20220013 Ver 1_Shoreline Stabilization_20220104

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.
Chris Amey
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
167 L A Drive
Address Line 2
City
Taylorsville
Postal / Zip Code
28681-8246
Is there an agent working on the project?* Yes
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
US

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:
Chris Arney Riprap -Agent Authorization.pdf 293.61Y-B
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Arney Riprap - Taylorsville
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: Chris Arney Riprap -Directions and
4.08MB
Survey.pdf
Latitude: * 35.831000 Longitude: *-81.210000
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*
Chris Arney Riprap - Scope of Work.pdf 2.07MB
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.)
Chris Arney Riprap - Buffer and Property
2.63MB
Pic.pdf
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: * 167 L A Drive Taylorsville NC 28681 (Lot 268)
Include phase/lot number

Directions to site: *
Printed directions 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 and developed.
Residential, undeveloped, etc.
6. Property Size .82
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
We plan to install riprap stone to prevent further erosion of the shoreline.
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.)
296 (riprap)
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.)
296 (riprap)
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)
Small trees and bushy plants. These will no be impacted because we will
be floating in the stone.
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: 12/23/2021

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20220013 Version: *
Select Reviewer:*
Select Reviewing Office:
Has payment been received?*
What amount is owed?*
Doug Perez:eads\djperez
Mooresville Regional Office - [phone]
No Payment Needed
Fee Received
• Need Fee - send electronic notification
• $240.00
$570.00

PROPERTY LEGAL DESCRIPTION:
LOT NO: 268 PLAN NO: PARCEL ID: 0016637
STREET ADDRESS:
167 LA Drive
Taylorsville, NC 28681
Please print:
Property Owner: Chris Arney
Property Owner:
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):
PNTiiP-
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Sig ure
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12/20/2021 1173 Shiloh Church Road, Hickory, NC to 167 L A Dr, Taylorsville, NC 28681 - Google Maps
Go? -, le Maps 1173 Shiloh Church Road, Hickory, NC to 167 L A Dr, Drive 7.0 miles, 11 min
Taylorsville, NC 28681
LM
Map data @2021 1 mil
1173 Shiloh Church Rd
Hickory, NC 28601
T 1. Head southwest on Shiloh Church Rd toward
Rosenbalm Ln
354 ft
t1 2. Turn left onto Rink Dam Rd
6.5 mi
r+ 3. Turn right onto Sam Poole Ln
0.3 mi
t-, 4. Turn left onto L A Dr
0 Destination will be on the left
0.2 mi
167LADr
Taylorsville, NC 28681
These directions are for planning purposes
only. You may find that construction
projects, traffic, weather, or other events
https://www.google.com/maps/dir/1173+Shiloh+Church+Road,+Hickory,+NC/ 167+L+A+Dr,+Taylorsville,+NC+28681/@35.8326512,-81.2962526,13z/a... 112

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BUILDING SETBACK LINES ARE
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REFERENCE:
PLAT BOOK 4, PAGE 16
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CRESCENT LAND 8 TIMBER CORP.
LAKE HICKORY
LOTS
LOT 268
WITTENBURG TOWNSHIP
ALEXANDER•COUNTY, N.C.
SCALE: 1"• 100' JANUARY 16, 1986
MISC. BOOK NO. 799. 4z8 DWG. NO. L.H. 4-D•3
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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: Taylorsville
Lake/ river/ ocean adjacent to property: Hickory
Property size (acres): .82 acres
Subdivision name or site address (include phase/lot number):
167 LA Drive Taylorsville NC 28681
Directions to site - please include road names and numbers, landmarks, etc.:
Printed directions included in this packet
Latitude (in decimal degrees) 35.831 Longitude (decimal degrees)-81.210
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Residential / Developed
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): We plan to install riprap stone to prevent further
erosion of the shoreline.
7. Will work be conducted from land? F j 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:
6,q 6 SN
Temporary impacts in square feet: 1
Q fjV
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:
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): rv,,; i I +r-e,- S u.,,
14 U 5"n6ek- e,
11. Sign/i4v/ - 11Q tl
Owner/Agent's Sig ure` [15A NCAC 02H .0502(f)] Date
FORM: SSGP 02-2017 Page 2 of 5

#Agent's signature is valid only if an authorization letter from the owner is provided.
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
Lake
(At Full Pend/ Normal Water Level)
Plan View
FORM: SSGP 02-2017 Page 3 of 5

Lake
(At Fall Pond/ Normal at )
a
Side View
}
Li
Tv t r^
0
CL
LL-
Full Pond/ Normal Water U
hore�ine
I ft.z 150 ft.
addict—i clearing
' If necessary
Plan View
Lake
(At I -+.ill pond) Nntma� Water Leuep
Existing flock
/ 30 ft x 7 ft
X7X: Riprap
3 ft x 15011
{m ' 8etau f.4 ndj NWL
. �,,
_ akx i50ft
Above full pond/ NWL
FORM: SSGP 02-2017 Page 4 of 5

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address:
Owner:
Contra(
Print Signature
County: Alexander
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 .024301
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 02B .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 02B .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, Chris Arney , 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 plan(s) and specification(s), and other supporting materials.
Signature (owner):
c /
Date: