20181113 Ver 1_Shoreline Stabilization_20180809

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DocuSign Envelope ID: 774F9792-C373-4BD3-9658-651CB4E90B62
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
DWR
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources
FORM: SSGP 10-2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center I11
Raleigh, NC 27699-1617 O I l
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
D
AUG 0 9 2018
0
4FFR
Name: Terrell & Peggy Edmunds
Mailing Address: 31319th ST DR NE
Unit 61
Hickory, NC 28601
Telephone Number: F.� 3 Io - 3d y-.3 Fax Number:
E-mail Address:cc1j, ed CSpi,t�sx
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http:/Iwww.saw.usace.army.mil/Portals/59/docs/regulatorylregdocs/PermitsISAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: William Garrison
Company Affiliation:
Mailing Address: 1936 Jamestown Road
Suite C
Morganton, NC 28655
Telephone Number: 828-334-1537 Fax Number:
E-mail Address: [e-mail]
Person to receive the Certification Approval: William Garrison
II. 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, structures (buildings, retaining walls, docks, impervious surfaces,
FORM: SSGP 10-2013 Page 1 of 3

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DocuSign Envelope ID: 35B32EEC-4F06-465D-AE07-5E43706A673F
etc.), 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.
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: Catawba Nearest Town: Hickory
Subdivision name or site address (include phase/lot number): Lot A— Hollar Hosiery
Mill, Inc — Parcel ID: 371515634512
Directions to site - please include road names and numbers, landmarks, etc.:
NE corner of NC 127 and 481h AVE NE, Hickory NC
Latitude (in decimal degrees) 35.79845 N Longitude (decimal degrees) 81.30573 W
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Wooded - Undeveloped
6. Property size (acres): 0.459 Acres
7. Lake/ river/ ocean adjacent to property: Lake Hickory
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Add rip -rap to reduce shoreline erosion on embankments:
add sea wall to undercut areas of shoreline to reduce shoreline erosion.
9. Will work be conducted from land? X From water? ❑
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool lake level/ Normal Water level in square feet or acres:
850 sf
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres: 830 SF (include dock access, filling old pond, and dock deck)
12. 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):
small to large sofa and hardwood trees with under brush
dotloelified
QW. 75 07/30& 3:27PM EDT Alton T Edmunds
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Mit William Garrison 7/30/2018 6:54:03 AM PDT
781 Ed33F 7567E �
Owner/Agent's Signature Printed Name Date
MA NCAC. 02H_,0502(fll
"Agent's signature is valid only if un authorization letter from the owner is provided.
FORM: SSCP 10-2013 Page 2 of 3

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DocuSign Envelope ID: 774F9792-C373-4BD3-9658-651CB4E90B62
Full Pond/
Normal Water Level
Shoreline
La ke
(At Full Pond/Normal Water level)
SEE ATTACHED SITE PLAN BY JEFFREY SWARTZ PE
. MA
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ft x 100 ft)*:
1. All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
3. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
4. Location of any proposed structures such as buildings, retaining walls, docks, etc.
5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
FORM: SSGP 10-2013 Page 3 of 3

SURVEY 6Y,
POOGER D. MORGAN SURVEYING
3735 CHARLES DALE DR. MORGANTON, NC 28655
PHONE: [phone]
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Call before You dig.
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DIAL $11 or 1.800.632.4949
SHORE,STABILIZATION IN THE LOCATION SHOWN ON
2 BUSINESS DAYS BEFORE DIGGING
0.459 Acres
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79,978 Sq. Feet
FIXED DOCK OR DECK MAY COVER A MAXIMUM OF 150
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PIN: 3715-1563-4512
SHORE,STABILIZATION IN THE LOCATION SHOWN ON
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0.459 Acres
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FIXED DOCK OR DECK MAY COVER A MAXIMUM OF 150
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SHORELINE
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SHORE,STABILIZATION IN THE LOCATION SHOWN ON
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SHORELINE (SLIS.ECT TO DUKE ENERGY APPROVAL). '
and
FIXED DOCK OR DECK MAY COVER A MAXIMUM OF 150
Peggy G. c'dmounds
MAX CCCK
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DISTANCE
SHOWN ON THE SHORELINE .STAIX17ATION PLAN. ALL
0.459 Acres
EXISTING STORM WATER CONVEYANCES WHIN THE 30
19,978 Sq. Feet
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4 " CALIPER
POND MUST BE REMOVED AND THE GRADE RESTORED TO
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POPLAR TREE
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150 SF
OVERLAND
MAX;.
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FOR ACCESS
HEIGHT (NOT INCLUDING SPLIT TRUNKS) WHIN THE
1/1" Pipe
BUFFER. UNDERBRUSH MAY BE TRIMMED TO GRADE,
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PER NCDWR SITE WSIT ON 7/13/2018.LOT PREDATES
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2001 AND THEREFORE ONLY A 30 FT LAKE BUFFER
APPLIES, A SEA STALL MAY BE INSTALLED FOR
SHORE,STABILIZATION IN THE LOCATION SHOWN ON
THIS PLANDUE TO THE PRESENCE OF AN UNDERCUT
Alton Terrell Edmunds
SHORELINE (SLIS.ECT TO DUKE ENERGY APPROVAL). '
and
FIXED DOCK OR DECK MAY COVER A MAXIMUM OF 150
Peggy G. c'dmounds
Sr YATHIN THE 30 FOOT BUFFER. ALL TREES TO BE
06.•2826 PG.• 651
REMOVED OVER A 4" CALIPER MUST BE MARKED AND
P1N:3715-1563-4512
SHOWN ON THE SHORELINE .STAIX17ATION PLAN. ALL
0.459 Acres
EXISTING STORM WATER CONVEYANCES WHIN THE 30
19,978 Sq. Feet
FT BUFFER MUST REMAIN. EXCEPT THE OLD SEVIMENI"
POND MUST BE REMOVED AND THE GRADE RESTORED TO
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PREEXISTING GRADE AND THE $OIL STABILIZED. TREES
OVER 4' IN CALIPER MAY BE LIMBED UP TO 509. OF
HEIGHT (NOT INCLUDING SPLIT TRUNKS) WHIN THE
BUFFER. UNDERBRUSH MAY BE TRIMMED TO GRADE,
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BUT ROOT SYSTEMS MUST REMAIN, GROUND COVER
MUST BE fN PLACE SUCH AS GRASS, IVY. OR OTHER
NATURAL VEGETATION WITHIN THE BUFFER IMMEDIA TEI.Y
^� STABILIZE ANY OISTUR6E0 AREAS W/TH GROUND COVER.
SITE AND SHORE STABILIZATION PLAN
SCALE: 1"=30'-0"
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dotiooD sienature verification
DocuSign Envelope ID: 774F9792-C373-4BD3-9658-651CB4E90B62
SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. u'JA, —PLAN NO. ,0 L4 PARCEL ID: 0
STREET ADDRESS: 06 (cwtN ¢,t" o � tic, u-1 (erAk LJ B-r6,iAve L2C
14 rT, 1"J, (--
Please print: �
Property Owner: u e QLL 4
Property Owner:
T
The undersigned, registered property owners of the above noted property, do hereby authorize
of Aj JA
(Contractor / genu (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 Owner's Address (if different than property above):
31.E 1 9± 5T ()P. tj & * c., i �" 0 "') 1)4 A
Telephone: ¢ t D 3 ,;' (ji __3
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
FDRZ-T verified
07/26/18 Z45AM EDT
FDR2-TXIP-MAUR-FDEY
x Authorized Signature Authorized Signature
Date Date

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DocuSign Envelope ID: 774F9792-C373-4BD3-9658-651CB4E90B62
CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: Shoreline Stabilzation — Lot A Cornor of NC 127 and 481h Ave
Owner:
Contrac
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, 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 0213.0243 (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, Terrell Edmunds J
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.
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Signature (owner): Date: