20180405 Ver 1_Shoreline Stabilization_20180320

State of North Carolina
Department of Environment and Natural Resources
DWRI 2 0 1 8 0 4 0 5 Division of Water Resources
Division of Water Resources
15A NCAC 02H.0500 —Water Quality Certification, Shorelind.. ab dpi§ ;
h..
FORM WP 10-2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: Drake A & Donna L Seeley
Mailing Address: 4841 Brantford Court
Telephone Number
West Chester, Ohio 45069-5503
513-205-4284 Fax Number: 513-247-6018
E-mail Address: [e-mail]
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
htto://www.saw.usace.armv.mil/Portals/59/docs/reeulatory/re2docs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name:
Company Affiliation:
Mailing Address: MAR 20 2018
AAM
8"M
WATER PERMttat
Telephone Number: Fax Number:
E-mail Address:
Person to receive the Certification Approval:
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,
FORM: SSGP 10-2013 Page 1 of 3

etc.), rip rap, excavation or dredging bel' ul
inrl'PdndJ Normal Water Level elevations,
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, 170 Cabin Bluff
Drive, Marion, North Carolina 28752; Lot #8
Directions to site - please include road names and numbers, landmarks, etc.: From
Morganton, North Carolina, take Hwy 126 / to South Mountain Institute Road / to Lake
James Road / Turn left onto Black Forest Drive / Turn left onto Cabin Bluff Drive to
Property.
Latitude 35.73699724960713 Longitude (decimal degrees) -81.97337653487921
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): residential, undeveloped, Lake James dock site
6. Property size (acres): 10.94 acres
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): Requesting permission for installation of 70' of shoreline
stabilization using gray boulders at the 1202' elevation on Black Forest Lot #8 on Lake
James in Marion, North Carolina 28752
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: 70' total
Length of rip rap installation along shoreline w/approx. 2' below surface (140 total 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: 70' total length of rip rap installation extending approx.. 20' land-
ward from normal lake level (1,400 total 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): negligible disturbance of
existing vegetation with exception of some existing dead scrub bushes and no more than
approximately 6 small sapling pine trees.
FORM: SSGP 10-2013 Page 2 of 3

Owner/Agent's Signature' [AA NCAC 02H .0502(f)] Date
`Agent's signature is valid only if an authorization letter from the owner is provided.
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(At Ful Pond/Normal ater Level)
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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

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