20230181 Ver 1_Shoreline Stabilization_20230202

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 1/31/2023
submitted on: *
Owner Information:
Name:* Ryan Grant
Email: * [e-mail]
Phone Number: [phone]
(xxx)xxx-xxxx
Mailing Address: *
Street Address
5832 Lake Hickory Place
Address Line 2
City
Hickory
Postal / Zip Code
28601-9400
Is there an agent working on the project? * Yes
No
Agent/Consultant Information
State / Province / Region
NC
Country
US
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
28603 USA
A signed and dated copy of the Agent Authorization letter:*
Grant- Agent Authorization Form.pdf 575.03KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
Grant- 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: Grant- GIS and Map Directions.pdf 2.47MB
Latitude:*
35.786000
Longitude: *-81.357000
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*
Grant- Scope of Work.pdf 4.32MB
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.)
Grant- Buffer Survey and Property Picture.pdf 6.05MB
4. Location of the property (where work is to be conducted)
Nearest Town: * Granite Falls
County: * Caldwell
Lake/ river/ ocean adjacent to Lake Hickory
property:

Subdivisions name or site address: *
Lot 12, 5832 Lake Hickory Place Hickory NC 28601
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
1.1
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.)
700
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.)
2,100
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)
We plan to remove 27 trees but replant native hardwoods 1 for 1. The lot
is lightly wooded with an existing floating dock (472 sqft.).
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
o I intend to electronically sign and submit the Shoreline Stabilization online form.

Full Name:*
Charlie Washburn
Signature:
Submittal Date: 1/31/2023

Initial Review
Is this accepted into the review process?* , Yes No
Project Number:* 20230181 Version:* 1
Select Reviewer: * Mitchell Anderson:eads\mlanderson
Select Reviewing Office: Asheville 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

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO: 12 PLAN NO:
STREET ADDRESS:
5832 Lake Hickory Place Hickory NC 28601
Please print:
Property Owner: Ryan Grant
Property Owner:
PARCEL ID: 08 SEC16 11
The undersigned, registered property owners of the above noted property, do herebyauthorize
Charlie Washburn
(Contractor/Agent)
, of Marine Construction LLC
(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):
Mailin
Telephone
Same as above
[phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
CI nt Signature
Date
a/
Charlie Washburn
130a3
Date

This map is NOT of land survey quality and is NOTsuita ble for such use.
k
0-0
October 14, 2022

Go Cgle Maps 1117 Shiloh Church Rd, Hickory, NC 28601 to 5832 Drive 6.3 miles, 11 min
Lake Hickory PI, Hickory, NC 28601
----- .."Y' —mac �uuflty, WNLO / AirouS, Landsat / Copernicus, Maxar Technologies, Orbis Inc, U.S. 2000 ft
Geological Survey, USDA/FPAC/GEO, Map data 92022

1117 Shiloh Church Rd
Hickory, NC 28601
1. Head southeast toward Shiloh Church Rd
r3 2. Turn right onto Shiloh Church Rd
-t 3. Continue straight onto Hubbard Rd
T 4. Continue onto Icard Dam Rd
+1 5. Turn left onto Petra Mill Rd
+1 6. Turn left onto Grace Chapel Rd
+, 7. Turn left onto Lake Hickory PI
5832 Lake Hickory PI
Hickory, NC 28601
92 ft
253 ft
1.9 mi
1.4 mi
0.9 mi
1.9 mi
0.1 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: Ryan Grant
Mailing Address: 5832 Lake Hickory Place
Hickory NC 28601
Telephone Number: [phone] Fax Number: N/A
E-mail Address: Grantr8l.rgCabgmail.com
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:
htta://www.saw.usace.armv.mil/Portals/59/docs/reeulatorv/reizdocs/Permits/SAMPLE AGENT ALITHORIZ
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) & (b)]
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: Caldwell Nearest Town: Granite Falls
Lake/ river/ ocean adjacent to property: Lake Hicko
Property size (acres)
1.1 Acres
Subdivision name or site address (include phase/lot number):
Lot 12, 5832 Lake Hickory Place Hickory Nc 26601
Directions to site - please include road names and numbers, landmarks, etc.:
Included in packet
Latitude (in decimal degrees) 35.786
Longitude (decimal degrees)-81.357
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 Dlan to stabilize the shoreline with rioraD 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:
700 sgft
Temporary impacts in square feet:
0 sgft
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:
Temporary impacts (temporary clearing, construction corridor) in square feet:
(Construction corridor= 3,500 sgft)
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):
ire,15 a ' k � oalnn) BOCK G LA17Z S�F}.) " J
11. Signature
Z2/
a -
Ow er/Agent's Signature' [15A NCAC 02H .0502(f)] 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)
_ , Fuji Oi
ull Pond/ Normal Water Level
`:�.._ NMI! i ter^;- "vg'e ix
Shoreline TAA-r
► ► ► b► ?AM
C0
(�Gnn9 G%eai')n
9
Plan View
Lake
(At full Vend/ Normal Water level)
Existing Dock
30ftx7ft
3ftx 150ft
Below full pond/ N WL
Full Pond/ Normal Water Level
Share'rine ® —
`" —4ftX15—rt
Riprap Above full pontl/ NWL
2 ft.z 150 ft.
add'rcional clearing
• If.—.,
EXAM
� PLE
Plan View
FORM: SSGP 02-2017 Page 3 of 4

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La ke
(At Full Pond/ Normal
a,X 85ofa
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ri
C
R
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3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing
*if necessary
Existing bank
FORM: SSGP 02-2017 (� /2
Page 4 of 4

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: Grant- 5832 Lake Hickory Place County: Caldwell
Owner:
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)]
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, flan Grant , 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): Date: A�z

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