20220115 Ver 1_Shoreline Stabilization_20220121

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.
Shane Cooper
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
964 18th Avenue Circle Northwest
Address Line 2
City
Hickory
Postal / Zip Code
28601-1200
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:
Shane Cooper - Agent Authorization.pdf 459.73Y-B
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Cooper - 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: Shane Cooper- Directions, GIS and
2.15MB
Survey.pdf
Latitude: * 35.768155 Longitude: *-81.354095
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*
Shane Cooper - Scope of Work.pdf 2.29MB
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.)
Shane Cooper - Property Picture and
2.13MB
Buffer.pdf
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: * 964 18th Ave Cir NW Hickory (LePointe Subdv, Lot 6)
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/Developed
Residential, undeveloped, etc.
6. Property Size .51
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
We plan to construct a wall and place riprap along part of 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.)
300 (wall)
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.)
1600 (wall and
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)
Bushes and vines.
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):
0 $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:* Charlie Washburn

Signature:
&A tzo W, OdA�t,r,
Submittal Date: 1/20/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20220115 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

M
PROPERTY LEGAL DESCRIPTION:
LOT NO, 6 PLAN NO: PARCEL ID: 370417127475
STREET ADDRESS:
964 181h Ave Or NW
Fllcko NC 28601
Please print:
Property Owner: Shane Cooper
Property Owner'.
The undersigned, registered property owners of the above rioted property, do hereby authorize
Charlie Washburn of
(Contractor/Agent)
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:
We hereby certify the above information submitted In this application Is true and accurate tothe
best of our knowledge
A-
Aut Slgnatu:
— - - ---------
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Authorized Signature
Date

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Catawba county Geospatial Real Estate Search
Information Services
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Parcel: 370417127475, 964 18TH AVE CIR NW HICKORY, 28601
Owners: COOPER SHANE KEVIN, COOPER-DIXON HOPE
Owner Address: 964 18TH AVE NW CIR NW
Values - Building(s): $478,800, Land: $247,000, Total: $725,800
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
10/06/2021

10/6/2021 1173 Shiloh Church Road, Hickory, NC to 964 18th Ave Cir NW, Hickory, NC 28601 - Google Maps
��, Uap5 1173 Shiloh Church Road, Hickory, Drive 6.2 miles, 12 min
GooNC to 96418th Ave Cir NW, Hickory, NC 28601
a
1173 Shiloh
cho'ch Road
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--
96418th'AYenue
f
1173 Shiloh Church Rd
Hickory, NC 2£1601
t 1. Head southwest on Shiloh Church Rd toward
Rosenbalm Ln
9 s (387 ft)
w, 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)
{r► 3. Turn right onto NC-127 S
0 Pass by Bojangles (on the right in 2.9 mi)
.,__.... _. 3.2 mi
t 4. Continue straight onto N Center St
0 Pass by McDonald's (on the right in 0.2 mi)
_._. _......." .._.-..... _-_.. 0.6 mi
https://www.google.com/maps/dir/1173+Shiloh+Church+Road,+Hickory,+NC1964+18th+Ave+Cir+N W,+Hickory,+NC+28601/@35.7878697,-81.363869... 1 /2

10/6/2021 1173 Shiloh Church Road, Hickory, NC to 964 18th Ave Cir NW, Hickory, NC 28601 - Google Maps
Continue on 20th Ave NW. Take 18th Ave Dr NW to 18th Ave
Cir NW
4 min (1.4 mi)
r►
5.
Turn right onto 20th Ave NW
0.5 mi
r►
6.
Turn right onto 2nd St NW
0.2 mi
'h
%.
Turn left onto 20th Ave Dr NW
0.2 mi
41
8.
Turn left onto 18th Ave Dr NW
0.4 mi
9.
Turn right onto 18th Ave Cir NW
0
Destination Will be on the right
0.1 mi
96418th Ave Cir NW
Hickory, NC 28601
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/1173+Shiloh+Church+Road,+H ickory,+NC/964+18th+Ave+Cir+N W,+H ickory,+NC+28601 /@35.7878697,-81.363869... 2/2

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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: _C�a_taW_ba Nearest Town: —Hickory
Lake/ river/ ocean adjacent to property: _q:ickom—
Property size (acres): 51 acres
Subdivision name or site address (include phase/lot number):
LePointe Subdivision Lot 6 - 964 18111 Ave Cir NW HickgLy NC 28601 __
Directions to site - please include road names and numbers, landmarks, etc.:
Printed directions included in this Vacket
Latitude (in decimal degrees) 35,768_155 Longitude (decimal degrees) -81,354095
5, Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): ---- Residential J-Developed
—
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Ve plan to construct a wail and piece riprap alan ttic
shoreline torevert furtt7er erasion. 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:
Temporary impacts in square feet:
r
9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet
land -ward
Permanent impacts (including back fill, excavatiop, 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):
11,
Ownerm
FORM: SSGP 02-201
fLSA NCAC 021L,0502 "f
o'l
A-4
Date
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
k" I
Full Pond/ :mil Water Le
Aft
Shoreline
Plan View
F
FORM: SSGP 02-2017 Page 3 of 5

Lake
;At Rdf Pond! No -al water cmcf) Existing
Dock
3o ftx7fc
f "Y, .'C=f �',f7 C.
3ftn x50ft
Full Pond/ Normal Watet Lev
P l—full pond!NWl
a
hore'ine i 1
aftx;,oh
RI ra
p P
Above full pond/ Nwl
7 ft. x 150h_
additwnel dear��
' ifE
necessary
E M
X ', L
P
E
Plan View v.,,; ;i,,...:;
FORM: SSGP 02-2017
Page 4 of 5

CAT :ER NOTIFIC, ATIQN FORM
County:
Print Signature
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 applicatiom [15A NCAC
02H.05O6and 15ANCACO28.O243(B)]
Trees are not allowed to be removed from Zone I Of the Buffer (within 30 ft of the full pond elevation), unless
approved.Except|on,thouatreasthatanasevcrek/undennincda\un0thm|mnoediateuhoreUnecanhcrmvumed.
Minimal shaping and sloping along the immediate shoreline |sallowed, [1SANC4[O2B.O243(6)]
Benching and grading inthe buffer |*not allowed, Excessive disturbance of ground cover. []5A NCAC 028.0243
(G)]
Beaches, impervious patios, Impervious walkways, etc. are not allowed inthe buffer unless specificallya
by the Division. There are limitation on size for decks. 115A 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 bwoutside the buffer, [15ANCACO2H.OS02and 15ANCACO28.0J43(4),(6),(8)]
Stornmwater cannot be piped or channeled for direct discharge to the |ak=. All constructed stonnvvater
d|ncMorAeu must be atthe natural elevation and discharged prior tuentering the buffer directed asdiffuse o/
sheet flow atnon-erosive velocities tothe lake. [1SANCACU2B.OZ43(5),(6)]
Acknowledgement of Notification
hereby state that \ have been informed ofthe Catawba