20171330 Ver 1_Shoreline Stabilization_20171016

644wMyl 4- 0
State of North Carolina
Department of Environment and Natural Resources
DWR 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
X0171330
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 Center r`�T
Raleigh, NC 27699-1650 OCT 1^ `
6 2011
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: KAREN KAUFFMANN & PETER WINOCUR
Mailing Address: 2 TARA CT
LAKE GROVE, NY 11755
Telephone Number: 631-766-2285 Fax Number:
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.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:
CARISSA( BENNICKGRADING.COM
Person to receive the Certification Approval: CARISSA PARKER
H. 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

KaVA'W' d- W "IDCu%
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: BURKE Nearest Town: NEBO
Subdivision name or site address (include phase/lot number): 1780/112
1752 YELLOW FORK TRAIL
Directions to site - please include road names and numbers, landmarks, etc.:
FROM MORGANTON TAKE HWY 126 / TL ONTO CARSON DR / TL ONTO YELLOW
FORK TRAIL 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): 3.5
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): 340' 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 340'= 1020 SQ FT
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool
33lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres: 2' X ZA ' =�SSQ 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): 8 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
1011.11 Ito]
caner nt's Signature [1SA1
Agent's gignature is valid only if an
low
// 7
Date
from the owner is provided.
FORM: 55GP 10-2013 Page 2 of 3

KaVNWOflrl
VU; O cum
Lake
At Full Pond,
a
Shoreline
�'7sb//1 a
a'x 3 �a
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ft 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

KAREN KAUFFMANN & PETER WINOCUR
LAKE JAMES
1780/112
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 /// 7

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Kauffman & Winocur - 1780 22
1780 lot 112
1752 Yellow Fork Trail
Latitude: 35.74575 N
Pisgah Natid Longitude: 81.89516W
ti
o St
126
Lake James en 5 \_arding Rd
�1
Omi 02 04 OFi
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Karen Kauffmann & Peter Winocur
1780 lot 112