude:* 35.742537
Street Address
1945 Yellow Fork Trail East
Address Line 2
City
Nebo
Postal / Zip Code
28761-0235
State / Province / Region
NC
Country
US
Longitude:*-81.894429
2. Provide a detailed site plan showing property boundaries and proposed locations of vegetation clearing,
structures (buildings, retaining walls, docks, impervious surfaces, etc.), rip rap, excavation or dredging
below Full Pond/ Normal Water Level elevations, and construction access corridors. You may use the
diagram under section 12.normal pool lake level/normal water level*
site plan.pdf 426.62KB
Please use the diagram at the link below:

https://edocs.deq.nc.gov/WaterResources/0/edoc/616616/Shoreline%20Layout.docx
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale of some sort- a
yard stick, shovel handle, etc.)*
Kope. jpg 6.92MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Nebo
County:* Burke
Lake/ river/ ocean adjacent to Lake James
property:
Subdivisions name or site address:* 1780lot 168
hclude phasellot number
Directions to site:*
Hwy 126 / TL Carson Dr / TL Yellow Fork Trl E to property
Rease include road naves and numbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
Residential
Residential, undeveloped, etc.
6. Pro pertySize 3.7
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
175' Shoreline stabilization, height will be 4'
8. How will the work be done? * r From Land
fJ From Water
9. Total amount of disturbance below the normal pool lake level/ normal water level:*
(including all clearing, backfill, excavation, rip rap, retaining walls, etc.)
175
square feet
10. Total amount of disturbance above the normal pool lake level/ normal water level and 50 feet
land -ward:*
(including all clearing, backfill, excavation, rip rap, retaining walls, etc.)
525
square feet
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet
landward to be impacted:*
(nunber of trees, for instance)
2 TREES LESS THAN 6" AND 1 TREE GREATER THAN 6" WILL BE
REMOVED TO COMPLETE THIS PROJECT. THEY WILL BE
REPLACED INCH FOR INCK WITH TREES TOTALING THE SAME
DIAMETER. ANY REMAINING DISTURBED AREA WILL HAVE
MULCH APPLIED TO IT
Sketch:
Application Fee:
Once the application has been accepted. You will need to send a corresponding fee in with the appropriate DWR#. The

application fee is as follows (pursuant to G.S. 143-215.3D):
0 $240.00 for impacts to lake (below normal water level) of less than 1 acre
0 $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:
o I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the
best of my knowledge and belief
o I, the project proponent, hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time.
o I agree that submission of this Shoreline Stabilization online form is a "transaction" subject to Chapter 66, Article 40 of
the NC General Statutes (the "Uniform Electronic Transactions Act');
o I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act');
0 1 understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
o I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:* Carissa Parker
Signature:

Initial Review
Is this accepted into the review
process?*
Project Number:* 20210276
Select Reviewer:*
Select Reviewing Office
Has payment been received?*
What amount is owed?*
rYes allo
Version:* 1
Amy Annino:eads\amannino
Asheville Regional Office - [phone]
r No Payment Needed
r Fee Received
r Need Fee - send electronic notification
r $240.00
f $570.00

GLENN KOPE & CAROLYN SULLIVAN
LAKE JAMES
1780 LOT 168
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.
SIGNATURE (S)IIA",
kl",-
<
DATE Z/z-4/q

r-a- State of North Carolina
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
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 Le
Shoreline
/0,- / b:�
Plan View
FORM: SSGP 02-2017 Page 1 of 3

Glenn Kope Carolyn Sullivan

Ip#* 20210276 Version* 1
Regional Office * Asheville Regional Office - [phone]
Reviewer List* Amy Annino
Pre -Filing Meeting Request submitted 2/10/2021
Contact Name * Carissa Parker
Contact Email Address*
Project Name's
Project Owner*
Project County*
Owner Address:
[e-mail]
1780168
Glen Kope & Carolyn Sullivan
Burke
Street Address
1945 Yellow Fork Trail
Address Line 2
aty
Nebo
Postal / Zip Code
28761
Is this a transportation project? " r- Yes (-- No
State / R avince / Region
NC
Country
USA
Type(s) of approval sought from the DWR:
F 401 Water Quality Certification - Pr' 401 Water Quality Certification -
Regular Express
F Individual Permit )-` Modification
W Shoreline Stabilization
Does this project have an existing project ID#?*
r" Yes r• No
Do you know the name of the staff member you would like to request a meeting with?
Amy Annino
Please give a brief project description below.*
175' Shoreline stabilization by barge
Please give a couple of dates you are available for a meeting.

Please attach the documentation you would like to have the meeting about.
By digitally signing below, I certify that 1 have read and understood that per the Federal Clean Water Act Section
401 Certification Rule the following statements:
• This form completes the requirement of the Pre -Filing Meeting Request in the Clean Water Act Section 401 Certification
Rule.
• I understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request.
• I also understand that DWR is not required to respond or grant the meeting request.
Your project's thirty -day clock started upon receipt of this application. You will receive notification regarding meeting location
and time if a meeting is necessary. You will receive notification when the thirty -day clock has expired, and you can submit an
application.
Signature
Submittal Date 2/10/2021
Reviewer Meeting Request Decision
....... .... .... ........ _.....
._
Has a meeting been scheduled?* r Yes r No