20140384 Ver 1_Shoreline Stabilization_20140414

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State of North Carolina
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 PA'
Four copies of the application (including attachments) and the application fee should be sent to:
Division of Water Resources
_•.
401 & Buffer Permitting Unit
L:NR 165 0 Mail Service Center
Ralei h N - g C 27699 1650 r Applicant Information [15A NCAC 02H .0502(a) ] v�? .
1. Owner Information
Name: KEITH ELMORE
Mailing Address: 16 OLMSTEAD RD
MORRISTOWN NJ 07960
Telephone Number: 678- 463 -9945 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:
httg: / /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
NEBO NC 28761
Telephone Number: 828- 659 -1000 Fax Number: 828 - 659 -1001
E -mail Address: CARISSA BENNICKGRADING COM
Person to receive the Certification Approval: CARISSA PARKER
II. Project Information [15A NCAC 02H .0502(a) & (b)j
I. 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

Ko4-I'A Elmo{�_
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: MCDOWELL Nearest Town- NEBO
Subdivision name or site address (include phase /lot number): OLD WILDLIFE CLUB /72
132 SCREECH OWL DR
Directions to site - please include road names and numbers, landmarks, etc
FROM MORGANTON TAKE HWY 126 / TR ONTO WILDLIFE RD / TA ONTO OLD
WILDLIFE CLUB'DR / TL ONTO GAMELANDS DR / TR ONTO HUNT CAMP DR / TL ONTO_
SCREECH OWL DR TO PROPERTY
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): 1.16
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)- 160' OF SHORELINE STABILIZATION BARGE HEIGHT
WILL BE 4 -5'
9. Will work be conducted from land? El 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 160' = 320_ SQ FT
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
wall's, etc.) above the normal pool lake'level/ Normal Water Level' and 50 feet land -ward in
square feet or acres- _ 3'X 160'= 480 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)- 6 TREES LESS THAN 6"
AND 1 TREE,GREATER THAN 6" WILL BE REMOVED TO COMPLETE THIS PROJECT. THEY
WILL BE REPLACED ACH FOR INCH WITH TREES TOTALING THE SAME DIAMETER. ANY
REMAINING DISTURBED AREA WILL HAVE MULCH APPLIED TO IT.
�l
Owner /Agent's Signature* [ 15A CAC 02H' 05n, 29m
YDt
Agent's signature is valid only if an authorization letter from the owner is provided
FORM SSGP 10 -2013 Page 2 of 3

FuIr,P.6 `d%
Norma'I,:W
f9mr® "M
Shoreline,
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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 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
A4

KEITH_ELMORE
LAKE JAMES
01D WILDLIFE CLUB / 72
To: North Carolina Division of Water Quality
I give, Cari'ssa Parker,..of Rennic-'k. Enterprises, 'LLC., permission to sign
as my agent on my application for shoreline stabilization.
Signature (s)
Date -A /� , /,,I

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Keith Elmore
Old Wildlife Club / 72

Keith Elmore - OWC 72
Longitude: 81.92065 W_
Pisgah National Forest
.�..
Lake James
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0 mi
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