20220784 Ver 1_Shoreline Stabilization_20220609

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 6/8/2022
submitted on: *
Owner Information:
...............................................................................................................
Name: * Martin Gansrow
Email: * [e-mail]
Phone Number: [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
6184 Plantation Pointe Dr
Address Line 2
City
Granite Falls
Postal / Zip Code
28630
State / Province / Region
NC
Country
USA
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
28630 USA
A signed and dated copy of the Agent Authorization letter: *
Martin Gansrow- Agent Authorization
600.2KB
Form.pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: *
Gansrow- 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: Martin Gansrow- GIS & Map Directions.pdf 3.1MB
Latitude:*
35.801000
Longitude: *-81.337000
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*
Martin Gansrow- Scope of Work.pdf 3.79MB
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.)
Martin Gansrow- Property Picture, Survey,
and Buffer.pdf
7.91 MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Hickory
County: * Caldwell

Lake/ river/ ocean adjacent to Lake Hickory
property:
Subdivisions name or site address: *
Directions to site: *
6184 Plantation Pointe Dr Hickory NC 28630- Plantation Pointe, Lot 56
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: *
Residential, Developed
Residential, undeveloped, etc.
6. Property Size
1.02
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.)
176
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.)
176
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)
Lightly wooded and grassy yard
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:
a 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");
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: 6/8/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20220784 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: 56 PLAN NO: - PARCEL ID: 08147 1 56
STREET ADDRESS:
6184 Plantation Pointe Dr
Granite Falls, NC 28630
Please print:
Property Owner: Martin Gansrow
Property Owner:
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):
same
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
Mour knowledg
6:11 Clien Sig ture Charlie Wash um
6'/7 / zoz7-___
Date Date

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This map is NOT of land survey quality and is NOT suitable for such use.
Owner
GANSROW MARTIN
GANSROW LAURA
5843 MCCLINTOCK DR
DENVER, NC 28037
Acct Number 163936
Parcel ID 08147 1 56
NCPIN 3705741414
Deferred Val $
Assessed Val $973,300
Calc Acreage 1.02606214
Land Units 1 (LT)
Legal Desc BK 1944 PG 374 YR 2018 ST 230.00
Plat Ref 00019/00417
Property Addr 6184 PLANTATION POINTE DR
Caldwell County
1:2,974
o 0.025 0.05 0.1 mi
1! 1 1? 1
O 0.04 0.08 0.16 km
May 13, 2022

bing maps
A Marine Construction of Hickory, 1173 Shiloh Church Rd, Hickory, NC
28601
B 6184 Plantation Pointe Dr, Granite Falls, NC 28630
A Marine Construction of Hickory
14 min , 6.2 miles
Light traffic (Leave at 2:42 PM)
Via Hubbard Rd, (card Dam Rd
• Local roads
i' 1 Head southwest on Shiloh Church Rd toward Rosenbalm Ln
It 2 Keep right to get onto Hubbard Rd
377 ft
0.6 mi
3 Turn right to stay on Hubbard Rd
Road name changes to (card Dam Rd
Turn left onto Petra Mill Rd
FI 6 Turn left onto Rocky Mount Rd
41 7 Turn left onto Lovelady Dr
1.4 mi
1.4 mi
0.9 mi
1.1 mi
423 ft
j--> 8 Turn right onto Plantation Pointe Dr
Arrive at Plantation Pointe Dr
9 The last intersection before your destination is Pier Point Dr
If you reach Peninsula Dr, you've gone too far
B 6184 Plantation Pointe Dr, Granite Falls, NC 28630
0.7 mi

Petra b1i11.5
Grace Chapel
Northlakes
rwe
14 min
V . .
6184 Plantation Pointe Dr.
,Granite Falls, NC 28630
Marine Construction
of Hickory
_
.Wittenbu"rg
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A Marine Construction of Hickory, 1173 Shil...
Oliuer'
Golf
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Pi& rTavern
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127
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miJdle
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B 6184 Plantation Pointe Dr, Granite Falls, N...
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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 Hickory
Property size (acres): 1.02 acres
Subdivision name or site address(include phase/lot number):
6184 Plantation Pointe Dr, Granite Falls NC 28630--Plantation Pointe, Lot 56
Directions to site-please include road names and numbers, landmarks,etc.:
Included in packet
Latitude(in decimal degrees) 35.801 Longitude (decimal degrees) -81.337
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped,etc.): Residential/Developed
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 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:
176 sgft
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:
176 sqft
Temporary impacts(temporary clearing,construction corridor) in square feet:
1104 sgft (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):
Lightly wooded and grassy yard.
1111Mture
a4
15.4&/ 0--/2 7
Owner/Agent's Signature' [15A NCAC 02M .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:
All proposed vegetation clearing
Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
Location of any proposed structures such as buildings, retaining walls, docks, etc.
Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
a.
b.
c.
d.
e.
Full Pond/ Normal Water Lave
Shoreline
• ?ee-ay.c. 'Z 11 n&* 1^-0d
C4911.1-rd c l (0,. (d i'rz 4 V'4-
Lake
(At Full Pond/ Normal Water Level)
eg' - Z' $eiod P;iL /
G
*pm rf�siroilr Mr;•iw,r r ."1 1ytatoro / .ro ti f nory1�JMW./�ftN
y►T4j(i111+�s►%��.r: aM MEM iiiNk 111M i
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Ca" ,.u1.+,`0 . CarrijOr 210 C
Flan View
0. Pre" )
3d' trY-
OKr-cw Z,
Full Pond/ Normal Water Level
� 'shorene
2ft. v150ft.
additional clearing
' t necessary
Lake
(At Full Pond/ Normal Water Level)
ittaT 1
ii Riprap `.S V
seer
�••••�•
Existing Dock
/efrftx7ft
3 fti )Soft
Niaa/ fug pond/ NWL
CZ'---
4ftcL50ft
Above full pond/ NWL
3AMPLiE
Plan View
FORM: SSGP 02-2017
Page 3 of 4

3 ft. below full pond water level 4 ft. above full pond water level
2 ft. additional clearing
If necessary
10 ft. bank
height
FORM: SSGP 02-2017 Page 4 of 4

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LOVELADY TOWNSHIP CALDWELL COUNTY NORTH CAROLINA
NCPIN REFERENCE: 3705535616
DEED REFERENCE: 1151-994
DATE OF SURVEY: MAY 25th, 2000 DATE OF PLAT: MAY 30th, 2001
DRAWN BY: SIAS DRAWING NUMBER: 00023
PRESENT OWNER:
J P PROPERTY, INC.
OWNERS UNDER CONTRACT:
AFT ENTERPRISES2 NC..
10.800 SIKES PLACE. SUITE 250
CHARLOTTE, NC 28277
( 704 ) 847-6006
SURVEYOR:
GERALD V. GRANT & ASSOCIATES
P.O. BOX 268
STATESVILLE, N.C. 28687
PHONE; [phone]
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PRIVATE ROAD DISCLOSURE STATEMENT
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64
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LA
Le
Lt
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612
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144
116
617
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1.01
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624
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660
1.21
LENGTH
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1418
1360
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4,63
3,71
76.74
6,47
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1,79
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4.60
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FINAL SUMMON PUT FOR
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GRAPHIC SCALE
0 RE
( $) n. 102 n
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9.16
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aim
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PADS 417 - 417 1353_900
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GERALD V. GRANT
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BOB
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PHONE [phone]
SHEET EIGHT OF EIGHT SHEET

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CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: Gansrow—Granite Falls County: Caldwell
Owner: Martin Gansrow bG;4 - 6244411A,1
010
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)j
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, Martin Gansrow , 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.
0( '' %ir' " �/
Signature(owner : Date: v? 7