20210822 Ver 1_Shoreline Stabilization_20210528

Shoreline Stabilization Application Form
15ANCAC 02H .0500 — Water QualityCertification, Shoreline Stabilization
FORM SSGP 10-2013
DRAFT -NOT FOR USE AT THIS TINE
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 view the form.
Attach documentation of Pre -Filing Meeting Request here:
pre file.pdf 841.85KB
Pre -fling Meeting or Request Date 4/22/2021
ID# 20210822
I. Applicant Information [15A NCAC 02H .0502(a)]
Version 1
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 *
Owner Information:
Name:*
Email:
*
Phone Number:*
Mailing Address:*
[e-mail]
Rease provide an email address for payrrent and requests for pore information here.
Joseph & Tamara Rice
carissa@bennickgrading. com
[phone]
(xxx)xxx-xxxx
Street Address
315 Westside Drive
Address Line 2
CitY
Chapel Hill
Rbstal / Zip Code
27516-8394
State / Rovince / Region
NC
Country
US

Is there an agent working on the
project? *
Agent/Consultant Information
..................................................................................................................
Name:*
Company Affiliation: *
Email:*
Phone Number:*
Mailing Address:*
C' Yes
r No
Carissa Parker
Bennick Enterprises LLC
[e-mail]
[phone]
(xxx)m-
Street Address
7836 US Hwy 70 E
Address Line 2
City State / Bovine/ Region
Nebo NC
Fbstal / Zip Code Country
28761 USA
Asigned and dated copy of the Agent Authorization letter:*
auth'.pdf 353.55KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
OWC 36
If your project has a formal name please use this. If your project does not have 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
C' Look up address
Property Address Lookup:*
Latitude:*
35.739319
Street Address
260 Rusty Hook Drive
Address Line 2
City State / Rovince / Fbgion
Nebo NC
Fbstal / Zip Code Country
28761 US
Longitude:* -81.922817
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 501.15KB
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.)*
Rice.pdf 3.6MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Nebo
County:* McDowell
Lake/ river/ ocean adjacent to Lake James
property:
Subdivisions name or site address:* Old Wildlife Club lot 36
hclude phase/lot number
Directions to site:*
from Morganton take Hwy 126 / TR onto Wildlife Rd / TR onto Old
Wildlife Club Dr / TR onto Rusty Hook Dr to property
Rease include road names and nurrbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
vacant wooded lot
Residential, undeveloped, etc.
6. Property Size
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
100' Shoreline stabilization by barge, height will be 3'
8. How will the work be done?*
r From Land
TJ From Water
9. Total amount of disturbance below the normal pool lake level/ normal water level:*
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
100
square feet
10. Total amount of disturbance above the normal pool lake level/ normal water level and 50 feet
land -ward:*
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
200
square feet
11. 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)
2 TREES LESS THAN 6" AND 1 TREE 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
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):
a $240.00 for impacts to lake (below normal water level) of less than 1 acre
a $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:
a I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the
best of my knowledge and belief
a 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.
a 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");
a 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");
a I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:* CarissaParker
Signature:

Initial Review
Is this accepted into the review C' Yes 0 No
process?*
Project Number:* 20210822
Select Reviewer:*
Select Reviewing Office:
Has payment been received?*
What amount is owed?*
Version: *
Amy Annino:eads\amannino
Asheville Regional Office - [phone]
1
✓ No Payment Needed
✓ Fee Received
C' Need Fee - send electronic notification
C' $240.00
✓ $570.00

JOSEPH & TAMARA RICE
LAKE JAM ES
OLD WILDLIFE CLUB 36
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)
DATE
4.4)Ag
6/4/94

Water Resources
ENVIRONMENTAL QUALITY
iCk
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
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
Full Pond/ Normal Water Level
Shoreline
FORM: SSGP 02-2017
Page 1 of 3

DWR Pre -Filing Meeting Request Form
ID#*
Regional Office *
Reviewer List*
20210822
Version *
Asheville Regional Office - [phone]
Amy Annino
Pre -Filing Meeting Request submitted 4/22/2021
Contact Name *
Contact Email Address*
Project Name
Project Owner*
Project County*
Owner Address:
Carissa Parker
[e-mail]
OWC 36
Joseph & Tamara Rice
McDowell
Street Address
315 Westside Dr
Address Line 2
oty State / R ovine / Region
Chapel Hill NC
Fbstal / Zip Code Country
27516 USA
Is this a transportation project?* r Yes C' No
Type(s) of approval sought from the DWR:
401 Water Quality Certification - i 401 Water Quality Certification -
Regular Express
Individual Permit E Modification
Shoreline Stabilization
Does this project have an existing project ID#?'
r Yes (7 No
Do you know the name of the staff member you would like to re guest a meeting with?
Amy Annino
Please give a brief project description below and include location information.*
100' shoreline stabilization by barge
By digitally signing below, I certify that I 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
Cr4,-is$ 45iWryi
Submittal Date 4/22/2021

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