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,�� � ® State of North Carolina
�j1� Department of Environment and Natural Resources
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Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources
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 Lg � � u j] E D
1650 Mail Service Center
Raleigh, NC 27699 -1650
MAY - 1 2014
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I. Applicant Information [15A NCAC 02H 0502(a)]
1. Owner Information
Name CHIP HILLS
Mailing Address 7247 GOVERNORS ROW
CHARLOTTE NC 28277
Telephone Number 408 - 368 -7831 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 pd f) must be attached if the Agent has signed this application form
Name-
CARISSA PAR
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 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

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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 MCDOWELL Nearest Town NEBO
Subdivision name or site address (include phase /lot number) 1780/4
2620 OLD NEBO BRIDGE RD
Directions to site - please include road names and numbers, landmarks, etc
FROM MORGANTON TAKE HWY 126 / TR ONTO CAMPBELL'S TRACE / TL ONTO OLD NEBO
BRIDGE RD TO PROPERTY AT END OF RD
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) 5.43
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): 1045' OF SHORELINE STABILIZATION BY BARGE
HEIGHT WILL BE 5 -7'
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-
3'X 1045'= 3135 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 TX 1045'= 3135 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) 24 TREES LESS THAN 6"
AND 4 TREES GREATER THAN 6" WILL BE REMOVED TO COMPLETE THIS PROJECT THEY
WILL BE REPLACED INCH FOR INCH, WITH TREES TOTALING THE SAME DIAMETER ANY
REMAINING DISTURBED AREA WILL HAVE MULCH APPLIED TO IT
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Owner /Agent's Signature* [15A NCAC 02H 0 2 f D zWe
{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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(At Full Pond / Normal Water Level),,
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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
• 145 73' IS IMZ — CHECK FOR $437 25 WILL BE MAILED TO DUKE FOR HEP
FORM SSGP 10 -2013 Page 3 of 3

CHIP HILLS
LAKE JAMES
1780/4
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 � - i - I y

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