20140358 Ver 1_Shoreline Stabilization_20140410

-Dan ScxNile 2 0 1 4 0 3 5 8
State of North Carolina
Department of Environment and Natural Resources
DWR 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
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: DONALD SAVERY
Mailing Address
Telephone Number
E -mail Address:
INDIATLANTIC FL 32903
321 - 795 -5222 Fax Number:
2. Agent/ Contact Person Information
AA P R 1 0 2014
NR _ N
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
htto : / /www.saw.usace.arniv.rniI/ Portals /59/ dots /reF,ulatory /readocs /Perm_its /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
NC 28761
Telephone Number: 828- 659 -1000 Fax Number: 828- 659 -1001
E -mail Address: CARISSA@ BEN NICKGRADING.COM
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, impervious surfaces,
etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
FORM: SSGP 10 -2013 Page 1 of 4

,Dov1 Soll���1
.l
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 NearestTown. MORGANTON
Subdivision name or site address (include phase /lot number): SOUTH POINTE / 213
1480 BRAXTON GATE DR EXT
Directions to site - please include road names and numbers, landmarks, etc.:
FROM MORGANTON TAKE HWY 126 / TL ONTO,SOUTHPOINTE DR / TL ONTO
PEN BROKE DR It TL ONTO BRAXTON GATE DR EXTENSION TO PROPERTY
5 Describe the existing land use or condition of the site at the time of this application
(residential,, undeveloped, etc.): VACANT WOODED'LOTAREA
6. Property size (acres): .69
7. Lake/ river/ ocean adjacent to property: LAKE JAMES
8. Describe proposed work (include discussion as to how hardening of shoreline has.been
avoided, or why it is necessary) 310' OF SHORELINE STABILIZATION BY BARGE, HEIGHT
WILL BE 3 -4-'
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.
2'X 310'-- 620 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: 2'X 310' = 620 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): 8 TREES LESS THAN 6"
AND 2 TREES GREATER THAN 6" WILL BE REMOVED TO COMPLETE THIS PROJECT. THEY
WILL BE REPLACED INCH FORJNCH, WITH TREES TOTALING -THE SAME DIAMETER. ANY
REMAINING DISTURBED AREA WILL HAVE MULCH - APPLIED TO IT.
Owner /Agent's Signature* A [1 NCAC`02H 0502(fpj ID e,
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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Nor
I X 310' 20�
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 any proposed structures such as buildings, retaining walls, docks, etc.
5. Location of any excavation or dredging below the Full Pond'/ Normal Water Level elevation
6. Location of construction access corridors
FORM- SSGP 10 -2013 Page 3 of 3

DONALD SAVERY
LAKE JAMES
SOUTH POINTE / 213
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) I _
Date�� �7

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Don Savery
South Pointe / 213

Don Savery SP 213
'te
Donald Savery
Braxton Gate Dr
South Pointe lot 213
Latitude: 35.76460 N
Lon itude: 8482790 W
Lake James
- . W,415�
�4,fO
40\0 Untain Rd
U ml U.2 U.4 U.b U.6 1 1.2 1.4
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