20240004 Ver 1_Shoreline Stabilization_20240102

1/2/24, 4:53 PM
Non -DOT - Approver
Shoreline Stabilization Application Form
NORTH CAROLINA
Environmental Qvulhr
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
Submission Form Initial Review
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.
Owner Information:
Name: * Robert Roe
Email-* I [e-mail]
Phone Number: 1 [phone]
(xxx)xxx-xxxx
Mailing Address: * Street Address
140 Venetian Drive
Address Line 2
City
State / Province / Region
Delray Beach
FL
Postal / Zip Code
Country
33483-6808
......................................................................................
US
Click to add another owner
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1 /2/24, 4:53 PM Non -DOT - Approver
Is there an agent working on the project? * O Yes
O No
Agent/Consultant Information
Name: * Emma Joyner
Company Affiliation: * Engineering of Brevard
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address: * Street Address
PO Box 202
Address Line 2
City
State / Province / Region
Brevard
North Carolina
Postal / Zip Code
Country
28712
United States
A signed and dated copy of the Agent Authorization letter: *
Upload
74 Toxaway Landing Dr - Agent Authorization Form.pdf 222.45KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: * Roe Bulkhead & Boat House
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. *
O Upload File
* Lookup address
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Non -DOT - Approver
Property Address Lookup:*
Latitude: * 35.137782
Street Address
74 Toxaway Landing Drive
Address Line 2
City
State / Province / Region
Lake Toxaway NC
Postal / Zip Code
Country
28747-9665 US
Longitude: *-82.939123
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
Upload
23-45... 3.72MB X
Please use the diagram at the link below:
https:Hedocs.deq.nc.gov/WaterResources/0/edoc/616616/Shoreline%2OLayout.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.)
Upload
Existi... 1.2MB X
4. Location of the property (where work is to be conducted)
Nearest Town: * I Lake Toxaway
County: * I Transylvania
Lake/ river/ ocean adjacent to Lake Toxaway
property:
Subdivisions name or site address: * 74 Toxaway Landing
Include phase/lot number
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Directions to site: *
From Brevard
Take US-64 West for 15 miles
Turn Right onto Blue Ridge Rd (0.9mi)
Turn Left onto Cold Mountain Rd (0.4mi)
Turn Left onto Innsbrook Dr (210 ft)
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: *
Single Family residential home with maintained lawn and existing wood & masonry bulkhead and dock.
Residential, undeveloped, etc.
6. Property Size 0.249
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
. Obtain all necessary Permits for required work
2. Conduct on -site, pre -construction meeting .
3. The existing wood dock is to be removed
4. Establish a Bench -Mark elevation on site and confirm Lake water -level.
5. Coffer Dam (precast concrete & waterproof liner) to be placed approximately 12 ft beyond the existing bulkhead/sea-wall,
8. How will the work be done?* p From Land
Q 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.)
1500
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.)
2000
square feet
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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)
The lawn is a maintained grass lawn with a total of four trees scattered around open grass area of the back yard.
Sketch: Upload
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):
$323.00 for impacts to lake (below normal water level) of less than 1 acre
$767.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:
o I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the best
of my knowledge and belief
o 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 1 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:*
Signature:
Submittal Date:
Previous
Comments
Emma E Joyner
12/19/2023
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