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Home My WebLink About20140411 Ver 1_Shoreline Stabilization_201404232 0 1 4 0 4? 1 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 Four copies of the application (including attachments) and the application fee should be sent to: Division of Water Resources PA `_�� 401 & Buffer Permitting Unit Q� 1650 Mail Service Center Raleigh, NC 27699 -1650 R 2 2014 Applicant Information [15A NCAC 02H 0502(a)] 1. Owner Information Name LYNN BLACK Mailing Address 1723 ASH COVE COURT MORGANTON NC 28655 Telephone Number 828 - 584 -9067 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 159 /docs /regulatory /regdocs /Permits /SAMPLE AGENT AUTH ORIZATION FORM pd f) 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 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 L�nV_\ t31 ctJ__ 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 MORGANTON Subdivision name or site address (include phase /lot number) SOUTH POINTE / 123 1723 ASH COVE COURT Directions to site - please include road names and numbers, landmarks, etc. FROM MORGANTON TAKE HWY 126 / TL ONTO SOUTHPOINTE DR / TR ONTO ASH COVE COURT TO PROPERTY 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) 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)- 100' OF SHORELINE STABILIZATION BY BARGE HEIGHT WILL BE 2' 9. Will work be conducted from land? E] 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 1' X 100 ' = 100 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. 1' X 100'= 100 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 P CIA &03-C& q11 q // L/ Owner /Agent's Signature* [15A N AC 02H 0502(f)] Dat xAgent's signature is valid only if an authorization letter from the owner is provided FORM SSGP 10 -2013 Page 2 of 3 Lynn S/adc La ke (At FuII Pond/ Normal Water Level) • �x�. �.:a� s;±sc�'. �w N? ax�- a,.r,G. n«:pa"F ;� .�:t,:�, ,,,� sd. �n��a'c a1�� ,wsa: ucwn:'..., /u�— 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 LYNN BLACK LAKE JAMES SOUTH POINTE / 123 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. 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