20220318 Ver 1_Shoreline Stabilization_20220301

Shoreline Stabilization Application Form
NORTH CAROLINA
EnWnnmentufQu&lry
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
DRAFT -NOT FOR USE AT THIS TIME
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:
[e-mail]
Please provide an email address for payment and requests for more information here.
Name:* Randy Hodge
Email:* [e-mail]
Phone Number: [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
465 Players Ridge Road
Address Line 2
City State / Province / Region
Hickory NC
Postal / Zip Code Country
28601 United States
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

Mailing Address: *
Street Address
1173 Shiloh Church Rd
Address Line 2
City State / Province / Region
Hickory NC
Postal / Zip Code Country
28601 United States
A signed and dated copy of the Agent Authorization letter: *
Randy Hodge - Agent Authorization.pdf 316.73KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: *
Randy Hodge - Granite Falls
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: Randy Hodge - Directions, GIS.pdf 3.64MB
Latitude: * 35.787000
Longitude: *-81.459000
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*
Randy Hodge - Scope of Work.pdf 2.8MB
Please use the diagram at the link below:
https://edocs.deq.nc.gov/WaterResources/0/edoc/616616/Shoreline%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.)
Randy Hodge - Survey and Property
Picture.pdf
6.4MB
4. Location of the property (where work is to be conducted)
Nearest Town: * Granite Falls
County: * Caldwell
Lake/ river/ ocean adjacent to Rhodhiss
property:
Subdivisions name or site address: *
Hayes Mill Landing, Phase 2, Lot 2
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 / Undeveloped
Residential, undeveloped, etc.
6. Property Size
1.035
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 stone 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.)
564
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.)
564 and 1880
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)
Wooded lot, 6 impacted 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):
o $240.00 for impacts to lake (below normal water level) of less than 1 acre
o $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");
o I 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:
Submittal Date:
2/24/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number: * 20220318 Version: * 1
Select Reviewer: * Amy Annino:eads\amannino
Select Reviewing Office: Asheville Regional Office - [phone]
Has payment been received?* No Payment Needed
Fee Received
Need Fee - send electronic notification
What amount is owed?* $240.00
$570.00

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO: 2
STREET ADDRESS:
3063 Sams Way
Granite Falls, NC 28630
Please print:
Property Owner: Randy Hodge
Property Owner:
PLAN NO: PARCEL ID: 08116D 2 2
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):
(mailing) 465 Players Ridge Rd
Hickory, NC 28601
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate o the
best of our knowledge.
Authorized Signa
Date
2-//'1712_,'Ld
Authorize5 Signature
Ti 1
ez,/�=
Date

5887
a 1s 8970
This map is NOT of land survey quality and is NOT suitable for such use.
Owner
HODGE RANDY LYNN
465 PLAYERS RIDGE RD )raAL
HICKORY, NC 28601
Acct Number 168828
Parcel ID 08116 D 2 2
NCPIN 2775008421
3080
8 A w MIL
Deferred Val $
Assessed Val $119,300
Calc Acreage 1.03591677
Land Units 1 (LT)
Legal Desc BK 1989 PG 2092 YR 2020 ST 200.00
Plat Ref 00022/00202
Property Addr 3063 SAMS WY
Caldwell County
1:3,226
0 0.0275 0.055 0.11 mi
1 / r 1 I
0 0.0425 0.085 0.17 km
February 16, 2022

bing maps
A 1173 Shiloh Church Rd, Hickory, NC 28601
B 3063 Sams Way, Granite Falls, NC 28630
30 min , 12.9 miles
Light traffic (Leave at 3:23 PM)
Via Hubbard Rd, Falls Ave
A 1173 Shiloh Church Rd, Hickory, NC 28601
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21. The last intersection before your destination is Millrace Dr
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e Falls, NC 28630
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These directions are subject to the Microsoft® Service Agreement and are for informational purposes only. No guarantee is made regarding their completeness or accuracy.
Construction projects, traffic, or other events may cause actual conditions to differ from these results. Map and traffic data © 2022 TomTom.

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: Caldwell Nearest Town: Granite Falls
Lake/ river/ ocean adjacent to property: Lk Rhodhiss
Property size (acres): 1.035 acres
Subdivision name or site address (include phase/lot number):
3063 Sams Way Granite Falls NC 28630 — Hayes Mill Landing, Ph 2, Lot 2
Directions to site - please include road names and numbers, landmarks, etc.:
Included in packet
Latitude (in decimal degrees) 35.787 Longitude (decimal degrees) -81.459
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Residential/Undeveloped
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 stone along the shoreline to
prevent further erosion.
7. Will work be conducted from land? XX 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:
"f 6 st4 4' (9"?'
Temporary impacts in square feet:
0
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:
564 62-1 r�
Temporary impacts (temporary clearing, construction corridor) in square feet:
1, 880 tifr (Con� r� ,dam ('� r1'�`�a')
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): I%e cj L i0
11. Si
; -'
ure
Owner/Ag- ' 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
i�9,k�{}i::$?t•T.(.``.'�J,�%ii.�%��i,37R".t'�. 't?�3��:'�'}iiS:� f• iG_V�r4r�'./2+�C7f�t �.'`L_.'�%%r�Y'.+��fvi "` .
Full Pond/ Normal Water Levu
mist awe Now t*
Shoreline
Plan View
�: 4r�<>:Y
a,
3 Be-tokJMa
ft/ Itt ?oTha
Ab,,,te, Lii./
aft WU
Z L rt
F Pond," Normal Water
-Shorenr}e ,
2 ft. x 150 ft.
additional clearing
if necessary
Plan View
(At FA Pond/ Mcnmai Water ieve1}
Existing Doc
✓ 30 ft ft
ftxl5Qft
& <'w fill pot3 / NWI.
:r ::i*
4ftx150ft
Above full pond/ NWL
ed/r
FORM: SSGP 02-2017
Page 3 of 4

3 Pitinvt, 04/
F� p ?Ak.1
Side View
13
0
u.
..:st:;. ice`•'>'
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i
10 ft. bank
height
Side Vi
3 ft. below full pond water level
pre
4 ft. above full pond water level
2 ft. additional clearing
*if necessary
Existing bank
I
i
FORM: SSGP 02-2017
Page 4of4

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: Randy Hodge — Granite Falls Co nty: Caldwell
Owner: Randy Hodge
Print Signature
Contractor/agent: Charlie Washburn — Marine Construction LLC
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 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 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, Randy Hodge , 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):\Z—.."'SDate: �// V/ rLZ