20140457 Ver 1_Shoreline Stabilization_20140505

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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
Four copies of the application (including attachments) and the application fee should be sent to:
Division of Water Resources
401 & Buffer Permitting Unit PAID
1650 Mail Service Center
Raleigh, NC 27699 -1650 V 1I�s JjJ/
Pv1q y - 5 2014 U
Applicant Information [15A NCAC 02H .0502(a)] WA
1. Owner Information ►TY
Name: ANDY & RHONDA CHUSED
Mailing Address: PO Box 579
ATLANTIC BEACH NC 28512 -0579
Telephone Number: 252- 342 -6244 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.pdf) must be attached if the Agent has signed this application form.
Name:
Company Affiliation
Mailing Address:
SSA PARKER
BENNICK ENTERPRISE
7836 HWY 70 E
NEBO NC 28761
Telephone Number: 828 - 659 -1000 Fax Number: 828- 659 -1001
E -mail Address: _CARISSAP 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

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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 NEBO
Subdivision name or site address (include phase /lot number) 1780/92
2231 OBETH RD
Directions to site - please include road names and numbers, landmarks, etc
FROM MORGANTON TAKE- HiWY`126 /TO CARSON DR IN 1780 [TR ONTO YELLOW FORKS
TR / TR ONTO OBETH 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) 5
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
2'X 200'= 400 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/ Normali Water Level and
50 feet landward to be impacted (number of trees, for instance) 1 TREE LESS THAN 6"
,AND 1 TREE 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.
Owner /Agent's Signature* [15A N AC-02, 0502 f Da 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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Full"Poricl%
N'ormai�W r.L�evel, `
Shoreline
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Please approximately sketch the following information on this plan (prov1de dimensions for each
item, such as 10 ft x 100 ft) *.
I. 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
f
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vP�
5i' a
r�4 ��'��'• Yom- � �: - - T , _
Please approximately sketch the following information on this plan (prov1de dimensions for each
item, such as 10 ft x 100 ft) *.
I. 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

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ANDY & RHONDA CHUSED
LAKE JAMES
1780/92
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)
Date- (-- 15 -1`�

Andy Chused
1780/92

Andy & Rhonda Chused
C1.
It
ace
CKSed nal Forest
1780 lot 92
2231 0 beth Rd I
Latitude: 35.74917 N
Longitude: 81.90498 W
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