20210905 Ver 1_Shoreline Stabilization_20210701

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:
Tim Gaines - Prefile Approval.pdf 749.69KB
Pre -fling Meeting or Request Date 5/5/2021
ID# 20210905 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 err -ail address for payment and requests for pure infornation here.
Owner Information:
Name: * Tim & Nancy Gaines
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
984 18th Ave Circle NW
Address Line 2
City
State / Frovince / Region
Hickory
NC
Fbstal / Zip Code
Country
28601
USA

Is there an agent working on the
project? *
Agent/Consultant Information
.................................................................................................................
Name:
Company Affiliation:*
Email:
Phone Number:*
Mailing Address:*
F Yes
r No
Charlie Washburn
Marine Construction LLC
[e-mail]
[phone]
(XXX)XXX-XXXX
Address
1173 Shiloh Church Road
Address Line 2
City
Hickory
Fbstal / Zip Code
28601-7855
Asigned and dated copyof the Agent Authorization letter:*
Tim Gaines - Agent Authorization.pdf 310.02KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Gaines - Hickory NC
State / Province / Fbgion
NC
Country
United States
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: Tim Gaines -Directions and GIS.pdf 1.66MB
Latitude:* 35.766654 Longitude:*-81.356518
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*
Tim Gaines - Summary & Drawings.pdf 2.36MB
Please use the diagram at the link below:
https://edocs.deq.nc.gov/WaterResources/0/edoc/616616/Shoreline%2OLayout.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.)*
Tim Gaines - Property Pic.pdf 1.29MB

4. Location of the property (where work is to be conducted)
Nearest Town:* Hickory
County:* Catawba
Lake/ river/ ocean adjacent to Hickory
property:
Subdivisions name or site address:* Le Pointe Subdivision Lot 10
hclude phasellot number
Directions to site:*
Printed directions included above
Rease include road narres and numbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
Residential, Developed.
Residential, undeveloped, etc.
6. Property Size 1.20
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
We plan to place riprap along the shoreline to prevent further erosion.
8. How will the work be done? * r1 From Land
r From Water
9. Total amount of disturbance below the normal pool lake level/ normal water level:*
(including all clearing, backfill, excavation, rip rap, retaining walls, etc.)
996 perm, 0 temp
square feet
10. Total amount of disturbance above the normal pool lake level/ normal water level and 50 feet
land -ward:*
(including all clearing, backfill, excavation, rip rap, retaining walls, etc.)
996 perm, 2490
construction
corridor
square feet
11. 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)
Grassy yard and a few bushes.
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):
a $240.00 for impacts to lake (below normal water level) of less than 1 acre
a $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:* Charlie Washburn
Signature:

Initial Review
Is this accepted into the review
process?*
Project Number:* 20210905
Select Reviewer:*
Select Reviewing Office
Has payment been received?*
What amount is owed?*
rYes allo
Version:* 1
Alan Johnsomeads\adjohnsonl
Mooresville Regional Office - [phone]
r No Payment Needed
r Fee Received
r Need Fee - send electronic notification
r $240.00
f $570.00

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO: 10
STREET ADDRESS:
9R4 1 Rth Ave Circle NW
Hickory, NC
Please print:
Property Owner: Tim Gaines
Property Owner: Nancy Gaines
PLAN NO:
PARCEL ID: 370417110887
The undersigned, registered property owners of the above noted property, do herebyauthorize
Charlie Washburn
(Contractor/Agent)
, of
Marine Construction LLC
(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 Owners Address (if different than property above):
same
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate tothe
best of our knowledge. �J
Authorized Signature
Date
Autho ed Signature
©5-- //
Date

1173 Shiloh Church Rd
Hickory, NC 28601
al 1. Head southwest on Shiloh Church Rd toward
Rosenbalm Ln
10 s (38? ft)
h 2. Slight left to stay on Shiloh Church Rd
2 min (1.0 mi)
Continue on NC-127 S to Hickory
_..,... _ ...... _____ ._.... 6 min (3.8 mi)
i 3. Turn right onto NC-127 S
19 Pass by Bojangles (on the right in 2.9 mi)
3.2 mi
41 4. Continue straight onto N Center St
Pass by McDonald's (on the right in 0.2 mi)
__...... 0.6 mi
Continue on 20th Ave NW. Take 18th Ave Dr NW to 18th Ave
Cir NW
https://www.google.com/maps/dir/1173+Shiloh+Church+Rd,+Hickory,+NC+28601-7855,+USA/984+18th+Ave+Cir+NW,+Hickory,+NC+28601/@35,787... 1 /2

5/5/2021
1173 Shiloh Church Rd to 984 18th Ave Cir NW, Hickory, NC 28601 - Google Maps
4 min (1.3 mi)
i
5.
Turn right onto 20th Ave NW
0.5 mi
6.
Turn right onto 2nd St NW
0.2 mi
i
7.
Turn left onto 20th Ave Dr NW
0.2 mi
8.
Turn left onto 18th Ave Dr NW
0.4 mi
9.
Continue onto 18th Ave Cir NW
407 ft
98418th Ave Cir NW
Hickory, NC 2860*1
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 1 73+Shiloh+Church+Rd,+Hickory,+NC+28601-7855,+USA/984+18th+Ave+Cir+NW,+H ickory,+NC+28601 /@35.787... 2/2

Ccatawba counter Geospatial Real Estate Search
t€vim, s.„... Information Services
" 1 in=400ft
w- E
VS
Parcel: 370417110887, 984 18TH AVE CIR NW HICKORY, 28601
Owners: GAINES NANCY C,
Owner Address: 984 18TH AVENUE CIR NW
Values - Building(s): $1,042,000, Land: $390,000, Total: $1,432,000
This map/report product was prepared from the Catawba County, NC Geospatial Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling information contained on this map or data on this report. Catawba County promotes and recommends
the independent verification of any data contained on this map/report product by the user. The County of Catawba, its employees, agents, and
personnel, disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect or consequential which arises or may
arise from this map/report product or the use thereof by any person or entity.
Copyright 2021 Catawba County NC
05/05/2021

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: Catawba Nearest Town: Hickory
Lake/ river/ ocean adjacent to property: Hickory
Property size (acres): 1.20 acres
Subdivision name or site address (include phase/lot number):
Le Pointe Subdivsion — Lot 10
Directions to site - please include road names and numbers, landmarks, etc.:
Included in packet
Latitude (in decimal degrees) 35.766654 Longitude (decimal degrees)-81.356518
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Residential
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): We plan to place riprap along the shoreline to prevent
further erosion.
7. Will work be conducted from land? IP/ 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:
1=16 5o f{- Dbir 'e4. d 1' Iti f4P
Temporary impacts in square feet:
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:
414 S /Mlgn a h t I l fy
Temporary impacts (temporary clearing, construction corridor) in square feet:
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): o o..
a JAM yArd and R iay/ [AvIS
11. Sign urn
Owner/Agent's Signature* [15A NCAC 02H .0502(f)1
Date
"Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 02-2017 Page 2 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
2 ft. K ISo ft.
.1461 clearing
H necessary
Plan View
Lake
pad/ awmat Watettevelt Existing Dock
IMINI-I'S RISHIS
d
1-4 be4oal ,VV4
0, 4 >ve- )V4&-
r am IMI Irw IMI'IMI
FORM: SSGP 02-2017 Page 3 of 4

r_
Side View
FORM: SSGP 02-2017 Page 4 of 4

ID#* 20210905 Version* 1
Regional Office* Mooresville Regional Office - [phone]
Reviewer List* Alan Johnson
Pre -Filing Meeting Request submitted 5/5/2021
Contact Name * Charlie Washburn - Marine Construction LLC
Contact Email Address*
Project Name *
Project Owner*
Project County*
Owner Address:
Is this a transportation project?*
[e-mail]
Gaines - Hickory NC
Tim & Nancy Gaines
Catawba
Street Address
984 18th Ave Cir NW
Address Line 2
city
Hickory
Fbstal / Zip Code
28601
r Yes r No
Type(s) of approval sought from the DWR:
r- 401 Water Quality Certification - 1- 401 Water Quality Certification -
Regular Express
r- Individual Permit r- Modification
W Shoreline Stabilization
Does this project have an existing project ID#?*
r Yes r No
State / Rovince / Region
NC
Country
USA
Do you know the name of the staff member you would like to request a meeting with?
Please give a brief project description below and include location information.*
We plan to place riprap along the shoreline to prevent further
erosion.
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.
• I 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.
Sianature
Submittal Date 5/5/2021