20220734 Ver 1_Shoreline Stabilization_20220526

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 5/25/2022
submitted on: *
Owner Information:
Name: * Noreen Van Derzee
Email: * [e-mail]
Phone Number: [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
37 Morningside Rd
Address Line 2
City
Verona
Postal / Zip Code
07044-1421
State / Province / Region
NJ
Country
US
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:*
[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: *
Noreen Van Derzee- Agent Authorization
321.48KB
Form.pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: *
Van Derzee- 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: Noreen Van Derzee- Directions & GIS.pdf 3.7MB
Latitude:*
35.784000
Longitude: *-81.489000
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*
Noreen Van Derzee- 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.)
Noreen Van Derzee- Property Picture, Buffer,
2.14MB
& Survey.pdf
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: *
Directions to site: *
1794 Waters Edge, Lot 62- Edgewater Subd
Include phase/lot number
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: *
Included above
Residential, undeveloped, etc.
6. Property Size
1.51
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.)
234
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.)
234
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

a I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name: * Charlie Washburn
Signature:
Submittal Date: 5/25/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20220734 Version:* 1
Select Reviewer: * Amy Annino:eads\amannino
Select Reviewing Office: Asheville 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
PROPERTY LEGAL DESCRIPTION:
LOT NO: Edgewater 62 PLAN NO: PARCEL ID: 08 5713 2 62
STREET ADDRESS:
1794 Waters Edge
Granite Falls, NC 28630
Please print:
Property Owner: Noreen Van Derzee
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) 37 Morningside Rd
Verona, NJ 07044
Telephone: [phone] -.
We hereby certify the above information submitted in this application is true and accura 'to the
best of our knowledge.
f
(/o:2
Cl• nt Si nature Char e shburn
5 / Z 51251Z
Date Date

to icing maps
A 1173 Shiloh Church Rd, Hickory, NC 28601 34 min , 16.5 miles
B 1794 Waters Edge Dr, Granite Falls, NC 28630 Light traffic (Leave at 9:16 AM)
Via Falls Ave, Dry Ponds Rd
.
A 1173 Shiloh Church Rd, Hickory, NC 28601
T 1 Head southwest on Shiloh Church Rd toward Rosenbalm Ln 377 ft
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IT 2 Keep right to get onto Hubbard Rd 0.6 mi
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)7' 3 Turn right to stay on Hubbard Rd 1.4 mi
t 4 Road name changes to Icard Dam Rd 1.4 mi
1 4 Turnleft onto Petra Mill Rd
5
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r> Turn right onto Rocky Mount Rd, then immediately turn right onto 1.3 mi
6. Grace Chapel Rd
41 7 Turn left onto Falls Ave
3.5 mi
8. Bear right onto N Main St 0.1 mi
1° 9. Keep straight to get onto US-321 N Alt N Main St 0.3 mi
10. Turn left onto N Highland Ave 49 ft
11. Road name changes to W Highland Ave 190 ft
ri 12 Bear right onto Sunset St 1.0 mi
41 13. Turn left onto Dry Ponds Rd 3.9 mi
41
14. Turn left onto Liberty Rd 0.7 mi

Turn right toward Waters Edge Dr 0.3 mi
15. • Private Road
Bear left onto Waters Edge Dr 0.5 mi
Keep straight to get onto Waters Edge Dr
0.5 mi
17. a Private Road
Arrive at Waters Edge Dr
18.
The last intersection before your destination is Edgewater Trail
B 1794 Waters Edge Dr, Granite Falls, NC 28630

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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: _ Caldwell _ Nearest Town: Granite Falls
Lake/ river/ocean adjacent to property: Lk Rhodhiss
Property size (acres): 1.51 acres
Subdivision name or site address (include phase/lot number):
1794 Waters Edge, Granite Falls NC 28630— Edgewater Subd, Lot 62
Directions to site - please include road names and numbers, landmarks, etc.:
Included in packet
Latitude (in decimal degrees) 35.784 Longitude (decimal degrees) -81.489
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 build a seawall consisting of Redi-Rock block
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:
234 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:
2.314 sqft
Temporary impacts(temporary clearing, construction corridor) in square feet:
Q (construction 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):
1.1 woocaect k vvl4+ sal! +rets 4 ,.typo b s h
11. Signat e
Sit ZZ
1�^f ti5A NCAC .0502(f)IDate
O ner/Agent s Signat [1 02N
"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 t'()r d,Nnrmt al Water Levzl)
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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
Existing bank
4 ft, above full pond water level
2 ft. additional clearing
'if necessary
FORM: SSGP 02-2017
Page 4 of 4

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CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: Van Derzee—Granite Falls County: Caldwell
Owner: Noreen Van Derzee
Print Signatur
Contractor/agent:Charlie Washburn—Marine Construction L
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 Noreen Van Derzee , 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.
- z_ _51/f 4Z._
Signature (owner): ref L a` Date:
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