20230815 Ver 1_Shoreline Stabilization_20230610

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 6/5/2023
submitted on: *
Owner Information:
........ ......... ........
Name: * Gilbert Family Trust
Email: *
Phone Number:
Mailing Address: *
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
4870 Meritage Place
Address Line 2
City
Rockledge
Postal / Zip Code
32955-5193
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: * Charlie Washburn
Company Affiliation: * Marine Construction LLC
Email: * [e-mail]
State / Province / Region
FL
Country
Us

Phone Number:*
[phone]
(xxx)XXx-xxxx
Mailing Address: *
Street Address
PO Box 6400
Address Line 2
City
Hickory
Postal / Zip Code
28603
A signed and dated copy of the Agent Authorization letter:
Gilbert- Agent Authroization Form.pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Gilbert- Lot 137 Lakeside Reserve
State / Province / Region
NC
Country
USA
959.74KB
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:
Latitude: * 35.783000
Longitude: *-81.454000
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 *
of
Please use the diagram at the link below:
https:Hedocs.deq. nc.gov/WaterResou rces/0/edoc/616616/Shorel i ne%2OLayout.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.)
Pic
4. Location of the property (where work is to be conducted)
Nearest Town: * Connelly Springs
County: * Burke
Lake/ river/ ocean adjacent to Lake Rhodhiss
property:
Subdivisions name or site address: * Lot 137 Lakeside Reserve Sub. Phase 2, 2235 Castle Peak Mtn.
Include phase/lot number
Directions to site: *
Printed and Attached 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 1.25
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 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.)
420
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.)
840
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)
The lot is wooded and undeveloped. We plan to remove 13 trees but will replant them 1 for 1 with Native Hardwood 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):
$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:
I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the best
of my knowledge and belief
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.
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');
d 1 agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act');
d 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:
C-417MA;- <%( ad4AVt,W
Submittal Date: 6/5/2023

Initial Review
Is this accepted into the review process?* J Yes O No
Project Number: * 20230915 Version:`
Select Reviewer: *
Select Reviewing Office
Has payment been received?*
What amount is owed?*
Joey Winston:[e-mail]
Asheville Regional Office - [phone]
No Payment Needed
Fee Received
Need Fee - send electronic notification
$240.00
$570.00

AGENT AUTHORIZATION FORM
Please note that multiple forms may be necessary if there are more than two owners of the property.
PROPERTY LEGAL DESCRIPTION:
STREET ADDRESS OF EXISTING HOME or LATITUDE/LONGITUDE OF NEW CONSTRUCTION:
2235 Castle Peak Mtn Connelly Springs, NC 28612
35.783/ -8 1 .454
Parcel ID: 2774282655
Property Owner Name(s)—please print:
Property Owner: Gilbert Family Trust
Property Owner:
The undersigned, registered property owners of the above noted property, do herebyauthorize
Charlie Washburn , of Marine Construction LLC
(Contractor/Agent) (Name of company)
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 Mailing Address (if different than property address above):
4870 Meritage Pi. Rockledge, FL 32955
4870 Meritage Pl. Rockledge, FL 32955
Property Owner(s)Telephone: (321 ) 266-3644
We hereby certify that the above information submitted in this application is true and accurate to the
best of our knowledge.
Author Signat Authorized Signature
Date Date �—

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CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: Gilbert- Lot 137 Lakeside Reserve County: Burke
Owner: Gilbert Family Trust S;
Print Signature
Contractor/agent:Charlie Washburn—Marine Construction
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 026.0243 (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, Gilbert Family Trust 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): ���.E �l _ � � �°� —
Date:

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
ENV IRONMENrAL 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: Gilbert Family Trust
Mailing Address: 4870 Meritage PI.
Rockledge, FL 32955
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.mil/Portals/59/docs/regulatory/regdocs/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) & (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: Burke Nearest Town: Connelly Springs
Lake/river/ocean adjacent to property: Lake Rhodhiss
Property size (acres): 1.25 Acres
Subdivision name or site address(include phase/lot number):
Lot 137 Lakeside Reserve Subdivision Phase 2
Directions to site-please include road names and numbers, landmarks, etc.:
Included in packet
Latitude (in decimal degrees) 35.783 Longitude(decimal degrees) -81.454
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): We plan to stabilize the shoreline with riprap to prevent
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:
420 sgft
Temporary impacts in square feet:
0 soft
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:
fi4n sgft
Temporary impacts(temporary clearing, construction corridor) in square feet:
(Construction corridor= 2.100 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):! of is wooded and and v loped.
We plan to remove 13 trees but will replant them 1 for 1 with Native Hardwood Trees,
11. Signa r
'L(. L
Owner/A nt's Sig ature` [15A NCAC 02H .0502(f11 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
La ke
(At Full Pond/Normal Water Level)
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Full Pond/ Normal Water Leev l
cz-� � Fv�tp�ndJNwL.
Shoreline
10� _ M CornidrX RI ParkONwt-
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Plan View
Lake
(At Full Pond/Narmal Water Level)
Existing Dock
3aftx 7 ft
3Rx 150 ft
Full Pond/
.�iNormal
+Water Level Below full pond/NWL
r Jhorellne-- 4Rx 350 ft
Riprap Move full pond/NAIL
2 ft.x 150 ft.
additlonal clearing
"if ru"mary
EXAMPLE
Plan View
FORM:SSGP 02-20117 _ Page 3 of

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U-
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' if necessary
#I Existing bank
10 ft.bank a
I height
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FORM:SSGP 02-2017 a s^�� 2 3 Page 4 of 4

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