20120128 Ver 2_Shoreline Stabilization_20160721

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State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
DhMislon of Water Resources
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15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
Shoreline Stabilization Application Form
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Four copies of th{ application (including attachments) and the application fee should be sent to:
Division of Water Resources 1� O
401 & Buffer Permitting Un PAAIIU V 1 I
1650 Mail Service Center �l
Raleigh, NC 27699-1650
I. Applican6nformation [15A NCAC 02H .0502(a)] 8 Vfa
1. Owner Information
Name:
Mailing Address:
11131 MCCLURE MA
{ CHARLOTTE NC 28277
Telephone Number: 704-877-3353 Fax Number:
16 A
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: 1 CARISSA PARKER
CompanylAffiliation: BENNICK ENTERPRISES LLC
Mailing Address: 7836 HWY 70 E
NEBO NC 28761
Telephone Number: 828-659-1000 Fax Number: 828-659-1001
E-mail Address: [e-mail]
Person to receive the Certification Approval: CARISSA PARKER
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If. 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 d 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,
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FORM: SSGP 10-20 13 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: MCDOWELL Nearest Town: MARION
Subdivision name or site address (include phase/lot number): BLACK FOREST LOT 7
172 CABIN BLUFF DR
Directionsto site - please include road names and numbers, landmarks, etc.:
TAKE HWY 126 / TL ONTO SOUTH MOUNTAIN INSTITUTE RD / TL ONTO BLACK FOREST DR
LTL ONTO CABIN BLUFF DR 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): 9
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): 160' OF SHORELINE STABILIZATION BY BARGE, HEIGHT
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WILL BE 6'
9. Will workbe 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:
4'X160'=640 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: 2'X 160' = 320 SQ FT
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): 6 TREES LESS 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.
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'Agent's signature is valid only if an authorization letter from the owner is provided.
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FORM: SSGP 10-2013 'Page 2 of 3
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Full Pond
SI
Lake
At Full Pond,
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

DOUG BAUMGARTNER
LAKE JAMES
BLACK FOREST LOT 7
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TO: NORTH CAROLINA DIVISION OF WATER QUALITY
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I GIVE CARISSA PARKER, OF BENNICK ENTERPRISES, LLC.,
PERMISSION ITO SIGN AS MY AGENT ON MY APPLICATION FOR
SHORELINE STABILIZATION.
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SIGNATURE (S)
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Doug Baumgartner
Black Forest lot 7

Doug Baumgartner
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Black Forest lot 7
172 Cabin Bluff Dr
Latitude: 35.73663 N
Longitude: 81.97131 W
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