20220551 Ver 1_Shoreline Stabilization_20220408

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:
Name:*
Email:*
Phone Number:
Mailing Address: *
[e-mail]
Please provide an email address for payment and requests for more information here.
Lorie Kayler
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
34 Bomac Rd
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
PO Box 6400
Address Line 2
City State / Province / Region
Hickory NC
Postal / Zip Code Country
28603 United States
A signed and dated copy of the Agent Authorization letter: *
Lorie Kayler - Agent Authorization.pdf 1.67MB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: *
Kayler - Taylorsville
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: Lorie Kayler - GIS and Directions.pdf 1.67MB
Latitude:*
35.828000
Longitude: *-81.261000
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*
Lorie Kayler - Scope of Work.pdf 3.55MB
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.)
Lorie Kayler - Property Picture, Survey and
Buffer.pdf
5.07MB
4. Location of the property (where work is to be conducted)
Nearest Town: * Taylorsville
County: * Alexander
Lake/ river/ ocean adjacent to Lake Hickory
property:
Subdivisions name or site address: *
11 Rocky View Rd, Taylorsville NC 28681 - Sid Spencer Subd, Lot PTO 9
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 .70
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.)
92
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.)
92
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)
Natural yard area.
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
a 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");
a 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 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:
t
Submittal Date: 4/8/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20220551 Version:* 1
Select Reviewer: * Doug Perez:eads\djperez
Select Reviewing Office: Mooresville Regional Office - [phone]
Has payment been received?* ( No Payment Needed
C Fee Received
C• Need Fee - send electronic notification
What amount is owed?*
C• $240.00
C $570.00

LOT NO
AGENT AUTHOR TON FORM
GAL Di RW11004:
PLAN NO:
Property Owner:
Owner: y .
Property Owne F ._.,.,._.....�
The
rs al the above noted
by
to ad on my behalf and take all actions necessary for the processing, issuance and acceptance of this
perm t or certification and any and all standard and special conditions attached.
Property Own Address (it different than property above)
(Mailingl 34 Barnet Rd
Lake Junalliske, NC Z8745
Telephone: 83O- 45-2419
We hereby certify the above information su
best of our knowledge.;
the

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3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. ({nclt 6e a male of
some sort- a yard stick, shovel handle, etc.}
4. Location of the property (where work is to be conducted)
County: Alexan r Nearest Town: Taavlorsv
Lake/ river/ocean adjacent to property.
Property sire (acres); ,7 at es
Subdivision name or site address (include phase/lot number):
11 to k i w Rd Ta r vine N fig1— Sid Wncer S4.1
Lk Hickory
t PTO9
Directions to site please include road names and raurnbers, landmarks, etc,:
included in packet
itude (in decimal degrees) _. 35.
Longitude (declrnel degrees)-81,261
Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.); .dential/Developed
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why It is necessary): a plan place rir r stone alone the shoreline
preyertt further erosion.
7. Will work be conducted frarr► land?
From prat
8. Total amount of impacts bellow the normal pool lake level / Normal Water level
Permanent Impacts (including all excavation, backfill, rip rap, retaining walls, etc.) in sguar
92
Temp, rary impacts in sqfeet
9. Total amount of arnppacts above the normal poi lal Iel l Normal ' 4later
land -ward
Permanent impacts (Including back fill, excavation, rip rap, retaining walls, etc
92
Temporary impacts (;temporary clearing, cot sitruction corridor) In square feet:
10, Please describe the vegetation above the norr
feet landward to be impacted (number of trees,
natural yard area
Signe
Normal Water Level and 50
ent's SI Da
Agent's signature, s valid on 1f he ow er is provi
P 02••2017
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