20220962 Ver 1_Shoreline Stabilization_20220719

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 7/15/2022
submitted on: *
Owner Information:
Name: * Nancy Thompson
Email: * [e-mail]
Phone Number: [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
1352 Misty Lane
Address Line 2
City
Hickory
Postal / Zip Code
28601
State / Province / Region
NC
Country
USA
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name:* Yvette Huffman
Company Affiliation: * Lake Permit Services
Email: * [e-mail]

Phone Number:*
Mailing Address:*
[phone]
(xxx)xxx-xxxx
Street Address
PO Box 6369
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:*
Nancy Thompson - Agent Auth.pdf 528.17KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC O2H .O5O2(a) & (b)]
Project Name: *
Thompson - 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: Nancy Thompson - Directions and GIS.pdf 1.46MB
Latitude:*
35.810034
Longitude: *-81.235971
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*
Nancy Thompson - Scope of Work.pdf 2.03 M B
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.)
Nancy Thompson - Survey and Buffer.pdf 1.91 MB
Nancy Thompson Prop Pic 1 pdf.pdf
Nancy Thompson Prop Pic 2 pdf.pdf
Nancy Thompson Prop Pic 3 pdf.pdf
1.21MB
1.01 MB
1.06MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Hickory
County: * Catawba

Lake/ river/ ocean adjacent to Hickory
property:
Subdivisions name or site address: *
4155 54th Ave NE, Hickory NC 28601
Include phase/lot number
Directions to site: *
Included in this packet.
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
1.78
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Homeowner is requesting approval to have riprap (Class B stone) placed
along the shoreline, 127 ft, 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.)
127
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.)
254 sqft, 8700 sqft
temporary
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)
See attached scope of work.
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
• $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");
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:* Yvette Huffman
Signature:
Submittal Date: 7/15/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20220962 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
PROPERTY LEGAL DESCRIPTION:
LOT NO: PLAN NO: PARCEL ID: 373511760990
STREET ADDRESS:
4155 54th Ave NE
Hickory NC 28601
Please print:
Property Owner: Nancy Thompson
Property Owner: •
The undersigned, registered property owners of the above noted property, do herebyauthorize
Yvette Huffman , of Lake Permit Services, 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) 1352 Misty Lane
Hickory, NC 28601
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
4Clie t Signore frtLYvettuffman—Lake a M' rvices
p V/g/ o or7J)4lV)
Date Date

7/14/22, 10:14 AM Interstate 40 to 4155 54th Ave NE, Hickory, NC 28601 - Google Maps
Go gle Maps 1-40 to 4155 54th Ave NE, Hickory, NC 28601
4155 54th
freatAvenue Northeast
eTt
I-40
9
Take 1-40 E to Herman Sipe Rd in Conover
1. Head east on 1-40 E
( 2. Take exit 133 toward Rock Barn Rd
E 1 3. Turn left onto Rock Barn Rd NE
4 4. Turn left
:te;)=
6 min (4.3 mi)
0.9 mi
0.2 mi
0.1 mi
269 ft
R 5. Use the left lane to merge onto 1-40 W via the ramp
to Hickory
a3 6. Take exit 130 toward Old US 70
r 7. Turn right onto 1st St W
f > 8. Turn right onto Herman Sipe Rd
2.3 mi
0.3 mi
0.4 mi
4 min (2.4 mi)
Drive 12.4 miles, 19 min
Map data ©2022 1 mi
;,iare, 3rr
https://www.google. com/maps/d it/Interstate+40/4155+54th+Ave+N E,+H ickory,+NC+28601/©35.7618407,-81.2520636,13z/am=t/data=!3m 1 !4b1 !4m 14... 1/2

7/14/22,10:14 AM Interstate 40 to 4155 54th Ave NE,Hickory,NC 28601 -Google Maps
Take Sulphur Springs Rd NE to 37th St Dr NE
7 min(4.7 mi)
4 9. Turn left onto County Home Rd
1.5 mi
* 10. Turn left onto Springs Rd
0.6 mi
11. Turn right onto Sulphur Springs Rd NE
2.6 mi
Drive to 54th Ave NE
2 min(1.0 mi)
+1 12. Turn left onto 37th St Dr NE
0.3 mi
T 13. Slight right onto 54th Ave NE
0 Destination will be on the left
0.6 mi
4155 54th Ave NE
Hickory, NC 28601
These directions are for planning purposes
only.You may find that construction projects,
traffic,weather,or other events may cause
conditions to differ from the map results,and
you should plan your route accordingly.You
must obey all signs or notices regarding your
route.
https://www.google.com/maps/dir/Interstate+40/4155+54th+Ave+NE,+Hickory,+NC+28601/@35.7618407,-81.2520636,13z/am=Udata=!3m 114b1!4m 14... 2/2

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Parcel: 373511760990, 4155 54TH AVE NE HICKORY, 28601
Owners: THOMPSON KEITH WAYNE, THOMPSON NANCY JEANNE
Owner Address: 5316 SUMMER CT
Values - Building(s): $0, Land: $158,800, Total: $158,800
This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends
the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and
personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may
arise from this map/report product or the use thereof by any person or entity.
Copyright 2021 Catawba County NC
07/07/2022

4. Location of the property (where work is to be conducted)
County: Catawba Nearest Town: Hickory
Lake/ river/ocean adjacent to property: Lake Hickory
Property size (acres): 1.78 acres
Subdivision name or site address (include phase/lot number):
4155 54th Ave NE, Hickory NC 28601
Directions to site - please include road names and numbers, landmarks, etc.:
Included in this packet
Latitude (in decimal degrees) 35.810034 Longitude (decimal degrees) -81.235971
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): Homeowner requests to have riprap placed along the full
shoreline (127 ft) 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:
127 sqft
Temporary impacts in square feet:
None
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:
254 sqft
Temporary impacts (temporary clearing, construction corridor) in square feet:
8700 (construction corridor)15 ft wide by 580 ft long
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): 87 ft of sandy beach. 40
ft of shoreline is a slight bank with height of 1-2 ft. Scrappy vines with one snag. Grassy yard.
Couple of trees.Trees will NOT be impacted. Minimal disturbance to buffer.
11. Signature
Owner/Age: is Signature' [15A NCAC 02H .0502(1)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

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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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FORM: SSGP 02-2017 Page 3 of 4

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CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: Thompson - Hickory
County: Catawba
Owner: Nancy Thompson y�2i'
Print Signature p
Contractor/agent: JK Landscaping & Grading -Jeff Kerley /A
Lg)/
Print Si nature2'17'
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, Nancy Thompson , 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.
4\ Signature (owner): f!!C- �1�FI�)d�-> Date: 0 ,7
Signature (owner): Date:

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