20220046 Ver 1_Shoreline Stabilization_20220110

Submission Form
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*
Owner Information:
Name: *
Email: *
Phone Number:
Mailing Address: *
[e-mail]
Please provide an email address for payment and requests for more information here.
Thomas & Brenda Staab
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
3033 Mansfield Lane
Address Line 2
City
Virginia Beach
Postal / Zip Code
23457-1181
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: *
Company Affiliation:
Email: *
Phone Number:*
Carissa Parker
Bennick Enterprises LLC
[e-mail]
[phone]
(xxx)xxx-xxxx
State / Province / Region
VA
Country
US

Mailing Address:* Street Address
7836 US 70 E
Address Line 2
City
State / Province / Region
Nebo
NC
Postal / Zip Code
Country
28761
US
A signed and dated copy of the Agent Authorization letter:
auth.pdf 215.12KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Black Forest 25
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.*
Upload File
Look up address
Property Address Lookup: * Street Address
1503 Black Forest Drive
Address Line 2
City
State / Province / Region
Marion
NC
Postal / Zip Code
Country
28752
US
Latitude: * 35.724865 Longitude: *
-81.976540
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 STAAB.pdf 380.69KB
plat.pdf 624.96KB
Please use the diagram at the link below:
https:Hedocs.deq.nc.gov/WaterResources/O/edoc/616616/Shoreline%2OLayout.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.)
Staab pic.pdf 5.13MB
4. Location of the property (where work is to be conducted)
Nearest Town: * Marion

County: * McDowell
Lake/ river/ ocean adjacent to Lake James
property:
Subdivisions name or site address: * Black Forest 25 1503 Black Forest Dr
Include phase/lot number
Directions to site: *
Take Hwy 126 to S Mtn Institute Rd to Lake James Rd to Black Forest Dr
to property
Please include road names and numbers, 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 12
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
795' shoreline stabilization, height will be 5'
8. How will the work be done?* From Land
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.)
795
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.)
3180
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)
9 TREES LESS THAN 6" AND 8 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
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:
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');
a 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:
Submittal Date: 1/6/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20220046 Version: *
Select Reviewer:*
Select Reviewing Office:
Has payment been received?*
What amount is owed?*
Mitchell Anderson:eads\mlanderson
Asheville Regional Office - [phone]
No Payment Needed
Fee Received
• Need Fee - send electronic notification
• $240.00
$570.00

THOMAS & BRENDA STAAB
LAKE JAM ES
BLACK FOREST 25
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.
SIGNATURI
DATE 2 Zu-L

Thomas Staab
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
Lake
(At Full Pond/ Normal Water Level)
Full Pond/ Normal Water
Shoreline
Black Forest 25
Plan View
1' x 795'
4' x 795' RAP
FORM: SSGP 02-2017 Page 1 of 3

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Thomas Staab
Black Forest 25