20231385 Ver 1_Site Plan_20231013

La ke
(At Ful!Pond/ Normal Water Level)
Full Pond/ b�ach� recu
Normal Water Level
_
Shorel€ne
t' "ove x aau' 1 �moo�e red,
cL�C� rocs core expo5cd,
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Please approximately sketch the following information on this plan, length of shorellne
(provide dimensionsfor 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/ formal 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

CATAWBA RIPARIAN BUFFER NOTIFICATION FORD
Propen 6 ame/ad,drress: 1711 Rn l U IO i'rco-re5\l-►1�.1,e.NC_Coun-gvo
Print Signature
Contractor/agent: j �54one LLC.
Print Z
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 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)]
Aeftn wledgement of Notification
Ke__r_O&CS 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: l b a

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Tax Map Information
Print map scale is approximate.
•PIN
Critical layout or measurement
• Address
171PENINSUL
171 PENINSULA DR
Y
•Account #
Acct80104404
activities should not be done using
• Tax Owner
GRAVES BETHANY REVOCABLE
TRUST
this resource.
•Mailing
1001 PAWLEY WAY
MAP FOR REFERENCE ONLY
Address
NOTA LEGAL DOCUMENT
•
WINTER GARDEN, FL 34787
• GIS Owner
GRAVES BETHANY REVOC TR
Iredell County, North Carolina makes no claims and no
• Deed Info
3009 / 1511 - WD - 20230811
warranties, expressed or implied, concerning the validity or
• Tax Acres
0.48 AC
accuracy of the G IS data presented on this map.
• Lot #
11
• Description
NORMAN SHORE PB13-1
Geometry updated 10/04/2023
Data updated 09/27/2023
• Zoning
R20
• Old Parcel #
1702G17000B011
• Bldg Value
$218,370
• OBXF Value
$6,940
• Land Value
$525,000
•Total Value
$750,310
• Defer Value
$0
• Tax Districts
-ALLCNTY FIRE- -

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AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. _ II PLAN NO. __ PARCEL ID:
STREET ADDRESS: I0 l ?ey11 ns U iC -1r
Liar sv
Please print:
Property Owner:
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
1 n ►c+�e> � of CACC 54o rl-e PPec�/;tea L-C'
(Contractor / Agent) (Name of consulting fir ) .J --�
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):
Telephone: w H p 2UO3
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature Owner
Date: I b /.6/Q,:R
Autho ed Signature Ag nt
Date: 16 l /,23