20211228 Ver 1_Shoreline Stabilization_20210817

Water Resources
ENVIRONMENTAL OUALITY
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
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
Karen Higgins
DWR — 401 & Buffer Permitting Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
A. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name:
Mailing Address: i2OO P)eSscmu
C i O j h1(. 2�1-IUS
Telephone Number:336-14.4414S Fax Number:
E-mail Address: -1-01NA.10arx%Co. GpM
If sending via delivery service (UPS, FedEx, etc.)
Karen Higgins
DWR — 401 & Buffer Permitting Branch
512 N. Salisbury Street
Raleigh, NC 27604
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.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf)
Name: ISIor S kth
Company Affiliation: `E C1. 1fe (SS1StOtrtr"
Mailing Address: 221.)b Q,esS!mu' AVL.
C,S/), Nc Z�aos'
Telephone Number: ?):46- .f; 1a1c.-3 Fax Number:
E-mail Address: .1-01\11 b. LDM
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: Pelson Nearest Town: :mD1 cx
Lake/ river/ ocean adjacent to property: VikiCc,Lo QL
Property size (acres): 3 S 2
Subdivision name or site address (include phase/lot number): toot pm
tax 1 tr. 0 tit f 1 Dii CLvin& by C:.mG101 t•1(., 21343
Directions to site - please include road names and numbers, landmarks, etc.:
DviI VP in G G+t Cow s 1O'Zu 5er ptacetri O.Lfl ss Ae, do m 1 c
CiOrr Da) (7,raSSy 11-110w1(S ¥o • I ottt ShDYe. 0.td its DULY_ Mao
Latitude (in decimal degrees)'=jG ry11St 40J Longitude (decimal degrees)-10 .\rL` ^�
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Ce,S►c1JS reed
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
in��cr.il�rv.� Grovel O(Y1 riptp\Q fin kvnid 6xeSttY\ c r 1 SttNtpulf-j0,94\1Lared..
7. Will work be conducted from land? Lg
From water? n
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:
C)D
Temporary impacts in square feet:
9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet
land -ward
Permanent imp cts (including back fill, excavation, rip rap, retaining walls, etc.) in square feet:
?)000 SPA. .
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):
Erorl�d ipti_ VVII cLtafi aryl citftrn fi'ml a nofmal 10.1.tc► 61 v O ii On .
FORM: SSGP 02-2017
Page 2 of 5

11. Signatur `7��
Owner/Agent's Signature' [15A NCAC 02H .0502(f)l 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
Full Pond/ Normal Water Level
M !
Shoreline
Plan View
Lake
(At Full Pond/ Normal Water Level)
,
FORM: SSGP 02-2017
Page 3 of 5

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
DCLVL Ytl:ord#t tOxc
LOT NO. I U PLAN NO. �' I !-Z PARCEL ID: ?j -
STREET ADDRESS: I On ( .incistun eci, Sn Dic► N(, 2� 343
Please print: �y
Property Owner: %(4SSCIRAA C'1(J I l hO
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
TN►or ¶rnl �n
(Contra or / Agent)
of [2.)e,SS-t x ( r _
(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):
Telephonert 2S13 -s &10
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature
Date:
Authorized Signature
Date:

Taylor Smith
From: RaleighNCREG <[e-mail]>
Sent: Friday, July 23, 2021 11:49 AM
To: Tom Berry; Taylor Smith
Cc: Norton, April R CIV USARMY CESAW (USA); Thames, Joyce A CIV USARMY CESAW (USA)
Subject: [EXTERNAL] SAW-2021-01587 (Thomas Berry / Hyco Lake 1017 Corington Rd / Semora
NC / Person County)
Good Morning,
We have received your RGP 30 request, assigned the request file number SAW-2021-01587.
Please refer to this file number in all correspondence.
Thank you,
Josephine Schaffer
Regulatory Division
Wilmington District, USACE
[phone] ext. 28
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REVISIONS
PROPERTY OF
BESSEMER. GROUP
PO. max //// Q,.EeA&aDRO. N.C. 274ei rE. Yr.Z7341K3
TOWNSHIP: L'S',VA//NGNAM ,COUNTY:
COMPANY
0/6.e.eY C. CALL /corr - L .5
2502 FRY srmetT ames.oesmomo,,.I.C. .i 7¢o,3
-ow. „IN - aca. 7S44
DATE: S- /*- D• /
SURVEYED BY: JCC
SCALE
STATE: NORTH CAROL/NA
SCALE: /'_ zcio'
DRAW BY: Jcc
FIELD BOOK
_ZONE: TAX MAP: q.3 PARCEL: 4
CIAEcKED E CLOSURE BY: JCL.
DRAWING AV.
J. Zoo/- 36

Taylor Smith
From:
Sent:
To:
Subject:
Sent from my mobile.
[e-mail]
Wednesday, July 21, 2021 7:54 AM
Taylor Smith
[EXTERNAL]
i

3

•
4

5

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DWR Pre -Filing Meeting Request Form
Contact Name*
Contact Email Address*
Project Owner*
Project Name*
Project County*
Owner Address: *
Bessemer Group/ Thomas Berry
[e-mail]
Bessemer Group/ Thomas Berry
Bessemer Group Dock
Person
Street Address
2200 E BESSEMER AVE
Address Line 2
City State / Province / Region
Greensboro NC
Postal / Zip Code Country
27405 United States
Is this a transportation project? * Yes No
Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Individual Permit
Shoreline Stabilization
Does this project have an existing project ID#? *
Yes No
NORTH CAROLINA
En ronnrnrol Qualify
401 Water Quality Certification - Express
Modification
Do you know the name of the staff member you would like to request a meeting with?
Stephanie Goss
Please give a brief project description below and include location information. *
After the fact, Rip Rap Installation.
Dock 106
1017 Covington Road
Please see attached for project details.
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.

Amber Neal
From: [e-mail]
Sent: Friday, June 04, 2021 3:41 PM
To: Amber Neal
Subject: Pre -Filing Meeting Request Acknowledgement - Bessemer Group Dock
Attachments: DWR Pre -Filing Meeting Request Form.pdf
The North Carolina Division of Water Resources has received the Pre -Filing Meeting Request Form
for Bessemer Group Dock that you submitted on 6/4/2021. Attached is a copy of your request.
All certification requests (applications) must include documentation that a pre -filing meeting request was
submitted to the certifying authority at least 30 days prior to submitting the certification request.
The Division can not accept an application for your project earlier than 30 days from this pre -filing meeting
request. Applications that do not meet this 30-day requirement will be returned.
Please save this email/attachment; it must be submitted with your application to document that this
requirement has been met.
This email was automatically generated by Laserfiche workflow. Please do not respond to this email address,
as responses are not monitored.
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