20190539 Ver 1_Shoreline Stabilization_20190424

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
"."a ter 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.)
Karen Higgins Karen Higgins
DWR-401 & Buffer Permitting Branch DWR-401 & Buffer Permitting Branch
161-7 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:
Mailing Address:
Telephone Number: dao-Sn Fax Number:
E-mail Address: `01AeaCe'A 3 t'�a zrt' ,
2. Agent/ Contact Person Information
�\ 201 90538
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:
htto://www.saw.usace.armv.mil/Portals/59/docs/reRulatory/reRdocs Permits SAMPLE AGENT AUTHORi
ZATION FORM.pdf) _
Name:
Company Affiliation: s�
Mailing Address: \\ 3
VS - C a $ (oc9
Telephone Number: lg � 44S-36AAro Fax Number:
E-mail Address: W-\GaC'V'—(Z "
B. Project Information f 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 detai{ed site plan showing property boundaries and proposed locations of
vegetation clearing, buildings, retaining waits, 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 he stabitrced. (include a
scale of some sort a yard stick, shovel handle, etc.)
4. Location of the property (where work is to be conducted)
County: "a%- - Nearest Town:
Lake/ river/ ocean adjacent to property: �o
Property size (acres):
Subdivision name or site address (include phase/lot number): 644-
Directions
4 -
Directions to sit6 please ' clude road names and
Sq Adm Qa. v Y"4-v.4\:�ht fro s'tt� w. Vt— _T&V.V-�"
�a1+�' +Aoo• . lntzea...x laW Sti . I.Nksk Q,k- Qk .
etc.: Vag. iAoq,%zI a
�w I+S E)O%Xe t"Porr..
Latitude (in decimal degrees) 35. 14 _Si 4 k Longitude (decimal degrees) - 21. 13 b a -t 0
5. Describe the eodsting land use or condition of the site at the time of this application
(residential, undeveloped, etc.): - 4.s:A a
6. Describe proposed work (include discussion as to how hardening Of shoreline has
been avoided, or why it is necessary): 1Swe e Lw, Eroc(ty, e
7. Will work be conducted from land? From water? ®O"—
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: S7a �f S r
Temporary impacts in square feet:
3. Total amount of impacts above the normal pool lake level / Normal Water Level and
50 feet land -ward Q
Permanent impacts (including back fill, excavation, rip rap, retaining walls, etc.) in square
feet: AL S -
Temporary impacts (temporary clearing, construction corridor) in square feet:
O
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):
&eoss
11. Signature
FORM: SSCP 02-2017
Page 2 of 3

Owner/Agent's Signature` [15A NCAC 02H .0502(f)] Date
Agent's signature is valid only if an authorization fetter from the owner is provided.
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
/31
Full Pond/ Normal Water Leve='-
Shoreline a,
Lake a)
(At Full Pond/ Normal Water Level) IS 1 µ
CIS 's
0 0
Z
a
C .—. --
Sid1Q . View-
!iew- Lake
(At k*PM&NmYW Water left) Existing Dock
3Dftz7
3ftxU0ft
MW U Pond/NWL
Full Pond./ Normal Water levet
• .tioreTine •• � _
aftzis0ft
A M P L E
Riprap Abom full pm & NWL
ztLtIM&
adMonal dmft
• IFnemsary
L.
FORM: SSGP 02-2017 Plan View Page 3 of 3

T Ft
Normz
SI
La ke
(At Full Pond/ Normal Water Level)
V4 Sl^ ,1044, ( t R„j
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.
S. 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

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: (A4 40' 44_ t,. Ku� V\tOA06L4 _County: S u,�YiA6�
Owner:
Print
Contractor/agent: _
Print
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),'uniess
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 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, \ hereby state that I have been informed of the Catawba
Riparian Buffer R e Any work6nducted 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(i) and specification(s), and other supporting
materials.
Signature (owner): CQ ZA_L�. Date: z

catawba county Geospatial Real Estate Search
MAKING. LIVING. BRIER. Information Services
N
W+E 1 in=80ft
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Parcel: 370519711465, 644 41 ST AVE CT NW HICKORY, 28601
Owners: LACKEY BRADLEY, LACKEY TASHA FOX
Owner Address: 644 41 ST AVENUE CT NW
Values - Building(s): $277,000, Land: $38,100, Total: $315,100
This map/report product was prepared from the Catawba County, NC Geospatial Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling information contained on this map or data on this report. Catawba County promotes and recommends
the independent verification of any data contained on this map/report product by the user. The County of Catawba, its employees, agents, and
personnel, disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect or consequential which arises or may
arise from this map/report product or the use thereof by any person or entity.
Copyright 2014 Catawba County NC
04/12/2019

0catawba county Geospatial Real Estate Search
..G. „Y,„G. g...... Information Services
N
W+E 1 in=80ft
VS
Parcel: 370519711465, 644 41ST AVE CT NW HICKORY, 28601
Owners: LACKEY BRADLEY, LACKEY TASHA FOX
Owner Address: 644 41 ST AVENUE CT NW
Values - Building(s): $277,000, Land: $38,100, Total: $315,100
This map/report product was prepared from the Catawba County, NC Geospatial Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling information contained on this map or data on this report. Catawba County promotes and recommends
the independent verification of any data contained on this map/report product by the user. The County of Catawba, its employees, agents, and
personnel, disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect or consequential which arises or may
arise from this map/report product or the use thereof by any person or entity.
Copyright 2014 Catawba County NC
04/11/2019

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YOUR TRIP TO.- MZDQ330D
544 41st Avenue Ct NW, Hickory, NC, 28601-8081
11 MIN 1 5.1 MI fEl
Trip time based on traffic conditions as of 3:51 PM on April it, Print a full health report of your car with HUM
2019. current Traffic: Light vehicle diagnostics [phone]
O1. Start out going northeast on Shiloh Church Rd toward Lynwood Ln
Use of e,r bom, and maps is sublecl to our Terms of Use. We don't guarantee accuracy, route cond,fi s or usability. You assume all risk of use.
Then 0.16 miles
0.16 total miles
r+
2. Turn right onto NC Highway 1271NC-127. Continue to follow NC -127.
Then 2.84 miles
3.00 total miles
3. Turn right onto 39th Avenue Dr.
39th Avenue Dr is just past 39th Avenue Ct.
If you reach Jenkins Elementary School you've Done a little too far.
Then 0.50 miles
3.50 total miles
4. Turn slight left to stay on 39th Avenue Dr,
39th Avenue Dr is just past 3rd St.
If you are on 4th Street Ct and reach 4th Street Ln you've pone a little too far.
Then 0.78 miles
4.28 total miles
S. Take the 1st right onto 61h Street Dr.
6th Street Dr is fust past 4th Street Blvd.
If you are on 36th Ave and reach 7th Street PI you've gone a little too far.
Then 0.42 miles
4.70 total miles
6. Take the 1 st right onto 39th Ave.
If you reach 40th Avenue Ln you've pone a little too far.
Then 0.15 miles
4.86 total miles
T
7. 39th Ave becomes 6th St.
Then 0.17 miles
5.03 total miles
`
8. Turn left onto 41st Avenue Ct.
If you reach 42nd Avenue PI you've gone a little too far.
Then 0.10 miles
5.12 total miles
O9.
644 41st Avenue Ct NW, Hickory, NC 28601-8081, 644 41 ST AVENUE CT NW
is on the right.
Your destination is at the end of 41st Avenue Ct.
Use of e,r bom, and maps is sublecl to our Terms of Use. We don't guarantee accuracy, route cond,fi s or usability. You assume all risk of use.

Exempt Subdivision Certificate
This plot ie not subject to the Subdivision Regulation.
of the City at Hickory.
.111 a Zoning Administrator, City of Hickory
Flood Plain Notation
Tha primary structures as shown this, plat
aro not located in a 100 -year Rood plan
zone.: x
FEMA Panel Number. 37103705DOL
Effective Dale: 07-07-09
Watershed Notation
Thopvroal. of lone aha.. on this plat ars
loaaled in a WS Cri6col Area Watershed Area
Legend:
Q 1/2' Rebar (a)
eExisting Iron Pin (alp)
•Calculated Point (ep)
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repReinforced Concrete Pipe
r/w= Right of way
ou = Aerial Uti9Ues
th Fire Hydrant '
pb Power eco
pm a Power Meter
pp Power Polo
tie Telephone Pedestal
wen Water Motor
Certifleete of Type of Survey
This survey Is al another category, such as the recombination
of existing paroeis, court—ordered —ay. or oth.r
axe pilon to the dentition of suledi-lon.
Certificate of Ownership and Dedication
I (.oI edify that I am (.e are) thea r (a) of Ne pmyarty
doaerriiDad hereon, which property Is located Rhin the eubdrciaion
regulation jurisdiction of the City of Mekorryy that 1 (we) hereby
freey adopt this pkn of nubQ Non d dadka/e to public use
all areae Baa- on Nie plot as nireeln, alleys, .alien, parlor,
open epees, and eaxments, except those poalfcall� IneReoted
a. private, im thM I (.e) .91 maintain II such areas until the
Iter of deek.11an 1. accepted by the ap ropdate public authority.
NI property shown on this plat a. dedicated for public use shelf
be deemed to be dedca for any other public use an
authorized by low when ueh othsr use is approved by the
Hickory Cly Council In the puhlla Inloreel.
ownera�
Curve Table
Curve I Radius I Delta I Tangent I Are Length I Chard Bae, I Chord Dial
55,021 20.82 1 52.28 1 W59'28'W 1 49.94
I Lake I
I Hickory I
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Ownerta—
STATE OF NORM CAROLINA COUNTY OF
I, history Public for sold County and State, do
harahy ...IifYY that perwnaly appeared
before me Is day and acknowledged the due execution of No foregoing instrument.
Witness my hand and official ..I. this _day o/ . 2018,
Notary Public
My commWlon expire,:
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5617001 4
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Review Officer Certificate
State of North Carellno
Ceunty of Catawba
I, Raview Officer of Calowba County
wrtlly that this
map to which the certification fe affixed
meets all statutory requirements for recording.
Line Table
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Lot 2:
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3 6'22'40'E 10
from and actual Nea rvoy under my supervision (deed d°acdpDan
1.288 Acres oy',r.
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that the boundaries not eurvayad ora shown as
broken res, that the unad'uated Ikear error or closure la 1: 10,000+.
in
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That this plot was prepare accordance with North Carolina General
G.S. 47-30 oa a .ended.
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Witnoas my original signature and license number end seat this
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Ownerta—
STATE OF NORM CAROLINA COUNTY OF
I, history Public for sold County and State, do
harahy ...IifYY that perwnaly appeared
before me Is day and acknowledged the due execution of No foregoing instrument.
Witness my hand and official ..I. this _day o/ . 2018,
Notary Public
My commWlon expire,:
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136.19 mnil ,.�
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Review Officer Certificate
State of North Carellno
Ceunty of Catawba
I, Raview Officer of Calowba County
wrtlly that this
map to which the certification fe affixed
meets all statutory requirements for recording.
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Notes:
Current tax records are used to identify
adjoining properly owners.
The property shown hereon is subject to
all easements, right of ways, restrictions,
and agreements not shown hereon.
There were no North Carolina horizontal
control markers found to exist within
2000' of the surveyed property.
Total Area: 2.117 Acres
(area computed by the coordinate method)
The surveyed property is zoned: R-2 (Hickory)
Broken lines represent property lines which
are not actually surveyed. These dashed lines
were taken from deeds or other sources.
The surveyed property Iles within the City of
Hickory Planning District.
The surveyed properly will be served by
public water and Individual septic.
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Line Table
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I 819'08' 'E 1 49.98'
that the boundaries not eurvayad ora shown as
broken res, that the unad'uated Ikear error or closure la 1: 10,000+.
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Notes:
Current tax records are used to identify
adjoining properly owners.
The property shown hereon is subject to
all easements, right of ways, restrictions,
and agreements not shown hereon.
There were no North Carolina horizontal
control markers found to exist within
2000' of the surveyed property.
Total Area: 2.117 Acres
(area computed by the coordinate method)
The surveyed property is zoned: R-2 (Hickory)
Broken lines represent property lines which
are not actually surveyed. These dashed lines
were taken from deeds or other sources.
The surveyed property Iles within the City of
Hickory Planning District.
The surveyed properly will be served by
public water and Individual septic.
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Certificate of Survey and Accuracy
1/2'
e
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1, D ... Id S. Morar. certify that this plat eve drown under my .appw.m;sion
Trust Trustee
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from and actual Nea rvoy under my supervision (deed d°acdpDan
recorded
mul'\
in book 3221. page 727 . book 3353. page g98);
\
Tasha Fox Lackey
that the boundaries not eurvayad ora shown as
broken res, that the unad'uated Ikear error or closure la 1: 10,000+.
in
pa\
That this plot was prepare accordance with North Carolina General
G.S. 47-30 oa a .ended.
Statute
Witnoas my original signature and license number end seat this
Hickory, NC 28601
22nd day .f October 2D18 A.D.
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Shawn E. Houser
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Leigh Ann Houser
I inch o 60 ft.
Db. 2220, Pg. 1847
Pb. 32, Pg. 30
Pb. 32, Pg. 30
Exempt Recombination Plot for
Bradley E. Lackey and
Tasha Fox Lackey
Address: 644 41st Avenue Court NW-- Hkk.M NO 28601
Address; 4124 61h Street Drive NW-- Hickory, NO 28601
Hickory Township Catawba County North Censure
Seale: 1'.50' Drawn By: toe File: 918210
Deed Reference: Book 3221 Page 727
Deed Reforan.,: Book 3353 Page 296
PinNumber. 3705-19-71-1465
put Number. 3705-19-71-06135
Plat Reference: Book 32 Page 30
Tax Map Number. 194H Block 01 Lots 14 k 96
surveyBy. qg/jk Data of Survgr. f0-05-18
Drawing Number: Hae -5234
Donald S. Miller— Surveying
3815 22nd Street NE-- Hickory, NO 28601
Phone: [phone]
+�.
Lot
MorgareL.8 Women
Recovable Living
1/2'
e
W
Owner:
Trust Trustee
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Bradley E. Lackey
Db. 2960, Pg. 346
'Vas.
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Tasha Fox Lackey
Pb. 32, Pg. 30
' g$85, g,k
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844 41st Avenue Court NW
P
Hickory, NC 28601
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Willliam Gibbs,
blas 11
80 to
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Db. 2697, Pg. 1316
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Pb. 32, Pg. 30
Lot 28
David L. Bowman
/
Db. 1873, Pg. 583
Pb. 32, Pg. 30
Exempt Recombination Plot for
Bradley E. Lackey and
Tasha Fox Lackey
Address: 644 41st Avenue Court NW-- Hkk.M NO 28601
Address; 4124 61h Street Drive NW-- Hickory, NO 28601
Hickory Township Catawba County North Censure
Seale: 1'.50' Drawn By: toe File: 918210
Deed Reference: Book 3221 Page 727
Deed Reforan.,: Book 3353 Page 296
PinNumber. 3705-19-71-1465
put Number. 3705-19-71-06135
Plat Reference: Book 32 Page 30
Tax Map Number. 194H Block 01 Lots 14 k 96
surveyBy. qg/jk Data of Survgr. f0-05-18
Drawing Number: Hae -5234
Donald S. Miller— Surveying
3815 22nd Street NE-- Hickory, NO 28601
Phone: [phone]