20140446 Ver 1_Shoreline Stabilization_20140501

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 LtN44R AY - ] 2014
I. Applicant Information [15A NCAC 02H 0502(a)] - WATE AL11Y
1 Owner Information
Name MICHAEL TAMBERELLA
Mailing Address 1000 DORNOCH RD
GASTONIA, NC 28054
Telephone Number 704 - 864 -6090 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
htta / /www saw usace armv mil / Portals /59 /dots /reRulatory /re2docs /Permits /SAMPLE AGENT AI;TH
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)]
1 Attach a vicinity map (i a 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

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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 MORGANTON
Subdivision name or site address (include phase /lot number) DRY CREEK / 16
1621 OLD DRY CREEK RD
Directions to site - please include road names and numbers, landmarks, etc
FROM MORGANTON TAKE HWY 126 / TL ONTO SOUTHPOINTE DR / TR ONTO OLD DRY
CREEK RD 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) 686
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) 200' OF SHORELINE STABILIZATION BY BARGE, HEIGHT
WILL BE 2 -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
1' X 200 ' = 200 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 200' = 200 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
Owner /Agent's Signature [15A NCAC 0214_ 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

Full Pond/
Normal Water Level
MM��� MM
Shoreline
La ke
(At Full Pond/ Normal Water Level)
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ILP
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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

MICHAEL TAMBERELLA
LAKE JAMES
DRY CREEK LOT 16
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
Date ' Y

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Michael Tamberella
Dry Creek 16

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Pisgah National Forest Michael Tamberella Dry Creek lot 16
1621 Old Dry Creek Rd
Latitude: 35.76032
Lon g itude:81.84077W
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