20211541 Ver 1_Shoreline Stabilization_20211025

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 view the form.
Attach documentation of Pre -Filing Meeting Request here:
Bang Hennings - Prefile Approval.pdf 687.21KB
Pre -fling Meeting or Request Date 7/30/2021
ID# Version
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]
Please provide an email address for payment and requests for more information here.
Owner Information:
Name: * Barry Hennings
Email: * [e-mail]
Phone Number: * [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
1704 Falcon Rd
Address Line 2
City
State / Province / Region
East Bend
NC
Postal / Zip Code
Country
27018
USA

Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: *
Charlie Washburn
Company Affiliation: *
Marine Construction LLC
Email: *
[e-mail]
Phone Number: *
[phone]
(xxx)xxx-xxxx
Mailing Address:*
Street Address
1173 Shiloh Church Rd
Address Line 2
City
Hickory
Postal / Zip Code
28601
A signed and dated copy of the Agent Authorization letter:
Barry Hennings - Agent Authorization.pdf 1.22MB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: * Hennings - Hickory
State / Province / Region
NC
Country
United States
If your project has a formal name please use this. If your project does not have 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.*
- Upload File
Look up address
Upload Map: Barry Hennings -Directions and GIS.pdf 1.33MB
Latitude: * 35.813000 Longitude: *-81.332000
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*
Bang Hennings - Job Desciption.pdf 3.08MB
Please use the diagram at the link below:
https://edocs.deq.nc.gov/WaterResources/0/edoc/616616/ShoreIine%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.)*
Barry Hennings - Property Picture.pdf 1.18MB

4. Location of the property (where work is to be conducted)
Nearest Town: * Taylorsville
County: * Alexander
Lake/ river/ ocean adjacent to Hickory
property:
Subdivisions name or site address: * 90 Lakeside Loop Ext - Hickory NC 28601
Include phase/lot number
Directions to site:
Included above.
Please include road names 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. Property Size .54
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Included above
8. How will the work be done?* From Land
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.)
210
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.)
210 riprap & 840
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)
Mulch bed and scrappy plants. No disturbance to existing trees.
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');
a 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:
r aw ' l
Submittal Date: 10/22/2021

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20211541 Version: *
Select Reviewer:*
Select Reviewing Office:
Has payment been received?*
What amount is owed?*
Alan Johnson: eads\adjohnson I
Mooresville Regional Office - [phone]
No Payment Needed
Fee Received
• Need Fee - send electronic notification
• $240.00
$570.00

PROPERTY LEGAL DESCRIPTION:
LOT NO: PLAN NO:
STREET ADDRESS:
PARCEL ID: 0003990
90 Lakeside LoopExt
_
__..__.-.....— —
--
HickoryC85
Please print:
property Owner: Bara t ennin s
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Charlie Washburn of Marine Construction LLC
(Contractor/Agent) (Name or 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):
Mailingj1704 Falcon --
East Bend NC 22018 __..._
Telephone: 336-9i2-8 20.__
We hereby certify the above information submitted in this application is true and accurate tothe
best of our know) e.
tur
A orized " na
Authorized signature
Date Date

1173 Shiloh Church Road, Hickory, NC to 90 Lakeside Loop, Drive 2.3 miles, 5 min
o,. , le Maps Hickory, NC 28601
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Map data ©2021 1000 ft, ..s
1173 Shiloh Church Rd
Hickory, NC 28601
t 1. Head southwest on Shiloh Church Rd toward
Rosenbalm Ln
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t 2. Continue straight onto Hubbard Rd
1.6 mi
of 3. Turn left onto Icard Ridge Rd
0.5 mi
41 4. Turn left onto Lakeside Loop
279 ft
41 5. Turn left to stay on Lakeside Loop
449 ft
90 Lakeside Loop
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.

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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: Alexander Nearest Town: Taylorsvilie
Lake/ river/ ocean adjacent to property: Hickory
Property size (acres): .54 acres
Subdivision name or site address (include phase/lot number):
_ 90 Lakeside Loop Ext Hickor NC 28601
Directions to site - please include road names and numbers, landmarks, etc.:
Printed directions included -in this packet
Latitude (in decimal degrees) 35.813 Longitude (decimal degrees)-81,332
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Residential
5. Describe proposed work (include discussion as to how hardening of shoreline has b en
avoided, or why it is necessary):
. 1 I " I I . , l L_ n
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:
1 IA f_ t4 infs 11
Temporary impacts in square feet:
4 1,0 �A.r_ri rn7 sk f1
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:
a 10 sY f+ f I -
Temporary impacts (temporary clearing, construction corridor) in square feet:
8�io s, f+ oar+wc h10h c'o�rl'd
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):y
Lai „� b� a; sf, �b,&d .
_.;_�...� lr —_--_— -----
11, Signature
08/31 /2021
Owner/Agent's Sigl atureIrl _ NCAC O2H ,O50 (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 anv excavation or dredging below the Full Pond/ Normal Water Level elevation
Dull Pond/ . `-
Shoreline
Plan View
I Full
Lake
(At Full Pond/ Normal Water Level)
,of i11 Doti
L\
140 1 I z- fi Q 1
Riprap
2 ft. x 150 ft.
addltiorwl deering
if ne —ry
3 ft r 150 ft
Nelow tint pond] N WL
€rr4
_ 4kM1SOft
Above full pond/ NWL
001
5
E
Plan View
? F
Y
""We
--.j-
FORM: SSGP 02-2017 Page 3 of 4

FORM: SSGP 02-2017 Page 4 of 4

Contact Name *
Contact Email Address*
Project Owner*
Project Name *
Project County*
Owner Address:*
Is this a transportation project?*
Charlie Washburn - Marine Construction LLC
[e-mail]
Joe Barrett Hennings
Hennings - Hickory
Alexander
Street Address
90 Lakeside Loop Ext
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 - r 401 Water Quality Certification -
Regular Express
I— Individual Permit r Modification
W Shoreline Stabilization
Does this project have an existing project ID#?*
r Yes r No
State / R ovine ( Fdgion
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.

Signature
Submittal Date 7/30/2021