20140426 Ver 2_401 Application_20160916

State of North Carolina
Department of Environment and Natural Resources
DW.�
Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
Shoreline Stabilization Application Form
Four copies of the application (including attachments) and the application fee should be sent to:
Division of Water Resources
401 & Buffer Permitting Unit
1650 Mail Service CenterD V
Raleigh, NC 27699-1650
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: DAVID C VORHOFF
Mailing Address: 1516 QUEENS RD WEST
CHARLOTTE NC 28207
Telephone Number: 704-372-6640 Fax Number:
E-mail Address:
2. Agent/ Contact Person Information
SFP
1 2416
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http://www.saw.usace.armV.miI/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: CARISSA PARKER
Company Affiliation: 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
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,
FORM: SSGP 10-2013 Page 1 of 4

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: NEBO
Subdivision name or site address (include phase/lot number): OLD WILDLIFE CLUB / 66
144 OTTER WALLER DR
Directions to site - please include road names and numbers, landmarks, etc.:
FROM MORGANTON TAKE HWY 126 / TR ONTO WILDLIFE RD / TR ONTO OLD WILDLIFE
CLUB RD / TO OLD WILDLIFE CLUB DR / TL ONTO GAMELANDS DR / TR ONTO HUNT CAMP
DR / TL ONTO OTTER WALLER DR
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): 2
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): 180' OF SHORELINE STABILIZATION BY BARGE, HEIGHT
WILL BE 5'
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:
3'X 180'= 540 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: 2X180'= 360 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): 14 TREES LESS THAN
6" AND 2 TREES 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.
i
Owner/Agent's Signature* 5A N AC 02H .0502(f)l Dat
+Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

Full Pond
Shoreline
-Da�I,d \/()(K&4-
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

DAVID C. VORHOFF
LAKE JAMES
OLD WILDLIFE CLUB / 66
TO: NORTH CAROLINA DIVISION OF WATER QUALITY
I GIVE CARISSA PARKER, OF BENNICK ENTERPRISES, LLC.,
PERMISSION TO SIGN AS MY AGENT ON MY APPLICATION FOR
SHORELINE STABILIZATION.
SIGNATURE (S)
DATE �i t

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DAVID VORHOFF
OLD WILDLIFE CLUB LOT 66

David Vorhoff OWC 66
Old Wildlife Club lot 66
144 Otter Waller Dr Forest
Latitude: 35.75173 N
Longitude: 81.92471 W
tic
44 126
Lake James
�ield5 Idea
Rd
126
0mi n5 1 15 7
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