20221136 Ver 1_Shoreline Stabilization_20220824

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 8/19/2022
submitted on: *
Owner Information:
...........................................................................................................................
Name: * Timothy Bennett
Email: * [e-mail]
Phone Number: [phone]
(xxx)xxx-xxxx
Mailing Address: *
Street Address
878 Pine Tree Road
Address Line 2
City
Taylorsville
Postal / Zip Code
28681-8073
State / Province / Region
NC
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:*
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 USA
A signed and dated copy of the Agent Authorization letter:*
Bennett- Agent Authorization Form.pdf 685.32KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: *
Bennett- Shoreline: 878 Pine Tree Rd
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: Bennett- GIS Map and Directions.pdf 2.36MB
Latitude:*
35.817000
Longitude: *-81.235000
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*
Bennett- Scope of Work.pdf 4.44M 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.)
Bennett- Buffer Form Survey and Property
Picture.pdf
6.47MB
4. Location of the property (where work is to be conducted)
Nearest Town: *
County: *
Lake/ river/ ocean adjacent to
property:
Taylorsville
Alexander
Lake Hickory

Subdivisions name or site address: *
Lot 878, 878 Pine Tree Rd Taylorsville NC 28681
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, Developed
Residential, undeveloped, etc.
6. Property Size
0.501 Acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
We plan to stabilize the shoreline with riprap to avoid 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.)
200
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.)
200
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)
Grassy Yard. We plan to removed zero trees and vegetation.
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
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:
• 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");
• 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: 8/19/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20221136 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 FORE
PROPERTY LEGAL DESCRIPTION:
LOT NO: 878 PLAN NO: 0002791
PARCEL ID:
STREET ADDRESS:
878 Pine Tree Rd Taylorsville NC 28681
Please print:
Property Owner: Timothy Bennett
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) Same as above
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
b our knowledge.
1,44.671,,,,,,,----- r),,i ___
Client Signature Charlie Washburn
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Imagery ©2022 Alexander County, Burke County, CNES / Airbus, Landsat / Copernicus, Maxar Technologies, Orbis Inc, U.S.
Geological Survey, USDA/FPAC/GEO, Map data ©2022
1 mi

1117 Shiloh Church Rd
Hickory, NC 28601
T 1. Head southeast toward Shiloh Church Rd
f* 2. Turn right onto Shiloh Church Rd
41 3. Turn left onto Rink Dam Rd
f+ 4. Turn right onto Church Rd
4-1 5. Turn left onto Pine Tree Rd
878 Pine Tree Rd
Taylorsville, NC 28681
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.
92 ft
220 ft
5.5 mi
0.4 mi
0.9 mi

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Water Resources 15A NCAC 02H.0500—Water Quality Certification,Shoreline Stabilization
ENVIRONMENTAL QUALITY
FORM: SSGP 02-2017
Shoreline Stabilization Application Form
Three copies of the application(including attachments)and the application fee should be sent to:
If sending via US Postal Service If sending via delivery service(UPS, FedEx,etc.)
Paul Wojoski Paul Wojoski
DWR—401 & Buffer Permitting Branch DWR—401 & Buffer Permitting Branch
1617 Mail Service Center 512 N.Salisbury Street
Raleigh, NC 27699-1617 Raleigh, NC 27604
A. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: Timothy Bennett
Mailing Address: 878 Pine Tree Rd
Taylorsville NC 28681
Telephone Number: [phone] Fax Number: N/A
E-mail Address: [e-mail]
2. Agent/Contact Person Information
A signed and dated copy of the Agent Authorization letter must be attached if the Agent has
signed this application form. (A form can be downloaded here:
http://www.saw.usace.army.rnii/Portalsf5R/does/regulatorviregdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf)
Name: Charlie Washburn
Company Affiliation: Marine Construction LLC
Mailing Address: PO Box 6400
Hickory, NC 28603
Telephone Number: 828-495-3040 Fax Number: N/A
E-mail Address: [e-mail]
B. Project Information [15A NCAC 02H .0502(a) &(h)]
1. Attach 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.
2. Provide a detailed site plan showing property boundaries and proposed locations of
vegetation clearing, buildings, retaining walls,docks, impervious surfaces,rip rap, excavation
or dredging below Full Pond/Normal Water Level elevations,and construction access
corridors. You may use the diagram provided at the end of this application form.
FORM:SSGP 02-2017 Page 1 of 3

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: Taylorsville
Lake/river/ocean adjacent to property: Lake Hickory
Property size(acres): 0.501 Acres
Subdivision name or site address(include phase/lot number):
Lot 878, 878 Pine Tree Rd Tavlorsville NC 28681
Directions to site-please include road names and numbers, landmarks,etc.:
Included in packet
Latitude(in decimal degrees) 35.817 Longitude(decimal degrees)-81.235
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 stabilize the shoreline with riprap to avoid further
erosion
7. Will work be conducted from land?x 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:
200 sqft
Temporary impacts in square feet:
sqft
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:
200 soft
Temporary impacts(temporary clearing,construction corridor) in square feet:
(Construction corridor= 1,160 sqft)
10. Please describe the vegetation above the normal pool lake level/Normal Water Level and S0
feet landward to be impacted (number of trees,for instance): Grassy Yard
We plan to remove zero trees and vegetation
11. Sign e0,S1,20.)D—
Owner/Agent's Signature (15A NCAC 02H .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:
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)
Full Pond/ Normal Water Level •i�• • ••A•• ri.•• M ,�• ��Will �d 1Nw�
Shoreline ME MM MW Mil ;�•sioNto�o:* • w•'�® r ore �..
�► a • it .t � 1 e 06o I . z"x106" Popove
coil Pond, [ tswi.
10 t1 ( 100'l &0115 jiOn COrrndac
Nd Trees +t be removed
Plan View
Lake
(At Full Pond/Normal Water Level)
Existing Dock
30ft x Oft
S �.�.�.�.�.=.s.�.�:�.� >•. 3 ft x 150 ft
err• In o: itet Below full pond/NWL Full Pond/Normal Water Level•'0! 'ir04104i�i4iS ►: .Z'i
a�t�`horeTne!� ice. lam: t c'►' T'`' +..r
V �� 4ftx3 d,
�iN f : Riprap •7 w Aho a Full pond/NWL
2 ft.x350ari wr.�rr��—�'i` wan
additional clearing.J7`f('�
it ne<P::ary
•
(
PLE
Plan View
FORM:SSGP 02-2017
Page 3 of 4

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or
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2"X\60" Npove Foil 644
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Side View
Lt-
3 ft below full pond water level 4 ft above full pond water level 2 ft.additional clearing
I I *if necessary
I
411
Existing bank ,�
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10 ft hank j111/
height ,~• "
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P Side View ,
FORM:SSGP 02-2017
Page 4 of 4

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: Bennett- 878 Pine Tree Rd County: Alexander
�
Owner: `: 4I
� _ 4,7v'1,47-1+ 2n (�Jrz,•
F rint
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)]
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(6j]
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
Timothy Bennett
I. ,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): 1414 141 Date: l �� �,

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