20201312 Ver 1_Shoreline Stabilization_20201116

Submission Form
Pre -Filing Meeting Information
Before submitting this form please ensure you have submitted the Pre -Filing Meeting Request Form as we will not be able
to accept your application without this important first step. The Pre -Filing Meeting Request Form is used in accordance
with 40 C.F.R. Section 121.4(a) "At least 30 days prior to submitting a certification request, the project proponent shall
request a pre -filing meeting with the certifying agency" and in accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5)
all certification requests shall include documentation that a pre -filing meeting request was submitted to the certifying
authority at least 30 days prior to submitting the certification request. Click here to read more information on when this
form is needed prior to application submission or here to viewthe form.
Attach documentation of Pre -Filing Meeting Request here:
Tamera Osgood Pre File.pdf 689.19KB
Pre -fling Meeting or Request Date 9/25/2020
ID# 20201312 Version 1
I. Applicant Information [15A NCAC 02H .0502(a)]
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all
mandatory questions are answered.
Primary Contact Email* [e-mail]
Rease provide an email address for payrrent and requests for pure information here.
Owner Information:
Name: * Tamera Osgood
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
5064 Harbor View Dr East
Address Line 2
City
State / Frovince / Region
Granite Falls
NC
Fbstal / Zip Code
Country
28630
USA

Is there an agent working on the
project? *
Agent/Consultant Information
.................................................................................................................
Name:
Company Affiliation:*
Email:
Phone Number:*
Mailing Address:*
F Yes
r No
Tony Gaines
Marine Construction of Hickory
[e-mail]
[phone]
(XXX)XXX-XXXX
Address
H 73 Shiloh Church Rd
Address Line 2
City
Hickory
Fbstal / Zip Code
28601
Asigned and dated copyof the Agent Authorization letter:*
Tamera Osgood Agent Authorization. pdf 341.98KB
Link to: Sample Agent Authorization Form
State / Province / Fbgion
NC
Country
USA
Project Information [15A NCAC 02H .0502(a) & (b)]
.........................................................................................................................................................................................................................................................................
Project Name:* Tamera Osgood 5064 Harbor view Dr East Granite Falls NC 28630
If your project has a formal name please use this. If your project does not hake a formal name, please identify your project by
the owner name and proposed activity (Jones Property Access Road, Smith Guest House, etc.) List in parentheses any
other names that have been used to identify the project in the past.
1. Provide 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.*
r Upload File
r Lookup address
Upload Map: Tamera Osgood GIS and Map.pdf 1.86MB
Latitude:* 35.792000 Longitude:*-81.390000
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, and construction access corridors. You may use the
diagram under section 12.normal pool lake level/normal water level*
Tamera Osgood Shoreline Layout.pdf 1012.63KB
Please use the diagram at the link below:
https://edocs.deq.nc.gov/WaterResources/0/edoc/616616/Shoreline%20Layout.docx
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale of some sort- a
yard stick, shovel handle, etc.)*
Tamera Osgood Picture.pdf 1.15MB

4. Location of the property (where work is to be conducted)
Nearest Town:*
Granite Falls
County:*
Caldwell
Lake/ river/ ocean adjacent to
Hickory
property:
Subdivisions name or site address:*
Anchors Landing - Lot 13
Include phasellot number
Directions to site:
From: 1173 Shiloh Church Rd
Hickory, NC 28601
Take Hubbard Rd, Icard Dam Rd, Grace Chapel Rd and Falls Ave to
Meandering Way in Lovelady
11 min (7.2 mi)
Head southwest on Shiloh Church Rd toward Rosenbalm Ln
387 ft
Continue straight onto Hubbard Rd
1.9 mi
Continue onto Icard Dam Rd
1.4 mi
Turn left onto Petra Mill Rd
0.9 mi
Turn right onto Grace Chapel Rd
1.3 mi
Turn left onto Falls Ave
1.5 mi
Continue on Meandering Way. Take Greens Dr and Beacon Ridge Dr to
Harbor View Dr E
5min (1.6mi)
Arrive 5064 Harbor View Dr E
Granite Falls, NC 28630
Rease include road nacres and numbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
Residential
Residential, undeveloped, etc.
6. Pro pertySize 1.74
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
We are placing fabric and riprap along the shoreline to help the erosion
issues.
8. How will the work be done? * I7 From Land
r From Water

9. Total amount of disturbance below the normal pool lake level/ normal water level:*
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
Perm: 209 sgft,
Temp: 209 sgft
square feet
10. Total amount of disturbance above the normal pool lake level/ normal water level and 50 feet
land -ward:*
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
Perm: 1045 sgft,
Temp: 1800 sqft
square feet
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet
landward to be impacted:*
(nunber of trees, for instance)
Vegetation is scrappy vines and weeds. Also, there are steps leading to
their dock.
Sketch:
Application Fee:
Once the application has been accepted. You will need to send a corresponding fee in with the appropriate DWR#. The
application fee is as follows (pursuant to G.S. 143-215.3D):
o $240.00 for impacts to lake (below normal water level) of less than 1 acre
0 $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:
o I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the
best of my knowledge and belief
o I, the project proponent, hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time.
o I agree that submission of this Shoreline Stabilization online form is a "transaction" subject to Chapter 66, Article 40 of
the NC General Statutes (the "Uniform Electronic Transactions Act');
o I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act');
0 1 understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
o I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:* Tony Gaines
Signature:

Initial Review
Is this accepted into the review
process?*
Project Number:* 20201312
Select Reviewer:*
Select Reviewing Office
Has payment been received?*
What amount is owed?*
rYes allo
Version:* 1
Amy Annino:eads\amannino
Asheville Regional Office - [phone]
r No Payment Needed
r Fee Received
r Need Fee - send electronic notification
r $240.00
f $570.00

PROPERTY LEGAL 61 RIPTIONl:
LOT NO, 13� M...��_ PAN NO: � _ __.. PARCEL ID:..._08 SEC4T225F
STREET ADDRESS:
5064 Harbor View Dr East
Granite Ealis,NG_ 28630
Please print:
Property Owner: Tamera O
Property Owner:
The undersigned, registered property owners of the above noted property, do herebyauthorize
jony Gaines , of _Marine Construction of Hickory Inc.
(Gontractor/Agent) (Name of crmsui#ng 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 Owners Address (if different than property above):
SAME_ ... _.........._ __ _ ...._....m.
Telephone: -i`..O:.`rM.._
We hereby certify the above informa in su fitted in this application is true: and accurate tothe
best of ou ge
Authors ign zed g ature

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8/19/2020 1173 Shiloh Church Rd to 5064 Harbor View Dr E - Google Maps
o -,gle Maps 1173 Shiloh Church Rd to 5064 Harbor View Dr E Drive 8.7 miles, 17 min
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Map data ©2020 1 mill
1173 Shiloh Church Rd
Hickory, NC 28601
Take Hubbard Rd, Icard Dam Rd, Grace Chapel Rd and Falls
Ave to Meandering Way in Lovelady
1 I min (7.2 mi)
t 1. Head southwest on Shiloh Church Rd toward
Rosenbalm Ln
387 ft
t 2. Continue straight onto Hubbard Rd
L4 mi
t 3. Continue onto Icard Dam Rd
.d mi
*1 4. Turn left onto Petra Mill Rd
D9 mi
j+ 5. Turn right onto Grace Chapel Rd
.�fnl
41 6. Turn left onto Falls Ave
15 mi
Continue on Meandering Way. Take Greens Dr and Beacon
Ridge Dr to Harbor View Dr E
5 rain (1 6 mi)
https://www.google.com/maps/dir/1173+Shiloh+Church+Rd,+Hickory,+NC+28601-7855,+USA/5064+Harbor+View+Dr+E,+Granite+Falls,+NC+286301... 1 /2

8/19/2020
1173 Shiloh Church Rd to 5064 Harbor View Dr E - Google Maps
!1
7. Turn left onto Meandering Way
0.3 mi
8. Slight left to stay on Meandering Way
253 ft
+y
9. Turn left onto Greens Dr
A Partial restricted usage road
_
0.5 mi
r►
10. Turn right onto Beacon Ridge Dr
A Restricted :Isage roar;
0.3 mi
+�
11. Turn left onto Harbor View Dr E
A Restricted :jsage road
0.4 mi
rr
12. Turn right to stay on Harbor View Dr E
A Restricted us: cle roa^
..._
62 ft
r►
13. Turn right to stay on Harbor View Dr E
A Restricted usage road
0 Destination will be on the left
358 ft
5064 Harbor View Dr E
Granite Falls, NC 28630
These directions are for planning purposes only.
You may find that construction projects, traffic,
weather, or other events may cause conditions to
differ from the map results, and you should plan
your route accordingly. You must obey all signs or
notices regarding your route.
https://www.google.com/maps/dir/l 173+Shiloh+Church+Rd,+Hickory,+NC+28601-7855,+USA/5064+Harbor+View+Dr+E,+Granite+Falls,+NC+28630/... 2/2

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.
P. Location of anv excavation or dredging below the Full Pond/ Normal Water Level elevation
La ke
(At Full Pond/ Normal Water levels Existing Dock
/3oftx7ft
vw��r��►�ro►rw��r� ��rr�r
Full Pond/ Normal Water L."el
nroreTlne—
ad jitienal tclearingif nec—ary
E AMPLE
Plan View
FORM: SSGP 02-2017
Page 3 of 4

i� f4- c�t3We-- r►l Fri
�,VII P�rd 0
G�
G
w Lake I I'
(At Full Pond/ Normal Water eveij
C
M =
E v
L
LEI
1
Side View
2 ft. additional clearing
3 ft. below full pond water level 4 ft. above fill pond water level *if necessary
Existing bank
10 ft. bank
Side Vi
M P L
FORM: SSGP 02-2017 Page 4 of 4

Contact Name *
Contact Email Address*
Project Owner*
Project Name*
Project County*
Owner Address:*
Tony Gaines - Marine Construction of Hickory
[e-mail]
Tamera Osgood
Tamera Osgood - Granite Falls NC
Caldwell
Street Address
6064 Harbor View Dr East
Address Line 2
City
Granite Falls
Fbstal / Zip Code
28630
6ir►c
T-
2c�a Ii2.
Z c 2D
State / Province / Region
NC
Country
USA
Is this a transportation project?* r Yes r No
Type(s) of approval sought from the DWR:
W 401 Water Quality Certification - r 401 Water Quality Certification -
Regular Express
r Individual Permit r7, Modification
W Shoreline Stabilization
Does this project have an existing project ID#?
rYes rNo
Do you know the name of the staff member you would like to request a meeting with?
Please give a brief project description below.*
(Project and mailing addresses are the same).
We will install fabric and riprap along shoreline to slow the erosion.
Please give a couple of dates you are available for a meeting.
. . ..........._...._........... _..._......_._ ...
9/28/2020
9/29/2020
9/30/2020
1011 /2020
Please attach the documentation you would like to have the meeting about.

Please attach the documentation you would like to have the meeting about.
Pdf0*
By digitally signing below, I certify that I have read and understood that per the Federal Clean Water Act Section
401 Certification Rule the following statements:
• This form completes the requirement of the Pre -Filing Meeting Request in the Clean Water Act Section 401 Certification
Rule.
1 understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request.
I also understand that DWR is not required to respond or grant the meeting request.
Your project's thirty -day clock started upon receipt of this application. You will receive notification regarding meeting location
and time if a meeting is necessary. You will receive notification when the thirty -day clock has expired, and you can submit an
application.
Signature *
Submittal Date 11/10/2020