20220642 Ver 1_Shoreline Stabilization_20220509

Shoreline Stabilization Application Form
NORTH CAROLINA
Environmental Quality
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 *
[e-mail]
Please provide an email address for payment and requests for more information here.
Pre -Filing Meeting Date Request was 5/6/2022
submitted on: *
Owner Information:
..................................................................................................................
Name:* Richard Fields
Email: * [e-mail]
Phone Number: [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
5524 Glasgow Place
Address Line 2
City
Hickory
Postal / Zip Code
28601
State / Province / Region
NC
Country
United States
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: * Charlie Washburn
Company Affiliation: * Marine Construction LLC
Email: * [e-mail]

Phone Number:*
Mailing Address:*
[phone]
(xxx)xxx-xxxx
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:*
Richard Fields - Agent Authorization.pdf 336.2KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: *
Fields - Hickory
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: Richard Fields - Directions & GIS.pdf 2.69MB
Latitude:*
35.803000
Longitude:* -81.331000
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*
Richard Fields - Scope of Work.pdf 2.35MB
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.)
Richard Fields - Property Picture, Buffer &
Survey.pdf
2.52MB
4. Location of the property (where work is to be conducted)
Nearest Town: *
County: *
Lake/ river/ ocean adjacent to
property:
Hickory
Alexander
Hickory

Subdivisions name or site address: *
000 North Shore Dr, Lot 19 Hickory NC 28601 - Oliver's Landing Lot 19
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/Undeveloped
Residential, undeveloped, etc.
6. Property Size .53
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Included above.
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.)
282
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.)
282 (1128 sqft
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)
Included above.
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: 5/6/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20220642 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

AGENT AUTHORIZATION FORM
(IV
PROPERTY LEGAL DESCRIPTION:
LOT NO: 19, Oliver's Lndg PLAN NO: PARCEL ID: 0019979
STREET ADDRESS:
000 North Shore Dr, Lot 19
Hickory NC 28601
Please print:
Property Owner: Richard Fields
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
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) 5524 Glasgow Place
Columbus, OH 43235
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our k • ledge.
•AAn-Signe re Charlie Washburn
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Da Date

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Structure Value:
Land Value:
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Physical Address:
Deed Reference: 0642 0607
Alexander County

bing maps
A 1173 Shiloh Church Rd, Hickory, NC 28601 6 min , 2.2 miles
B 926 N Shore Dr, Hickory, NC 28601, United States Light traffic(Leave at 10:13 AM)
Via Shiloh Church Rd, N Shore Dr
• Local roads
A 1173 Shiloh Church Rd, Hickory, NC 28601
1 Head southwest on Shiloh Church Rd toward Rosenbalm Ln 0.6 mi
2.
Turn right onto Joe Teague Rd 0.2 mi
l> 3 Turn right onto Wildlife Access Rd 0.2 mi
Tl 4. Keep left to get onto Hughes Blvd 0.3 mi
5 Bear left onto N Shore Dr 0.9 mi
Arrive at N Shore Dr on the right
6. The last intersection before your destination is Charlotte Ann Ln
If you reach Players Ridge Rd,you've gone too far
B 926 N Shore Dr, Hickory, NC 28601, United States

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(1)
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: Hickory
Lake/ river/ocean adjacent to property: Lk Hickory
Property size (acres): .53 acres
Subdivision name or site address (include phase/lot number):
000 North Shore Dr, Lot 19, Hickory NC 28601—Oliver's Landing, Lot 19
Directions to site - please include road names and numbers, landmarks, etc.:
Included in packet
Latitude (in decimal degrees) 35.803 Longitude (decimal degrees) -81.331
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:
282 sqft
Temporary impacts in square feet:
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:
282 sgft
Temporary impacts (temporar clearing, construction corridor) in square feet:
eon(sI1' :h Do corridor
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):
Wooded lot with brush, trees and vines.
\('D 11. S af liaLlic
2c� 202
Owner/Agent' Signature' [15A NCAC 02H .0502(f)l 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
Lake
(At Full Pond/Normal Water Level)
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Full Pond/ Normal Water Level
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Shoreline 1
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Plan View dot *o v, r,.tc , l ,
„ Lake
{At Fell Va"d'Nanai Water lrrelt
>� Existing dock
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additional clearing... iial1
'd necessary }
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Plan View
FORM:SSGP 02-2017 Page 3 of 4

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3 ft.below full pond water level 4 ft.above full pond water level 2 ft.additional clearing
I *if necessary
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Existing bank
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FORM:SSGP 02-2017 Page 4 of 4

0
CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: Fields—Hickory , County: Alexander
Owner: Richard Fields C2DAi(
41111
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 1SA NCAC 028.0243(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, Richard Fields , 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 Date: q/&)A°41

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