20221046 Ver 1_Shoreline Stabilization_20220803

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 4/26/2022
submitted on: *
Owner Information:
Name: *
Email: *
Phone Number:
Mailing Address: *
Hal Johnson
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
8290 Blackberry Lane
Address Line 2
City
Clemmons
Postal / Zip Code
27012
State / Province / Region
NC
Country
United States
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: * Tommy Fraley
Company Affiliation: * Foothills Dock & Shoreline LLC
Email: * [e-mail]

Phone Number:*
Mailing Address:*
[phone]
(xxx)xxx-xxxx
Street Address
7923 Houston Ave
Address Line 2
City State / Province / Region
Hickory NC
Postal / Zip Code Country
28602 United States
A signed and dated copy of the Agent Authorization letter:*
Johnson.pdf 97.06KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: *
Johnson Shoreline
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: map.pdf 251.07KB
Latitude:*
35.782690
Longitude:* 81.489210
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*
proposed work copy.pdf 2.22M 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.)
pictures.pdf 8.85MB
4. Location of the property (where work is to be conducted)
Nearest Town: * Granite Falls NC 28630
County:* Caldwell
Lake/ river/ ocean adjacent to Rhodhiss
property:

Subdivisions name or site address: *
Edge Water
Include phase/lot number
Directions to site: *
From I 40 exit 113 go north to Dry pond rd, turn right on Dry Ponds go 1
mile to Liberty rd, right onto Liberty, go approx .7 miles to Dream View at
the end of Dream View.
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
1.83
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Remove over hanging tress, shape and bank and add rip rap with barrier
under.
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.)
998
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.)
7500
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)
an eroding band with small over hanging trees more of less under growth
behind the trees.
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.
a 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
I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:* Tommy Fraley
Signature:
Submittal Date: 8/2/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20221046 Version:* 1
Select Reviewer: * Mitchell Anderson:eads\mlanderson
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

SAMPLE Acerr ALMIORMA ON FORM
PROPERTY LEGAL D
LOT NO. _ .S 7 PLAN NO. PARCEL ID:
b1 rt I AUUKtsa: Ofeet Al v.e ,w Pali, ?
i jp IN cr 4. S • yr 5 r a �+►
e FA 'S AIC
Please rint:
PPropertypOwner:
Ha r 7 cr Peo 46oo.- a 4-d i'1. 00'1,
Progeny Lamer:
The imde signed, regismered property owners of the atove noted property, do herd authorize
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take al actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
8290 8 /aCk,6efory Lcr Al C %,or#77 oft V 70/2..
Telephone,
We hereby certify the above iniorrrrauon sum m tns appicaaan is true ana aouraee I me
best of our knowledge.
Authorized Authorized agrtature
Date 3/3/
Da .3 _

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CAdwell Caldwell
Burke
Caldwell a.d.,
There is not a 911 Address associated with this
property, the lot to the west of this property is
5739 Dream View Point, Granite Falls NC 28630

Proposed
(Plan View)
Lake
(At Full Pond/ Normal Water Level)
4'below full pond
Full Pond/ Normal W . A _
Shoreline
4'above full pond
I 1
10'above additional clearing in order to get
equipment to the water
May need to clear as much as
10'in order to get equipment of the waters edge
102',two foot above full pond
4'below full pond
At Full Pond ,
4'above full pond

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