20200430 Ver 1_Shoreline Stabilization_20200327

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' State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Water Resources M 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, FedEx, etc.)
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 27604L-
I_A. Applicant Information [15A NCAC 02H .0502(a)] 1. Owner Information
Name: I lt% S ��DY F 5�� rj. h D
R
Mailing Address:
Telephone Number: Fax Number:
E-mail Address: /ISG'' C17ol7W /Irk
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter must be attached if the Agent has
signed this application form. (A form can be downloaded here:
http://www saw usace army mil/Portals/59/docs/regulatory/`regdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf)) 1 1
Name: �l/lM kks Jam`
Company Affiliation: 5P fiSSOG/$r6_S Alc_
Mailing Address: %3S 1%1-A /gV& 61,vo Se
!-11614rq / e, 2dGo Z
Telephone Number: 6W-7 Fax Number: 921- 32,7-4,7411
E-mail Address: ���m �i 5"55dGIe-le-51",x , C�ON''
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)' r
County: 64TWBA- Nearest Tow
Lake/ river/ ocean adjacent to property:` /G
Property size (acres): t ' Vl�
Subdivision name or site address (include phase/lot number):
L_k� g6ov�S�0- 112-15
Directions to site - please include road names and numbers, landmarks, etc.: 674M (�ca"[&Y-
Z_ A1 �7 A, on 39'-A 4VCy2 , 'lYfiq l't 4l Ab ` 44.5 /7&h7 Cj, feria ¢ 5�✓r<f C�s,<
Latitude (in decimal degrees)
35.?q31��
Longitude (decimal degrees) ^'5(• 332250
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): P2e5lc?am�tr►L Vnko'ArLI0p*�
Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary); ('/IcT1��7 SU/LtGr SToNbf lQ STvp ��7UrtGr
5#0fa11/Pg—
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
A
Temporary impacts in square feet:
vation, backfill, rip rap, retaining walls, etc.) in square feet:
2 So sF
Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet
land -ward
rmanent impac�s (including back fill, excavation, rip rap, retaining walls, etc.) in square feet:
✓MI-66 4-.0" x 2%5-1 /Lrp jig? ) l/oQ 5r—
Temporary impacts (temporary clearing, construction corridor) in square feet:
t�SS Cd2ruquy 3g5o s�-
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): 0 7ll s 6,#01a- an OW
QE 6Ank 7y Ar 40naybw E &&ILrs /1,1(yi4 eygmoq�w /Qj S7414t , M0%1dw
- G "Pr vs t2l4`u67-vti 7VVs£ /lewMvov ,57A.m .35'A,ra .57o, oN_- _-"OpTi
11. Signat re
JJ 3 L"f, 41 Zo2 a
n / ent's Signature' [15A NCAC 02H .0502(f)] Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 02-2017 Page 2 of 4

V4
+0 5 -O
IV/��.le'�
,l Q t t� 9
Lake xs�{s--�U--
¢r r
(At �uII Pond/ Normal Water Level) �;
PI P
�
-
1�n
xtr
C
Side View
FORM: SSGP 02-2017 Page 4 of 4

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
Full Pond Normal Water Leve
Shore ine
Plan View
Lake f
(At Full Pond/ NormW. al Water Levelj
.. t
—- ^ — — — —— dr'4Z3S
Io x ?5o ALAS,
lx
°I
Lake
- (At Full Pond/Normal Water Loaell
Existing Dock' .
...30R■7R ..
-- 3hr 150ft
Full Pon_0e"f
d/ Normal Water Level a%'i:;' :. ull pond/NWL
Shoreline 4�.% dhr l5oh
Riprap >t rv-,, Ahore full pond/NWL
t ft.x 150 ft.
additional clearing
If necessary
Plan View
FORM: FORM: 55GP 02-2017 Page 3 of 4

Provide three (3) copies of the application and supporting information (maps, drawings, etc.),
as well as the appropriate application fee (see below), to the Division of Water Resources,
401 & Buffer Permitting Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617.
Applicant Information
J,VJ Owner Information: Please provide complete and accurate contact information
Agent Information: Per 15A NCAC 02H .0502 , an agent may be given signatory
authority for the owner/applicant if a signed and dated copy of an Agent Authorization
letter is included with the application. (A sample form may be found at
http://www.saw.usace.army.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE
AGENT AUTHORIZATION FORM.pdf)
II. Pro ect Information
Vicinity/ Site Map: Some type of site map so that someone unfamiliar with the area can
locate your project. A county map or USGS topographic map indicating the project
location is usually sufficient.
'Site Plan: A site plan showing the location of the shoreline, location of the impacts to
the shoreline and/or lake bottom and the location and any vegetated areas that will be
impacted. In most cases the site plans do not have to be professionally prepared.
However, if you intend to conduct hydraulic dredging, professionally prepared drawings
will likely be required for the spoil structures. See example below.
[✓f Photograph of shoreline to be impacted/ disturbed
[Z' Description of property (including location information and lat/long coordinates) and
existing features on and near the site
Description of project and impacts/ disturbance proposed
III. Signature
Q Per 15A NCAC 02H .0502 , the application shall be considered a "valid application" only
if it bears the signature of a responsible officer of the company, municipal official,
partner or owner. This signature certifies that the applicant has title to the property, has
been authorized by the owner to apply for certification or is a public entity and has the
power of eminent domain.
IV. A plication Fee
r�The application must be accompanied by the appropriate application fee (checks made
out to the NC Division of Water Resources). The application fee is as follows (pursuant
to G.S. 143-215.3D):
➢ $240.00 for impacts to lake (below normal water level) of less than 1 acre
➢ $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
INSTRUCTIONS FOR APPLICATION SSGP307980 08-13 & SUPPORTING DOCUMENTATION Page 2 of 3

�Dlvlsion of Water Resources
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 —Water Quality Certification
Instructions for Application FORM SSGP 10-2013
(Shoreline Stabilization 401 WQC to accompany USACE GP30, GP79, or GP80)
Instructions for Shoreline Stabilization Application
When to use this form —This application form should be used to apply for a 401 Water Quality
Certification to impact:
Description
U.S. Army Corps of
Engineers (USACE) Permit
Federal Energy Regulatory Commission (FERC) regulated lake
shore or bottom
GP30
Tennessee Valley Authority (TVA) regulated lake shore or bottom
GP30
Local government regulated lake shore or bottom
GP30
USACE Reservoir owned/regulated lake shore or bottom
GP79
Private lake shore or bottom'
GP80
When this form should not be used —This application form cannot be used for wetland or
stream impacts. This information does not apply to landowners within the twenty coastal
counties that are affected by Division of Coastal Management (CAMA) rules.
For more information — If you have been advised that you require a 401 Water Quality
Certification, and would like more information about:
➢ The application process: http://porta1.ncdenr.org/web/wq/swp/ws/401/certsandpermits
➢ How to download an application form:
http://Porta1.ncd6nr.org/web/wq/swp/ws/401/certsandpermits/apply/forms
➢ Application fees:
http://portal. ncdenr.org/web/wq/swp/ws/401/certsandPerm its/apply/fees
If you are unable to download this information or application, please call [phone] to
request an application with instructions.
Please note — Not all impacts require written authorization from DWR. This may include the
construction of docks or boathouses if there is no dredging or filling involved (other than the
pilings). For more information, please visit the following website:
http•//portal ncdenr org/web/wq/swp/ws/401/certsandpermits/fags#always have to apply
How to apply — When submitting an application to DWR, please use the following instructions
as a checklist in order to ensure all required items are submitted. Adherence to these
instructions will help facilitate a quicker review time and reduce the amount of requested
additional information.
INSTRUCTIONS FOR APPLICATION SSGP307980 08-13 & SUPPORTING DOCUMENTATION Page 1 of 3

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT No. 72 S PLAN NO. PARCEL ID: 37052.c914157
STREET ADDRESS: 42 ('ob ` t' ST W NV N I (,6A-f ► & MeO I
Please print:
Property Owner: N►Y 10 P IMPIQ1 UY
Property Ovvner;
The undersigned, registered property owners of the above noted property, do hereby authorize
jlmnt 1)vSTc► of J VJ ASSoq'122 Itir,
(Contractor /Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property a-�ove):
Telephone:.849 - 'M L127
We hereby certify the above information submitted In this application is true and accurate to the
best of our knowledge.
%Z' ,
Authorized Signature
Date: 3/' V/Z o
Authorized Signature
Date: �_L''

3/13/2020
Hickory, NC to 4260 4th Street Ln NW, Hickory, NC, 28601-8034 Directions - MapQuest
YOUR TRIP TO: =CDQJ3 G'
4260 4th Street Ln NW, Hickory, NC, 28601-8034
11 MIN 1 5.0 MI %�
Est. fuel cost: $0.41
Trip time based on traffic conditions as of 2:18 PM on March 13, Print a full health report of your car with HUM
2020. Current Traffic: Moderate Q9 vehicle diagnostics [phone]
1. Start out going north on S NC 127 Hwy/NC-127 toward 1st Ave. Continue to
follow NC-127.
Then 3.91 miles 3.91 total miles
2. Turn left onto 39th Avenue Dr.
I 39th Avenue Dr is just past 38th Ave.
If you reach 39th Avenue Ct you've gone a little too far.
Then 0.50 miles
T 3. Stay straight to go onto 4th Street Ct.
Then 0.07 miles
4. Take the 1st left onto 4th Street Ln.
If you reach the end of 4th Street Ct you've gone about 0.2 miles too far.
Then 0.50 miles
{;� y 5. 4260 4th Street Ln NW, Hickory, NC 28601-8034, 4260 4TH STREET LN NW.
" Your destination is 0.2 miles past 41st Ave.
Your destination is at the end of 4th Street Ln.
M Save to My Maps
4.41 total miles
4.49 total miles
4.98 total miles
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https://www.mapquest.cc mid irections/list/1 /us/nc/hickory/to/us/nc/hickory/28601-8034/4260-4th-street-In-nw-35.793603,-81.330524 1 /2

3/13/2020 Hickory, NC to 4260 4th Street Ln NW, Hickory, NC, 28601-8034 Directions - MapQuest
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LQOPBACK CONNECTIONS
SEE DETAIL ON SHEET U-2.
H EADWORKS ASSY.
SEE DETAILS ON U-2
PROP. 1,500 GALLON
TOP SEAM PUMP TANK
WITH RISERS TO GRADE
EX. SOIL BORINGS BY PAUL
PENNINGER, LSS,
STEVE PRICE, LSS & CATAWBA
CO. HEALTH DEPT.
(2) 1.25-IN. SUPPLY LINE &
(1) 1-IN. RETURN LINE
AREA FOR PROPOSED SUBSURFACE DRIP
DRAINFIELD PER PAUL PENNINGER, LSS, STEVE
PRICE, LSS & CATAWBA COUNTY HEALTH
DEPARTMENT. CONTRACTOR SHALL INSTALL
PROP. ORENCO o I,:' nlAmclt;v �F wgLL DRIP LINES 2 FT ON CENTER MIN. & 6-IN BGS.
ADVANTEX AX-25RT 93s,
cQ�,r �' y SEE SHEET U-2 FOR DETAILS
TREATMENT UNIT V
PROP. 1,500 GALLON _ __� _�- - _=
�-` 63'04,05„ 223•�� __ _ CREATE DIVERSION BERM TO DIVERT
TOP SEAM SEPTIC TANK N - - - -_-- ---- __ - -- - f' r�2„ FLOW FROM EX. PIPES TO BELOW
WITH RISERS TO GRADE �, ._._.' --- `" --• ,- " ---;"� _'-- __ -- -- __-�.� ---'--- �=-�- -� A=; �_ R�g�R
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PROP. CONTROL PANEL
LOCATION ON SIDE OF
NEW RESIDENCE
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LANC
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FIR S 69°49 30 W 195.53
, � 1
- kE�1N R
p�4T��?��2i Rk
REPAIR AREA TO REMAIN
UNDISTURBED. ENGINEER RECOMMENDS
INSTALLING ORANGE BARRICADE FENCING
AROUND PERIMETER OF PRIMARY AND REPAIR
AREAS UNTIL SITE WORK IS COMPLETED.
Know what's below.
Call before you dig.
GRAPHIC SCALE
0 10 20 _ 40
1 inch = 20 feet
PUBLICATION OR REUSE OF THESE DRAWINGS OR ANY DETAILS WITHIN MUST BE WITH THE WRITTEN CONSENT OF PIEDMONT DESIGN ASSOCIATES, P.A.
Owner:
on
LAKE HICKORY
SITE
O
w 41at
2 c�
0
3gth A�111�
VICINITY MAP
NO SCALE
BOUNDARY SURVEY PROVIDED BY:
FOX SURVEYING COMPANY
770 NC HWY 16 S I PO BOX 637 TAYLORSVILLE, NC 28681
PHONE: [phone]
TOPOGRAPHIC SURVEY PROVIDED BY:
MILLER SURVEYING, INC.
328 FOURTH STREET S.W. HICKORY, NC 28602
PHONE: [phone]
DESIGN FLOW (TOTAL):
600 GID
LTAR:
0.15 GID/SF (GEOFLOW DRIP)
REPAIR LTAR:
0. IS G/D/SF
SEPTIC TANK SIZE:
1,500 GALLON (BAFFLED)
EFFLUENT FILTER:
OSI MODEL FTPSO436-28-NC
ADVANCED TREATMENT:
ORENCO ADVANTEX AX-25RT
RECIRCULATION PUMP:
ORENCO MODEL PF300512
TREATMENT STANDARD:
TS41
DISINFECTION METHOD:
ORENCO UV-125/31-P
PUMP TANK SIZE:
1,500 GALLON
FIELD DOSING PUMP:
ORENCO MODEL PF201012
SUBSURFACE DISTRIBUTION:
SUBSURFACE DRIP
NO. OF ZONES:
2
LATERAL LENGTH:
Zone 1: 7 Lines -1,000 LF
Zone 2: 8 Lines -1000 LF
SUPPLY MAIN SIZE:
(2)1.254NCH SCH 40 PVC
SUPPLY MAIN LENGTH:
135 LF (Zone 1) 180 LF (Zone 2)
RETURN MAIN SIZE:
(1)14NCH SCH 40 PVC
RETURN MAIN LENGTH:
180 LF
ZONE 1:
51IL EMITTERS @ 0:53 G/H-=-4.42 G/M
ZONE 2:
500 EMITTERS @ 0.53 G/H = 4.42 GIM
9 RUNSIDAY X 2 ZONES X 7.54 MIN X 4.42 G/M = 600 GID
NOTES:
SOIL EVALUATION PROVIDED BY PAUL PENNINGER, LSS AND
STEVE PRICE, LSS & REVIEWED WITH CATAWBA COUNTY HEALTH
DEPARTMENT.
- REFER TO SHEET U 2 FOR SYSTEM DETAILS & ELEVATIONS.
- PRIOR TO ANY CONSTRUCTION, BARRICADE ALL DISPOSAL,
AREAS FROM CONSTRUCTION TRAFFIC
CLEAR DRAIN FIELD OF ALL DEBRIS, LIMBS, ETC.
SURFACES. LIGHTLY HAND SMOOTH ANY IRREGULAR
- PRIOR TO INSTALLATION OF LATERALS, ENSURE THAT DISPOSAL
AREAS ARE CAPABLE OF SHEDDING RAINWATER AND FREE OF
ANY LOW AREAS
SEED & MULCH ALL DISTURBED AREAS.
MAINTAIN 2' MINIMUM SEPARATION ON ALL DRIP TUBING
OBSERVE ALL SETBACKS.
AREA IS AVAILABLE FOR SUBSURFACE DRIP REPAIR & SHALL
REMAIN UNDISTURBED
I
NIP, 2 7 2o2o
NOTE:
WATER TO THE RESIDENCE WILL BE SUPPLIED BY A
MUNICIPAL WATER SUPPLY,
REFER TO SPECIFICATION
PACKAGE FOR MATERIALS SELECTION
AND INSTALLATION REQUIREMENTS
- REFER TO SHEET U-2 FOR TREATMENT PLAN/PROFILE,
INSTALLATION DETAILS & ELEVATIONS
Approved: Date of Issuer
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REVISIONS
BY
REV. PER COM MENIM BY
CATAMcaHDOtFOM
(5/13/19)
DMD
Date: 8/6/19
Scale: 1 "=20 FT
1 CONTOURS
Drawn: ©MD
Checked: DLM
Project: 2019-06-06-EC
Job:2019-06-D6-EC
Sheet
U --1
A 8/13/19
ot 2 Sheet
a
Location: