20141222 Ver 1_Shoreline Stabilization_20141125

2 0 1 4 1 2 2 2 State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10 -2013
Shoreline Stabilization ApplicatiopIFArTL
Three copies of the application (including attachments) and the appffcaMh fee should be sent
to:
Division of Water Resources
401 & Buffer Permitting Unit RECP�1 s
1617 Mail Service Center NOV � 1/
Raleigh, NC 27699-1617 5 2014
STORM R LAiVD QZIFlLITy
I. Applicant Information [15A NCAC 02H .0502(a)] ATERPkRtvNTTING
1. Owner Information
Name: U.S. Army Corps of Engineers — Wilmington District (Timothy Taylor)
Mailing Address: W. Kerr Scott Dam and Reservoir, 499 Reservoir Road
Wilkesboro. NC 28697
Telephone Number: 336 - 921 -3390 Fax Number: 336 - 921 -2330
E -mail Address: timothy.l.taylor @usace.army.mil
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.armv. mil / Portals /59 /dots /reRuIatory /re2docs /Permits /SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name:
Company Affiliation
Mailing Address:
Telephone Number
I W -t
anaRinR Member
1901106M711.1
Robbinsville, NC 28771
865 - 806 -4227 Fax Number: 877 - 254 -3728
E -mail Address: drphillips47 @frontier.com
Person to receive the Certification Approval: D. R. Phillips
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,
and construction access corridors. You may use the diagram provided at the end of this
application form.
FORM: SSGP 10 -2013 Page 1 of 3

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: Wilkes Nearest Town: Wilkesboro
Subdivision name or site address (include phase /lot number): Bandits Roost
Campground, 667 Jess Walsh Dr., Wilkesboro, NC
Directions to site - please include road names and numbers, landmarks, etc.: *Please
see attached map and directions
Latitude (in decimal degrees) 36.11972 Longitude (decimal degrees) - 81.24528
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): developed campground
6. Property size (acres): Less than % acre disturbed
7. Lake/ river/ ocean adjacent to property: W. Kerr Scott Dam and Reservoir
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Uniformly grade horizontally 190 LF and vertically 20
LF. Place erosion mattine over entire area: place clean, NC class -B rio -rap 1' thick on entire
area from 1028 msl to aooroximatelv 1043 msl: silt fence will be place at the bottom of the
entire construction area at 1028 msl and be maintained throughout the duration of the
project.
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:
We anticipate approximately 380 sf of erosion control matting and rip -rap below
the normal pool lake level, with no excavation planned below the normal pool lake level.
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: We anticipate approximately 4750 sf of disturbance above
the normal pool lake level.
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): There are 3
hardwood trees to be removed to accommodate the work.
Owner /Agent's Signat re* [15A NCAC 02H .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

Agent's signature is valid only if an authorization letter from the owner is provided.
La ke
(At Full Pond/ Normal Water Level)
Full Pond/
Normal Water Level �v m
/Shoreline a
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C y,r►M1P rj'rovnd 12o.,d
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n�orm�l wafer /Iv.a -seal
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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

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO, PLAN N0. PARCEL ID:
STREET ADDRESS:
.2&e)g -) lr� r #* 203
Please print //tt
Property Owner: u 'S A nm- EA ;h e
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
(Contractor / AgeKt) (Name,of consulting firm)
to acL,on my'behalf and take.all actions necessary,for the'processing, issuance and:acceptance of
this permit or certification and any and "all standard and special conditions -
onditions attached.
Property Owner's Address (if different than property above):
Telephone: 31 G- 012_ - 3 -9 U
We hereby,certify the above information'submitted in this application is true and accurate to the
best,of our knowledge.
Authorized Signature
Date:
1
C C6 k)
Authonze&Signature
Date: % I

11/18/2014 Google Maps
Go Sle Drive 6.2 miles, 9 min
Directions from Wilkesboro, NC to Bandits Roost
141
its
O Wilkesboro, NC
1. Head southwest on W Main St toward S Cherry St
1
2. Continue onto NC -268 W /River St
t 8 Continue to follow NC -268 W
3. Turn right onto Jess Walsh Dr
FO
8 Destination will be on the left
O Bandits Roost
667 Jess Walsh Dr, Wilkesboro, NC 28697
These directions are for planning purposes only. You may find that construction
projects, traffic, weather, or other events may cause conditions to differ from the map
results, and you should plan your route accordingly. You must obey all signs or
notices regarding your route.
Map data @2014 Google
194 ft
5.8 mi
0.3 mi
https: / /www. googl e.com /maps /di r/W i I kesboro,+ N C /bandits +roost +C am pgroundl @36. 136712 ,- 81.2081491.13z/am= t/data =!4m 14!4m 13! 1 m 5! 1 m 1 ! 1 sOx88510d3... 1/1

ATTACHMENT 1 RECENED
Site Map NOV 2 5 2014
DENR -LAND QUALITY
STORMWATER PERMITTING