20200043 Ver 1_Shoreline Stabilization_20200107

�2612000V3
'r State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
K I a -
Water Resourc es 15A NCAC 02H .0500 -Water Quality Certification, Shoreline Stabilization
ENVIRONMENTAL 0UAL:1 V FORM: SSGP02-2017
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
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC 27699-1617 Raleigh, NC 27604
A. Applicant Information [15A NCAC 02H .0502(a)] --�) KJ
1. Owner Information
Name: Y1 C fC
Mailing Address: W Y1 Y'1
r .►11 11-7
Telephone Number: - Fax Number: —
E-mail Address: man Ict
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:
httr)://www.saw.usace.armv.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM. df)
Name: JAY-
-IL
Company Affiliation: Y C)r ✓iC..
Mailing Address: 1
Telephone Number: -T-A nZ��-I (n Fax Number: ',IU 4 -
E-mail Address: Aoylno . I Qy)C0 e e_(—dCK KS(
B. Project Information f15A 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

� . '
a
� , i
'
i

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: \,reAe.II Nearest Town: tIle.
le.
Lake river/ ocean adjacent to property: Kor YYl0-n
Propertysize(acres): •97 acres
ivision name or site address (include phase/lot number):
Directions to site - please include road names and numbers, landmarks, etc.: Fmrk l ll N3
ne. vrover • T .ocsu•
decimal degrees). �.5 (0�0 Longitude (decimal degrees)'U.QrJ45[TT
5. Describe the existing land use or cori4ition of the site at the time of this application
(residential, undeveloped, etc.):YipSIck-n-liak
6. Describe proposed work (include discussion as to how hardening of shoreline has
or why it is necessary):
7. Will work be conducted from land? [r From water? Er
8. Total amount of impacts below the normal pool lake level / Normal Water Level
uding all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
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 walls, etc.) in square feet:
Y pnts(t
in square feet:
10. Please describe the vegetation above the normal pool lake level/ N�of mal Water Level and 50
feet landward to be impacted (number of trees, for instance): /V011e�
11. Signature
/Z15-19
Owner/Agent's Signature* f15A NCAC 02H .0502(f)l Date
-Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 02-2017 Page 2 of 4

t

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
ull Pond/ Normal Water Leve
�77����
Shoreline
Plan View
FORM: SSGP 02-2017
La ke
(At Full Pond/ Normal Water Level)
Lake
uu Full Fa 1-1)
Existing Dock
IDx,7h
Sea 35Ua
eelowluu waN xwl
Full Pond/ Normal Water LerAMPLE
r ��reiine
<ft. Mitt
]h �Ift.
E
Plan View
4Z lI �� •
�f��
Page 3 of 4

Lake
(At Full Pond/ Normal Water Le
Side View
10 it. bank
Side Vi
C
O
3 ft. below full pond water level 4 ft. above full pad water level 2 ft. additional clearing
*if neceuary
Existing bank
AMPLE
FORM: SSGP 02-2017 Page 4 of 4

D DON ALLEN & ASSOCIATES.P. A.
e "Since Mort
Surveys Commercial + Residential +Mortgage �rveys + MultT—Fgmily,
Construction Staking * Subdivision Design * Topographical
111—D Raceway Drive * Mooresville * NC * 28117
[phone] [phone] Fax
I, certify that this map was drawn under my supervision from an actual
survey made under my supervision recorded in deed book 1441 page 2048 -and/or
plat book 14 - page that the ratio of precision is 1':10,000, that this map
was prepared in accordance with the General Statutes of North Carolina Chapter 89C.
my hand and seal on the 24 _ day of SEPT
��;f��a'•71�1�
5--- 5p00
8
svSy by �
i CMAL RE1D COIRM LINE ER
35973''00 .W
09
LOT f 19
81
DOUGLAS
WILLIAM
LOT 118
LAMBERT �m A 1f/
188111615
_ �, I,,
i 0.77 AC.
^'s
PROPOM
Tml
cc
i
'
Px NA0.
l
SET
rYO
/ LAKE NORM"
FAWN LANE
60' PUBLIC R/W
b
�%
rr�r el
t''
" Ara. " ;g, IG,
R/W
p0 ry0.
'PIS
0''�
LOT 117
D. ROBERT AYERS
Co "
' x
JANET S. AYERS
.c�,6`
CURVE TABLE
11391644
/ �`� S'�'
CURVE RADIUS LENGTK
REARM I CHORD
Ci 50,00, 93 IVSOWNr
E
NOTES
0' 20' 40' lowlE(E�ID
Ct].a - P.P. - POWER POLE
1) THIS PROPEFnY MAY BE SUB.F.OT TO
ANY EASEMENT AND/OR RICHM-OF-WAY
- OM POWER TRANS
OF RECORD.
2) ��OOMPI11E7) BY THE COORDINATE
SCALE IN. FEET
E.IP. = EMSDNG IRON FOUND
LP4 - # REBAR SET
') as wcCONTWR
BOUNDARY\SEEDC SURVEY
R/�'
AAIMN 1�D E Na LAKE
LM AT COWAN'S I = DAM (READING
-t'�-0�'�'"Y
=
ON 0,&/2018.
OF
CP - COMPUTED POW
4) NO GRID MONOMEM FOM WnHW
195 FAWN LANE
20OD FEEL LOT 118 CRESCENT LAND & TIMBER CORP SECT 6
SCALE 1"_ 40' DAVIDSON TWSP.. IREDELL CO.. N.C.
� OLT 10r 11e
ACQUIRED BY: DENNIS LEHMAN
Do FM
TAX MAP NO:_ 4MS82400

Earth
LM,
i
195 Fawn Ln
100 ft

NO*

.r
411
IL
n
I.
iV,
Amp Ar
I

y
1� I
1
l
�« _
n ..
IINN�� i'4'e li
�I' /(� 1.; _- r�,9 `..4.i V' 7"T "f f -
I .�y�yy�y���''{y�, R� 4+ .♦,f�.'h7. ♦ "tA, •a

1'�
`I

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project
Owner: PV)h ; e'
rn -
Contractor/agent:
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 028 .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. [1SA 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
"_Len✓1 I S L thrm n 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 -Specification(s), and other supporting
materials. �1
Signature (owner): _ /
Date:. 12 lS /_/9

k