20210506 Ver 1_Shoreline Stabilization_20211108

Submission Form
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 *
Owner Information:
Name: *
Email: *
Phone Number: *
Mailing Address:*
[e-mail]
Please provide an email address for payment and requests for more information here.
Holly Shivadecker
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
139 16th Avenue Northwest
Address Line 2
City
Hickory
Postal / Zip Code
28601
Is there an agent working on the project?* - Yes
O No
Agent/Consultant Information
...................................................................................................
Name: *
Company Affiliation:
Email: *
Phone Number:*
Charlie Washburn
Marine Construction LLC
[e-mail]
[phone]
(xxx)xxx-xxxx
State / Province / Region
NC
Country
United States

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:
Holly Shivadecker -Agent Authorization.pdf 276.38KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Holly & Nathan - Hickory NC
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: Holly Shivadecker -Directions and GIS.pdf 1.34MB
Latitude: * 35.793427 Longitude: *-81.336771
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*
Holly Shivadecker - Scope of Work.pdf 2.04MB
Holly Shivadecker - Survey.pdf 607.65KB
Please use the diagram at the link below:
https:Hedocs.deq.nc.gov/WaterResources/O/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.)*
Holly Shivadecker - Property Pic.pdf 1.69MB
Holly Shivadecker - Buffer.pdf 427.48KB
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: * 4124 6th St Dr NW Hickory NC 28601 (No subdivision name, Lot 2)
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 lot / Undeveloped
Residential, undeveloped, etc.
6. Property Size 1.07
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?* 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.)
470
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.)
235 (riprap) and
1200 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)
The vegetation consists of scrappy vines and approximately 6 to 7 dead
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:
&A tzo W, OdA�t,r,
Submittal Date: 11/5/2021

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20210506 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

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO: 2
STREET ADDRESS:
4124 611 St Dr NW
NC 28601
Please print:
PLAN NO:
PARCEL ID: 370519710685
Property Owner: Holly Shivadecker----
Property Owner:
The undersigned, registered property owners of the above noted property, do herebyauthorize
Charlie Washburn , of Marine Construction LLC
(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 Owners Address (if different than property above):
139 161h Ave NW __--
Hickory NC 28601 _ _
Telephone: [phone] __
We hereby certify the above information submitted in this application is true and accurate tothe
Authorized Signature
Date

3/4/2021 1173 Shiloh Church Rd to 4124 6th St NW, Hickory, NC 28601 - Google Maps
Google Maps 1173 Shiloh Church Rd to 4124 6th St NW, Hickory, Drive 5.0 miles, 9 min
NC 28601
a� $ .
52,
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Map data @2021 2000 ft r '
1173 Shiloh Church Rd
Hickory, NC 28601
t 1. Head southwest on Shiloh Church Rd toward
Rosenbalm Ln
__...... 387 ft
*1 2. Slight left to stay on Shiloh Church Rd
1.0 mi
& 3. Turn right onto NC-127 S
. .._ 2.0 mi
r 4. Turn right onto 39th Ave Dr NW 1.3 mi
�.► 5. Turn right onto 6th St Dr NW
4) Destination will be on the right
0.6 mi
4124 6th St NW
Hickory, NC 28601
These directions are for planning purposes only.
You may find that construction projects, traffic,
https://www.google.com/maps/dir/1173+Shiloh+Church+Rd,+Hickory,+NC+28601-7855,+USA/4124+6th+St+NW,+Hickory,+NC+28601 /@35.7994227,-... 1 /2

0�akxCatawba county Geospatia! Real Estate Search
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Parcel: 370519710685, 4124 6TH ST DR NW HICKORY, 28601
Owners: LACKEY TASHA FOX, LACKEY BRADLEY
Owner Address: 644 41ST AVENUE CT NW
Values - Building(s): $0, Land: $173,900, Total: $173,900
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
03/04I2021

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).Lw
County: _ � Nearest Town:
Lake/ river/ ocean adjacent to property:
Property size (acres): _ /' 0 7 av'
Subdivision name or site address (include phase/lot number):
etc.:
landmarks, ,
Dections
irt site - please include road names and numbe,
_ n
I . _ --
Latitude (in decimal degrees) ' 793y2- Longitude (decimal degrees)
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): S rci' f "'A N LaL- !--
6, Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
7, Will work be conducted from land?
From water? ❑
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:
v_
re porary impacts in square feet:
i. 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:
_ Temporary impacts (temporary tempo{- rary 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):
11. Signat r Zc�
owner/ e s Signa _._
c-Uzw .05o2L11 ate
Agent's signature is valid only if an authorization letter from the owner is provided. page 2 of 4
FORM: 55GP 02-2017

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 t nratinn of anv excavation or dredRinR below the Full Pond/ Normal Water Level elevation
Full Pond/ Normal Water Level
Shoreline
\(�Lti
Plan View
Lake
(At Full Pond/ Normal Water Level)
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Lake
(At Full Pond/ Normal Water Level)
Existing Dock
30 ft x 7ft
3ftx 150ft
Below full pond/ NWL
Full Pond/ Normal Water Level
nhorellne r r
4 ft. 150ft
Riprap
Above full pond/ NWL
2 ft. x 150 ft.
additional clearing
if necessary
E'�
K A INI P
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Plan View
FORM: SSGP 02-2017 Page 3 of 4

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Lake
(At Full Pored/ Normal Water
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Side View
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3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing
if necessary
Existing bank
10 ft. bank a
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FORM: SSGP 02-2017 Page 4 of 4

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Project Name/
Owner:
Contra(
CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Print 3%.HdLu't
County: Catawba
The approval is for the purpose and design described in your application. Impacts not indicated in the
application is a violation of the Buffer Rule. Site specific work should be provided in the application. [15A NCAC
02H .0506 and 15A NCAC 02B .0243(8)]
Trees are not allowed to be removed from Zone 1 of the Buffer (within 30 ft of the full pond elevation), unless
approved. Exception, those trees that are severely undermined along the immediate shoreline can be removed.
Minimal shaping and sloping along the immediate shoreline is allowed. [15A NCAC 02B .0243(6))
Benching and grading in the buffer is not allowed. Excessive disturbance of ground cover. [15A NCAC 02B .0243
(6)]
Beaches, impervious patios, impervious walkways, etc. are not allowed in the buffer unless specifically approved
by the Division. There are limitation on size for decks. [15A NCAC 026 .0243(4) and (6)]
Work to be conducted from land must indicate an access and indicate any trees that are to be removed. The
work corridor should be described. The approved access corridor shall be restored. Staging, spoil, construction
material must be outside the buffer. [15A NCAC 02H .0502 and 15A NCAC 026 .0243 (4), (6), (8)]
Stormwater cannot be piped or channeled for direct discharge to the lake. All constructed stormwater
discharges must be at the natural elevation and discharged prior to entering the buffer directed as diffuse or
sheet flow at non -erosive velocities to the lake. [15A NCAC 02B .0243(5), (6)]
Acknowledgement of Notification
I, Holly Shivadecker _ hereby state that I have been informed of the Catawba Riparian Buffer Rule. Any
work conducted in the buffer, not specifically stated in the application and approved by the Division of Water
Resources (DWR), is a violation and subject to enforcement. Due diligence will be taken such that the
construction will be built within substantial compliance and intent of the 401 Water Quality Certification and
Buffer Rules, the approved la (s) e ' cation(s other upporting materials.
Signature (owners): _
Date: