20240059 Ver 1_Site Plan_20240108

�e.
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
ter R&souE Ces 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
ENV H;O Nt. i? N i A L OLI p[.I F Y FORM; SSGP 02-2017
Shoreline Stabilization Application Form
Three copies of the application including attachments) and the 2pJlCat1gn fee Should he sent to:
If sending via US Postal Service
Paul Wojoski
DW€2 — 401 & Buffer Permitting Branch
1637 Mail Service Center
Raleigh, NC 27699-1.617
A. Applicant Information [15A NCAC 02H .0502 a
1. Owner Information
Name: Tjrn0 nv m
If sending via delivery service (ups, FedEx, etc.)
Paul Wojoski
DWR —401 & Buffer Permitting Branch
512 N_ Salisbury Street
Raleigh, NC 27604
Mailing Address: -
lA
Telephone Number: VW- Q - Fax Dumber:]
E-mail Address:
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 he downioaded here_
hLt w�vv +d.saw.usace.ar ;I `Porta 59 ocs reQt�lator re docslPern�itslSJkMi�fl AGi i _f Ai]" NQRiZ
A-i ION FORM. d:)
Name: Charlie Washburn
Company Affiliation: Marine Construction LLC
Mailing Address: PO Box 6400
Hickory,NC 281503
Telephone Number: 828-495-3040 Fax Number: N/A
E-mail Address: office marineconstructionllc.com
13. PropeCt information [15A NCAC 021-1 .G x02��J]
1. Attach a vicinity reap (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: 55GP 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: aufKL Nearest Town: ,,�
Lake/ river/ ocean adjacent to property- _ �,K, R h f '�'�`
Property size (acres): J.-
Subdivision name or site address (include phase/lot number): LAk?, 5—Pha
se -rl
Directions to site - please include road names and numbers, landmarks, etc.:
Included in packet
Latitude (ire decimal degrees) -11 Longitude (decimal degrees) �. �] . �1'AL.e
Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Residential
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): __LOeQlanyo _.sob-i ig Sho-e4i&t [ li b
S Ion.
7. Will work be Conducted from land? ), 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:
400 -,nf*
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 wails, etc.) in square feet:
U 00snft
Temporary impacts (temporary clearing, construction corridor) in square feet:
Cr�nsiruction corridor= b 0 s ft
10. Please describe the vegetation above the normal pool lake level/ Normal Water Level and 5g
feet landward to be impacted (number of trees, for instance):
�v2 Will fqlaM OMt
rd�oa
r/Agent's S� atur' ` [15A NgAC a2i� .C�)) Elate
nt's signot�ure is valid only if an authori2otion fetter from the owner is provided.
FORM: 55GP 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
h. 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 F€€ll Ponril Nnrmnl lRlntnr € ot,.,l .€... a:
tt��,,,, — - ---• r .. .v. r. a. �4�4 GeGYOLIV4I
Lake
(At Full Pond/ Notmat Water Level)
Full Pond/ Normal Water Level �7 R]0"1N4Ui-
Shoreline
1 . aoa om&Oo carte
�r �rc�ss
P I a n View
�dCnd�r
1kFLOPtIeWUNW19IVA"4t-dj ExistingnQ4iG
.0 30 rr O ft
3"' ]soft
FuII j%rrd! H0rmal W I �r ie € - anrn vrutrpcn uTnst
'fioresne'u..�., m
R€prap . ah.iwn
ihx 150Fe. Alv,f! PmVNVA .
1 aCaponai[€a�r.96
AMP E
'1Fnptets�ry
}
Plan View 1
L
FORM: SSGP 02-2017 T" M
Page 3 of 4

a� � �03Fk
C�k�i�e, �i]l1 ��n� � a 6.] � flan )-6 mxm our 143-re>zs . WC, w% I
a�lk � .s finer �r � Gshr►�h
.. ke = Wo be, a.'S""� in d�am.wr oromfer.
(At Mall Pond/NormaI Water Level} hll ' ~C a�� }�'.2�5 wit f be �rer►n tsG�tti10
l s Ll will jcte4w4yyaW plan ed
.
� in � Gk1?7']��tf Samson .� ensue maxrm urn
,. so cc ess.
Side View
3 ft. belovi fi dl pond water level 4 ft. above NJ pond water ievel 2 ft• adrWonal clearing
'if nBtessary
Existing bank
Side Vi
FORM; SSG;? 02-2017
Page 4 of 4

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: S *X County:
Owner; IStY14i'i']fJ UiitidQ'[i Print signature
5i T1oi l3l'e
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 anti grading in the buffer is not allowed. Excessive disturbance of ground cover_ [15A NCAC 02B .0243
(6)1
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. 115A NCAC 02H .0502 and 15A NCAC 028 M43 (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. [I5A NCAC 02B .0243(5), (6)]
Acknowledgemr ant of Noti}tc{st'ion
1, �_* A 51]li�illGl+� hereby state that l 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 speci€ication(s), and other supporting materials.
Signature (owne

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Hickory
North Carolina
Take 9th Ave Dr NW, Airport Rhodhiss Rd and Rhodhiss Rd
to Decker Rd in Burke County
15 min (8.1 mi)
fi 1. Head north on 4th St NW toward 3rd Ave NW
440 ft
'h 2. Turn left onto 3rd Ave NW
1.0 mi
T 3. Continue onto 11th St NW/Old Lenoir Rd NW
0 Continue to follow Old Lenoir Rd NW
0.6 mi
f 4. Continue straight onto Clement Blvd NW
1.0 m i
T 5. Clement Blvd NW turns slightly right and becomes
9thAve DrNW
'P 6. Continue onto Airport Rhodhiss Rd
F i 7. Turn left onto Burke St/Rhodhiss Rd
0 Continue to follow Rhodhiss Rd
Continue on Decker Rd to your destination
r4 8. Turn right onto Decker Rd
r+ 9. Turn right
T 10. Slight right
1.6 mi
2.6 mi
1.3 mi
3 min (1.1 mi)
0.6 mi
0.4 mi
292 ft
Lakeside Reserve
QGFM+QV, Connelly Springs, NC 28612
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Please note that multiple forms may he necessary if there are more than two owners of the property.
PPEOPERTY LEGAL DESCRIPTION:
STREET ADDRESS OF EXISTING HOME Or LATMDE/LONGMDE OF NEW CONSTRUCTION:
Parcel ID: —
Property Owner Name(s) -- Please print:
Property Owner.
Property Owner.
The undersigned, registered property owners of the above noted property, do hereby authorize
Charlie Washburn -- r of Marine Construction LLC
(Contractor/Agent)
{iVame 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 ail standard and speciai conditions attached.
Property Owners Mailing Address (if different than property address above):
- B S 6 PaSri(.. )Anne ►,� 1 YXD T' .AI.' a, ,- . 4 . .,„
Properly Owner(s) Telephone:
VRl tier by: erti that the above information submitted in this application is true and accurate to the
best f
0 our knowledge,
Autori2pd Signature — Authorized Signature
Date