20140313 Ver 1_Shoreline Stabilization_20140327

State of Nnrth rarnlinn
DWR Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10 -2013
Shoreline Stabilization Application Form 2 0 1 40 3 1 3
Four copies of the application (including attachments) and the application fee should be sent to:
Division of Water Resources
401 &Buffer Permitting Unit
1650 Mail Service Center
Raleigh, NC 27699 -1650
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: JENNIFER KERSTEN & TIMOTHY ROUSH
Mailing Address: 2101 DARTMOUTH PLACE
CHARLOTTE NC 28207
Telephone Number: 704- 562 -7519 Fax Number:
E -mail Address:
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http: / /www.saw.usace. army. mil / Portals /59 /docs /regulatory /regdocs /Permits /SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: CARISSA PARKER
Company Affiliation: BENNICK ENTERPRISES LLC
Mailing Address: 7836 HWY 70 E
0 NC 28761
Telephone Number: 828- 659 -1000 Fax Number: 828 - 659 -1001
E -mail Address: [e-mail]
Person to receive the Certification Approval: CARISSA PARKER
II. 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, structures (buildings, retaining walls, docks, itu.Zervious surfaces,
etc.), rip rap, excavation or dredging below Full Pond/ Normal Wiwak& 1Mlj-y
FORM: SSGP 10 -2013 11 M11 -1 7 42� j4
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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: BURKE Nearest Town -- NEBO
Subdivision name or site,address (include phase /lot number). 1780 LOT 174
2123 FIRESTONE TRAIL, NEBO NC 28761
Directions to site - please include road names and numbers, landmarks, etc..
FROM MORGANTON TAKE HWY 126 / TR ONTO CARSON DR /'TL ONTO YELLOW
FORK TRAIL, TL ONTO FIRESTONE TRAIL TO PROPERTY ON LEFT
5. Describe the existing land use or condition of'the site at the time of this application
(residential, undeveloped, etc.). VACANT WOODED LOT AREA
6 Property size (acres): 2.45
7. Lake/ river/ ocean adjacent to property- LAKE JAMES
8. Describe proposed work (include discussion as °to how hardening ofshoreline'has been
avoided, or why it is necessary): 80' OF SHORELINE STABILIZATION BY BARGE HEIGHT
WILL BE 3'
9. Will work be conducted from land? ❑ From water?
10. Total amount of disturbance (including all excavation, backfill, rip rap,,retaining walls, etc.)
below the normal pool lake level/ Normal Water Level in square feet or acres-
80'X 2'= 160 SQ FT
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres: '80'X 1' = 80 SQ FT
12. 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)- NO TREE REMOVAL
YIA�7r i�JJ�A vl�+
3
Owner /Agent's Signature* [15 CAC 0 0502(f)] Date
Agent's signature is valid only if an authorization letter from the owner is provided,
FORM SSGP 10 -2013 Page 2 of 3

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Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ft x,100 ft) *
1. All proposed vegetation clearing
2 Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
3 Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
4. Location of,an,y proposed structures such as'bueldings, retaining walls, docks, etc.
5 Location of'any excavation or dredging belowthe Full'Pond/ Normal Water Level elevation
6. Location of construction access corridors
FORM SSGP 10 -2013 Page 3 of 3
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Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ft x,100 ft) *
1. All proposed vegetation clearing
2 Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
3 Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
4. Location of,an,y proposed structures such as'bueldings, retaining walls, docks, etc.
5 Location of'any excavation or dredging belowthe Full'Pond/ Normal Water Level elevation
6. Location of construction access corridors
FORM SSGP 10 -2013 Page 3 of 3

JENUIFE'R KERSTEN / TIMOTHY RO.USH
LAKE JAMES
17801/174
To: North Carolina Division of Water Quality
I give Carissa Parker, of Bennick Enterprises, LLC., permission to sign
as my agent on my application for shoreline - stabilization.
Signature (s)
Date z /mil /y

Legend of shoreline areas are,
107 —A Mica -Ave. 1780 Lot- 1 �4 Shoreline from dily6l6dee§ FERC plan
Morganton, NC 28655 Stabilization Areas POTENTIAL_SHOREUNE
Phone, (828)437 -2290 PRELIMINARY MAP ONLY NOT TO BE © STADUZATION AREA
Fax [phone] USED FOR RECORDATION, SALES 'OR ®= ENVIRONMENTAL AREA
CONVEYANCE 09/10/2007'
Abernathy & E —mail aapcftellsouth.net
AssocAssociates P.C.. The purpose of this map is to show potential shoreline stabilization areas
iates, , , Owner rnusl receive aaorovol from all rec ulalor agenc ieS [prior lip c.anslrudion
L137 171 (Vote Refer to recorded
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Jennifer Kersten & Timothy Roush
1780 lot 174

Jennifer Kersten & Timothy Roush
Pisgah National Forest
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Jennifer Kersten / Tim ...
1780 lot 174 Lake James
2123 Firestone Trail
Latitude: 35.74235 N
Longitude: 81.89171 W
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