20190456 Ver 1_Shoreline Stabilization_20190411

';� State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
a -
Water Resources 15A NCAC 02H .0500 - Water Quality Certification, Shoreline Stabilization
ENVIRONMENTAL QUALITY FORM: SSGP 02-2017
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent to:
If sending via US Postal Service If sending via delivery service (UPS, Fe, eQA ID
Karen Higgins Karen Higgins
DWR - 401 & Buffer Permitting Branch DWR - 401 & Buffer Permitting Branch
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC 27699-1617 Raleigh, NC 27604 2 90 4 58
A. Applicant Information [15A NCAC 02H .0502(a)] \\\
1. Owner Information\
Name: JANAR TSARO
Mailing Address: 602 QUEENS FERRY RD
CARY, NC 27511
Telephone Number: 919-795-8746 Fax Number:
E-mail Address:
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter must b Qed if the Agent has
signed this application form. (A form can be downloaded here:
http://www.saw.usace.army.mil/Portals/59/docs/regulatory/regdoc err s/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf)
Name: CARISSA PARKER
Company Affiliation: BENNICK ENTERPRISES, LLC.
Mailing Address: 7836 HWY 70 EAST
NEBO NC 28761
Telephone Number: 828-659-1000 Fax Number: 828-659-1001
E-mail Address: CARISSA@BEN NICKGRADING.COM
B. 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, buildings, retaining walls, docks, impervious surfaces, rip rap, excavation
or dredging below Full Pond/ Normal Water Level elevations, and construction access
corridors. You may use the diagram provided at the end of this application form.
FORM: SSGP 02-2017 Page 1 of 3

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
Lake/ river/ ocean adjacent to property: JAMES
Property size (acres): 1.32
Subdivision name or site address (include phase/lot number): ARBOR LOT 22
485 DOCKSIDE DR
Directions to site - please include road names and numbers, landmarks, etc.:
FROM MORGANTON TAKE HWY 126 / TR ONTO WILDLIFE RD / TR ONTO OLD NC 10 /
TR ONTO FOREST LAKE HEIGHTS DR / TL ONTO DOCKSIDE DR TO PROPERTY AT THE END
Latitude (in decimal degrees) 35.73941 Longitude (decimal degrees) 81.94793
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): VACANT WOODED LOT
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): 1.80' SHORELINE STABILIZATION BY BARGE,
HEIGHT WILL B
7. Will work be conducted from land? ❑ From water?
8. Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent impacts (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
2' X 180' =571sVSQ FT %561)
Temporary impacts in square feet:
NO TEMP IMPACT
9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet
land -ward
Permanent impacts (including back fill, excavation, rip rap, retaining walls, etc.) in square feet:
1' X 180' = 180 SQ FT
Temporary impacts (temporary clearing, construction corridor) in square feet:
NO TEMP IMPACT
10. 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" 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
FORM: SSGP 02-2017 Page 2 of 5

511.i ature
Ow r/Agent's Signature" [1 ANC C 02H .0502 f Date
`Agent's signature is valid only if an authorization letter from the owner is provided.
12. Please approximately sketch the following information on this plan and provide dimensions for
each item:
a. All proposed vegetation clearing
b. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
c. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
d. Location of any proposed structures such as buildings, retaining walls, docks, etc.
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
Lake �S
(At Full Pond/ Normal Water Level)
Dull Pond/ Normal Water Lege
wwwwwa
Shoreline
A�()L-�Ovr
I o4- a�
Plan View
FORM: SSGP 02-2017 Page 3 of 5

JANAR TSARO
LAKE JAMES
ARBOR LOT 22
TO: NORTH CAROLINA DIVISION OF WATER RESOURCES
I GIVE CARISSA PARKER, OF BENNICK ENTERPRISES, LLC.,
PERMISSION TO SIGN AS MY AGENT ON MY APPLICATION FOR
SHORELINE STABILIZATION.
SIGNATURE (S) GSI
DATE lffa f-ck 20o

3C
Prr bo r I o+ as
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JanarTsaro
Arbor lot 22

Tsaro -Arbor 22
Pisgah National
Forest
485 Dockside Dr
The Arbor lot 22
L a k e J a m e s Latitude: 35.73941 N
I Longitude: 81.94793 W
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