20230039 Ver 1_Shoreline Stabilization Application Form REV_20230118

Shoreline Stabilization Application Form
15A NCAC 02H .0500 – Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
DRAFT-NOT FOR USE AT THIS TIME
I. Applicant Information
Please note: fields marked with a red asterisk * below are required. You will not be able to submit the form until all
mandatory questions are answered.
Primary Contact Email *
Pre-Filing Meeting Date Request was
submitted on:
Owner Information:
Is there an agent working on the project?*
Name:*
Company Affiliation:*
Email:*
Phone Number:*
I. Applicant Information [15A NCAC 02H .0502(a)]
[e-mail]
Please provide an email address for payment and requests for more information here.
Name:*
Email:*
Phone Number:*
Mailing Address:*
HOLMES ROAD LLC
[e-mail]
[phone]
(xxx)xxx-xxxx
City
Palm Beach Gardens
State / Province / Region
FL
Postal / Zip Code
33428
Country
US
Street Address
10262 Hunt Club Lane
Address Line 2
Yes
No
Agent/Consultant Information
Emma Barden
Odom Engineering, PLLC
[e-mail]
[phone]
(xxx)xxx-xxxx
Mailing Address:*
A signed and dated copy of the Agent Authorization letter:*
Link to: Sample Agent Authorizaon Form
City
Forest City
State / Province / Region
NC
Postal / Zip Code
28043
Country
USA
Street Address
169 Oak St.
Address Line 2
SIGNED VELARDO AGENT
AUTHORIZATION FORM.pdf 44.33KB
pdf only
II. Project Information
Project Name:*
If your project has a formal name please use this. If your project does not have a formal name, please identify your project
by the owner name and proposed activity (Jones Property Access Road, Smith Guest House, etc.) List in parentheses
any other names that have been used to identify the project in the past.
1. Provide 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.*
Property Address Lookup:*
Latitude:*Longitude:*
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 under
section 12.normal pool lake level/normal water level *
Please use the diagram at the link below:
hps://edocs.deq.nc.gov/WaterResources/0/edoc/616616/Shoreline%20Layout.docx
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)
Nearest Town:*
County:*
Lake/ river/ ocean adjacent to
property:*
Subdivisions name or site address:*
Project Information [15A NCAC 02H .0502(a) & (b)]
VELARDO SEAWALL
Upload File
Look up address
City
Lake Lure
State / Province / Region
NC
Postal / Zip Code
28746-9835
Country
US
Street Address
305 Holmes Rd
Address Line 2
35.427656 -82.198263
22177 - 305 HOLMES ROAD SITE -
2023.pdf 1.65MB
pdf only
305 HOLMES ROAD SITE PHOTOS.pdf 3.15MB
pdf only
Chimney Rock
Rutherford
Lake Lure
Holmes Road
Include phase/lot number
Directions to site:*
5. Describe the existing land use or condition of the site at the time of this application:*
6. Property Size
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
8. How will the work be done?*
9. Total amount of disturbance below the normal pool lake level/ normal water level:*
10. Total amount of disturbance above the normal pool lake level/ normal water level and 50 feet land-
ward:*
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet landward to
be impacted:*
Sketch:
From Lake Lure Town Administration, head south on Morse Park
Trail. Turn right to stay on Morse Park Trail. Turn left onto US-64
E/US-74 ALT E. Turn left onto Holmes Rd.
Please include road names and numbers, landmarks etc.
Residential.
Residential, undeveloped, etc.
0.82
Acres
Replacing the existing wood seawall and constructing a new
retaining wall that is connected to the seawall. Installing riprap at
the northwest side of the property.
From Land
From Water
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
200
square feet
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
250
square feet
(number of trees, for instance)
n/a
pdf only
Sign and Submit
Application Fee:
Once the application has been accepted. You will need to send a corresponding fee in with the appropriate DWR#. The
application fee is as follows (pursuant to G.S. 143-215.3D):
$240.00 for impacts to lake (below normal water level) of less than 1 acre
$570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:
I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the best
of my knowledge and belief
I, the project proponent, hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time.
I agree that submission of this Shoreline Stabilization online form is a “transaction” subject to Chapter 66, Article 40 of
the NC General Statutes (the “Uniform Electronic Transactions Act”);
I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the “Uniform Electronic Transactions Act”);
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:*
Signature:*
Nicholas Velardo