20211484 Ver 1_Shoreline Stabilization_20211012

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Director
NORTH CAROLINA
Environmental Quality
aca/19crf
?ckl)
State of North Carolina
Department of Environment Quality
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 09-2020
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
Paul Wojoski
DWR — 401 & Buffer Permitting Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
If sending via delivery service (UPS, FedEx, etc.)
Paul Wojoski
DWR — 401 & Buffer Permitting Branch
512 N. Salisbury Street
Raleigh, NC 27604
NOTE: 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) which states "At least 30
days prior to submitting a certification request, the project proponent shall request a pre -filing
meeting with the certifying agency." In accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5), all
certification requests 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. 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 to this application.
Date of Pre -filing Meeting Request:
DWR ID #
tP / (9J
(required)
Version (if applicable)
A. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: ..1Q OL..e-<
Mailing Address:
4. r.-\C.-
RECEIVED
OCT 122Q21
DEQ-WATER RESOURCES
401 & BUFFER PERMITTING
Telephone Number: qbq-clef t =4Z `9 Fax Number:
E-mail Address: is oLE•_{ cAm POEes-
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 11617 Mail Service Center I Raleigh, North Carolina 27699-1617
919.707.9000

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:
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
)\
Fax Number:
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.
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: "Bo P.. I< E Nearest Town: I\tc
Lake/ river/ ocean adjacent to property: i..:41. o± JA Aka' S
Property size (acres): 1- B /\c-- .
Subdivision name or site address (include phase/lot number):
Directions to site - please include road names and numbers, landmarks, etc.:
1dL1'z-4y .'Tv "\".11A.16t lAt l i T'`> L1 Al4
Latitude (in decimal degrees) Longitude (decimal degrees)
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): RZSI�i-&__
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): �1. (3-� SLD' c csy\A
'r ' �o �t x� ;N ' '►-O �r,�.
FORM: SSGP 09-2020 Page 2 of 6

7. Will work be conducted from land? 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:
Temporary impacts in square feet:
KID 'm e.
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:
Ct� (U.r�` -. ►z t{ s ,,« 4- ace_. l e. ibu, i c
Temporary impacts (temporary clearing, construction corridor) in square feet:
O`f l — occ-` ca u. ' , :�. S .T("e°
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): Lo es 0-
11. Signature
By signing below, I, as the project proponent, certify to the following:
• The project proponent hereby certifies that all information contained herein is true,
accurate, and complete to the best of my knowledge and belief
• The project proponent hereby requests that the certifying authority review and take action
on this C. 01 certification request within the applicable reasonable period of time
Owner/A
nature* [1 NCAC 02H .0502(f)] 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
z
FORM: SSGP 09-2020
Page 3 of 6

10/5/21, 10:04 AM
Morganton - Google Maps
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DWR Pre -Filing Meeting Request Form
NORTH CAROLINA
Environmental Quality
Contact Name *
Contact Email Address*
Project Owner*
Project Name*
Project County*
Brad Camp
[e-mail]
Brad Camp
rip rap for erosion control
Burke
Owner Address:* Street Address
4774 Linville Cove Ct.
Address Line 2
City State! R-ovince / Region
Morganton NC
Festal / Zip Corte Country
28655 United States
Is this a transportation project?* r" Yes (' No
Type(s) of approval sought from the DWR:
I` 401 Water Quality Certification - r- 401 Water Quality Certification -
Regular Express
E Individual Permit E Modification
V Shoreline Stabilization
Does this project have an existing project ID#?*
c Yes T No
Do you know the name of the staff member you would like to request a meeting with?
No
Please give a brief project description below and include location information.*
We would like to place 56 ft of rip rap along the edge of our shore at
Lake James to prevent soil erosion in the case of storm driven rising
lake waters.
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 upojeceipt 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.

1
Signature*
Submittal Date 8/24/2021