20230323 Ver 1_Shoreline Stabilization_20230306

Shoreline Stabilization Application Form
NORTH CAROLINA
Environmental Qualify
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
DRAFT -NOT FOR USE AT THIS TIME
Submission Form
I. Applicant Information [15A NCAC 02H .0502(a)]
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*
[e-mail]
Please provide an email address for payment and requests for more information here.
Pre -Filing Meeting Date Request was 10/25/2022
submitted on: *
Owner Information:
Name: *
Email:*
Phone Number:
Mailing Address: *
1780 HOA INC
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
5970 Fairview Road
Address Line 2
City
Charlotte
Postal / Zip Code
28210
Is there an agent working on the project? * Yes
No
Agent/Consultant Information
.........................................................................................................................................................................................................................
Name: * Carissa Parker
Company Affiliation: * Bennick Grading
Email: * [e-mail]
State / Province / Region
NC
Country
US

Phone Number:*
Mailing Address: *
[phone]
(xxx)xxx-xxxx
Street Address
7836 US 70 East
Address Line 2
City State / Province / Region
Nebo NC
Postal / Zip Code Country
28761-7650 US
A signed and dated copy of the Agent Authorization letter:*
auth.pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .O5O2(a) & (b)]
Project Name: *
1780 Old Nebo Bridge Rd - 1780 HOA
208.85KB
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. *
Upload File
Look up address
Property Address Lookup: *
Latitude:*
35.750000
Street Address
Old Nebo Bridge Road
Address Line 2
City State / Province / Region
Nebo NC
Postal / Zip Code Country
28761 US
Longitude: *-81.910000
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:
https://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.)
Rd
4. Location of the property (where work is to be conducted)
Nearest Town: *
County:*
Nebo
Burke
Lake/ river/ ocean adjacent to Lake James
property:
Subdivisions name or site address: *
1780 Community Docks area Old Nebo Bridge Rd
Include phase/lot number
Directions to site: *
Hwy 126 / Campbell's Trace / Old Nebo Bridge Rd to property
Please include road names and numbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application: *
Comm Dock Area by 1780 HOA
Residential, undeveloped, etc.
6. Property Size
1.5
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
15' shoreline stabilization by barge. height will be 6'
8. How will the work be done?*
From Land
From Water
9. Total amount of disturbance below the normal pool lake level/ normal water level: *
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
30
square feet
10. Total amount of disturbance above the normal pool lake level/ normal water level and 50 feet land-
ward: *
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
60
square feet
11. 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)
2 TREES 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

Sketch:
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):
d $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
d 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.
o 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");
o 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");
o I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
o I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name: * Carissa Parker
Signature:
c, ss,4 PA
Submittal Date: 2/28/2023

Initial Review
Is this accepted into the review process?* ) Yes 0 No
Project Number:* 20230323 Version:* 1
Select Reviewer: * Mitchell Anderson:[e-mail]
Select Reviewing Office: Asheville Regional Office - [phone]
Has payment been received?* No Payment Needed
Fee Received
Need Fee - send electronic notification
What amount is owed?* $240.00
$570.00

1780 HOA INC.
LAKE JAMES
1780 DOCKS - OLD NEBO BRIDGE RD
TO: NORTH CAROLINA DIVISION OF WATER RESOURCES
I GIVE CARISSA PARKER, OF BENNICK ENTERPRISES, LLC.,
PERMISSION TO SIGN AS MY AGENT ON MY APPLICATION FOR
SHORELINE STABILIZATION.
SIGNATURE (S)
1?-).c.__
DATE Z )"/?' 1

Water Resources
ENVIRONMENTAL QUALITY
1780 HOA Inc.
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 02-2017
Please approximately sketch the following information on this plan and provide dimensions for
each item:
a. All proposed vegetation clearing
b. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
c. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
d. Location of any proposed structures such as buildings, retaining walls, docks, etc.
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
Full Pond/ Normal Water Level
mot
Shoreline
La ke
(At Full Pond/ Normal Water Level)
MI`I• \A"76J" 4m4
ortAriiirweAPriar‘i
1780 Old Nebo Bridge Rd
(Community Dock Area)
Plan View
2'x 15' P
4'x 15' RAP
FORM: SSGP 02-2017
Page 1 of 3

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1780 HOA Inc
Old Nebo Bridge Rd