20230819 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: * William Busch
Email: *
Phone Number:
Mailing Address: *
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
2105 Worthington Drive
Address Line 2
City
Matthews
Postal / Zip Code
28104-6896
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
NC
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:
Busch- Agent Authorization Form.pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Busch- Lot 219 Waterfront Club
State / Province / Region
NC
Country
USA
778.68KB
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: * 35.779000
Longitude: *
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 *
IN
Please use the diagram at the link below:
https:Hedocs.deq.nc.gov/WaterResources/o/edoc/616616/Shoreli 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: * Granite Falls
County: * Caldwell
Lake/ river/ ocean adjacent to Lake Rhodhiss
property:
Subdivisions name or site address: * Lot 219 Waterfront Club Sub. Phase 3, 1051 Big View Ln
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 1.462
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 part of 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.)
50
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.)
50
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. We plant to remove two trees but will replant them one -for -one 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: * 20230919 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:
1051 Big View Ln. Granite Falls NC 28630
35.779/ -81 .557
Parcel ID: Parcel ID# 11 55A 1219
Property Owner Name(s)—please print:
Property Owner: William Busch
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):
2105 Worthington Dr. Matthews NC 28104
2105 Worthington Dr. Matthews NC 28104
Property Owner(s) Telephone: [phone]
We hereby certify that the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized ignatu e Authorized Signature
�' 3D a� b/slay
Date Date

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CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: Lot 219 Waterfront Club County: �camwall
Owner: William Busch / l
Print Signature
Contractor/agent:Charlie Washburn—Marine Construction L
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
1, William Rus;ph 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: 13A

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.:• State of North Carolina
a
Department of Environment and Natural Resources
Division of Water Resources
Y 15A NCAC 02H.0500—Water Quality Certification,Shoreline Stabilization
Water Resources
FORM: SSGP 02-2017
ENVIRONMENTAL QUALITY
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: William Busch
Mailing Address: 2105 Worthington Dr.
Matthews NC 28104
Telephone Number: 704-806-2485 Fax Number: NIA
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/dots/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: office@ marineconstructionllc com
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 Rhodhiss
Property size (acres): 1 462
Subdivision name or site address(include phase/lot number):
Lot 219 Waterfront Club Subdivision Phase 3
Directions to site -please include road names and numbers, landmarks,etc.:
Included in packet
Latitude (in decimal degrees) 35.779 Longitude(decimal degrees) -81.557
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 part of 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:
50 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:
50 sgft
Temporary impacts(temporary clearing,construction corridor) in square feet:
(Construction corridor= 250 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): The lot is wooded.
We plan to remove 2 trees but will replant them 1 for 1 with Native Hardwood Trees.
11. Signatur
I-f 3 93
Owner/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
La ke
(At Full Pond/Normal water Level)
Full Pond/ Normal Water Level ]'C�elowWtlnffidINWI-
Shoreline o a X a
01. x a5 Ca
Plan View
Lake
)At Full Pond/Normal Water l-v I) Existing Dock
30 hx 7ft
3kz 150ft
Below full pond)NWL
Full Pond/Normal Water Level
�5horeTne _4hz150ft
Riprap Above full pond/NWL
2 h.z150 h.
dddla0nel[ledrlllg
'x necessary
EXA M P E
Plan View
FORM:SSGP 02-2017 Page 3 of 4

Inl� �IG,n�-p re.-mare a �s
in 6WAMew- Pm mpotocA
W� \X Cram QuDwd, (tcanw-CY'M
Lake Wj- Iis�. N �P-Vlanl-ed WS will ! t
(At Full Pond/Normal Water L CU spko GPI " e4 y arld t o W
Sec m �0 ensue Maxlmcro
L
FU11 0
-a
c
0
Side View
IL
3 ft.below full pond water level 4 ft.above full pond water level 2 ft.additional clearing
rf necessary
Existing bank
10 ft.bank a
height O�ie'
�0
Q
Side Vi T MPLE
FORM:SSGP 02-2017 Page 4 of 4

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This map is NOT of land survey quality and is NOT suitable for such use.
Owner IRYALLC Deferred Val $0 Caldwell County
15563 DONNINGTON DR Assessed Val $193,900
CHARLOTTE,NC 28277 CalcAcreage 1.462 1:5,736
0 0.05 0.1
AcetNumber 170246 Land Units 1.462(AC) D2-
� � i r—
Parcel ID 11 55A 1219 Legal Desc BK 2006 PG 586 YR 20 ST 401.00 0 0.075 0.15 0.3 W
NCPIN 274 41 856 21 Plat Ref 000 36/0 01 90 May 24,2023
Property Add 0

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