20221218 Ver 1_Shoreline Stabilization_20220908

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 9/6/2022
submitted on: *
Owner Information:
Name: *
Email: *
Phone Number:
Mailing Address: *
All Uphill Mgmt c/O Ben Medlin
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
788 All Uphill Drive
Address Line 2
City
Taylorsville
Postal / Zip Code
28681-7165
Is there an agent working on the project? * Yes
No
Agent/Consultant Information
State / Province / Region
NC
Country
US
Name:* Yvette Huffman
Company Affiliation: * Lake Permit Services, LLC
Email: * [e-mail]

Phone Number:*
[phone]
(xxx)xxx-xxxx
Mailing Address:*
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:*
Ben Medlin - Agent Authorization.pdf 560.32KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
Medlin - Taylorsville
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: Ben Medlin - Directions and GIS.pdf 1.98MB
Latitude:*
35.827000
Longitude: *-81.252000
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*
Ben Medlin - Scope of Work.pdf 2.4MB
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.)
Ben Medlin - Prop pic, Survey and Buffer.pdf 3.81MB
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: *
000 Waterside Dr (Lot 5), 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 / Undeveloped
Residential, undeveloped, etc.
6. Property Size
1.278
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Property owner is requesting the placement of 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.)
1036
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.)
518 with 2590 temp
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)
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:* Yvette Huffman
Signature:
Submittal Date: 9/6/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20221218 Version:* 1
Select Reviewer: * Doug Perez:eads\djperez
Select Reviewing Office: Mooresville Regional Office - [phone]
Has payment been received?* No Payment Needed
Fee Received
Need Fee - send electronic notification
What amount is owed?* $240.00
$570.00

PROPERTY LEGAL DESCRIPTION:
LOT NO: 5 PLAN NO: PARCEL ID: 0061666
STREET ADDRESS:
000 Waterside Dr (Lot 5)
Taylorsville NC 28681
Please print:
Property Owner: All Uphill Management, LLC c/o Ben Medlin
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) 788 All Uphill Dr
Taylorsville NC 28681
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
(4„
OSP 201
IC fe0 sign ure Yve• - uffman,— Lake ermit Servic s
r
Date � A " • , 0 b, Date

8/26/22, 3:47 PM Hickory, North Carolina to Wittenburg Township, North Carolina - Google Maps
Go gle Maps
Hickory
North Carolina
Hickory, North Carolina to Wittenburg Township, Drive 13.7 miles, 24 min
North Carolina
End location: 000 Waterside Dr (Lot 5) Taylorsville NC 28681
4
Map data ©2022 2 mi
t 1. Head east on 2nd Ave NW toward 3rd St NW
O Pass by Bank of America (with Drive-thru services)
(on the left in 0.3 mi)
< 1 2. Turn left onto 2nd St NE
O Pass by Starbucks (on the right in 1.2 mi)
t 3. Continue onto NC-127 N/N Center St
O Continue to follow NC-127 N
f* 4. Turn right onto Rink Dam Rd
5. Turn right onto Church Rd
f3 6. Turn right onto Tadpole Ln
is 7. Slight left onto Waterside Dr
0.5 mi
1.4 mi
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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: Alexander Nearest Town: Taylorsville
Lake/ river/ ocean adjacent to property: Lk Hickory
Property size (acres): 1.278 acres
Subdivision name or site address (include phase/lot number):
000 Waterside Dr (Lot 5), Taylorsville NC 28681
Directions to site - please include road names and numbers, landmarks, etc.:
Included in packet
Latitude (in decimal degrees) 35.827 Longitude (decimal degrees) -81.252
5. Describe the existing land use or condition of the site at the time of this application (residential, undeveloped, etc.): Residential/Undeveloped rk...
Q/o (jC codt)
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Property owner requests permission to have riprap
(Class B Stone) placed 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 (includin all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
tD 3- sgft (4 x 2361 )
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:
6-f`t')sgft (_. 254
Temporary impacts (temporary clearing, construction corridor in square feet:
2 S9 D (construction corridor) El 0 w X 259 I
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): Trees, brush, and sandy beach
area. Tropes'` Oth)0,e)c- WI 11 m, n nM zc d h 1nC - (A h(I Q,
Vac41019 3-- 4- i-eS 4 brks h < <, rE &roc tot 1( he_ r -es, ubl shd
ct it rl e rr p p\o c 1'revi
11. Signatuj
7v 14004.t.- / � 1-� Jk/Z- 4,Ao 2 '2_Owner/Ag is Signature [:SA NCAC 02H .0502(f)] Date
FORM: SSGP 02-2017 Page 2 of 5

AdIto
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
-- bank
DAI Fo
2' '7'
Full Pond/ Normal Water Level
Shoreline --
3-1-Vr.e&3 (Si)
d 15&3to) and. brv\5k-
l-t-Dmeo w r r 3'
re,plCkce iroxfyf--tO,irl
Plan View
Lake
(At Full Pond/ Normal Water Level)
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(Urn
Lake
(At Ril Pond/Normal Water Level)
Full Pond/ Normal Water Level
Shoroiine
2ft. x150ft.
addltiona! clearing
• H necessary
Plan View
Existing Dock
30ftx7ft
3 ftx 150ft
Below full pond/ NWL
4ftx150ft
Above full pond/ NWL
FORM: SSGP 02-2017
Page 3 of 4

MeOn
3 ft. below full pond water level 4 ft. above full pond water level
2 ft. additional clearing
'if necessary
10 ft. bank
height
Side Vi
cs&b,
FORM: SSGP 02-2017
Page 4 of 4

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CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: Medlin - Taylorsville County: Alexander
Owner: All Uphill Management LLC c/o Ben Medlin 2zv 4-`4—�l
Print
S i
Contractor/agent: Lake Shore Grading — Mike Miller
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. [i5A 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, [i5A 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
All Uphill Management LLC c/o Ben Medlin , hereby state that 1 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):
Date: 0-2A71 L
Signature (owner): Date: