20240489 Ver 1_Site Plan_20240401

Full Ponrl/
IV
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(AtFUll Prod/Normal VllatapL�v®ij
2 'rri nva
IRS
IVb 7MEFS j26AAO
NL,-NlJik L Disrule
T & z.
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j5
Please approximately sketch the following information on this plan
Item, such a$ I0 ftx J00 ftJ+�:
i, l,®�®vide d/nyensionsforeach
All proposed vegetation clearing
Z. Location of rip rep or fill to be placed above the Full P
S. Location Of rip and/Normal Water Level eI vatlon
4• Location ofan rep or fill to ru pureed below the Full Pond/Normal Water level elevation
5, y proposed structural such as buildings, n
Location of any excavation or dyed n Ss, retaining walls, docks, etc.
6. Location Of Constr'uctlon a g below the Full Pond/ Normal Water Level elevation
access corrldors
FORM: SSGP 10.2013
Page of

5. Describe the existing land use or condition of the site at the time of t
undeveloped, etc.):
plication (residential,
o LF l'6L.c vA L
6. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary): 6V Ly A,�J
7. Will work be conducted from land? From water? I
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:
— 4�0
Temporary impacts in square feet:
J�E�h
9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet land-
wa rd
Permanent impacts (including back fill, excavation, rip rap, retaining walls, etc.) in square feet:
g44C),
Temporary impacts (temporary �err g, construction corridor) in square feet:
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):
11. Signature
By signing below, I, as the project proponent, certify to the following:
The project proponent hereby certifies that all information contained herein is true, accurate,
and complete to the best of my knowledge and belief
The project proponent hereby requests that the certifying authority review and take action on
this CWA 401 certification request within the applicable reasonable period of time
Owner/Agen Signature' [15A NCAev 02H _Q502kf:1 Date
'Agent's signature is valid only if an authorization letter 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
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Full Ponrl/
IV
Lake
(AtFUll Prod/Normal VllatapL�v®ij
2 'rri nva
IRS
IVb 7MEFS j26AAO
NL,-NlJik L Disrule
T & z.
bS )NL�
j5
Please approximately sketch the following information on this plan
Item, such a$ I0 ftx J00 ftJ+�:
i, l,®�®vide d/nyensionsforeach
All proposed vegetation clearing
Z. Location of rip rep or fill to be placed above the Full P
S. Location Of rip and/Normal Water Level eI vatlon
4• Location ofan rep or fill to ru pureed below the Full Pond/Normal Water level elevation
5, y proposed structural such as buildings, n
Location of any excavation or dyed n Ss, retaining walls, docks, etc.
6. Location Of Constr'uctlon a g below the Full Pond/ Normal Water Level elevation
access corrldors
FORM: SSGP 10.2013
Page of

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AGENT AUTHOILIZA RON FORM
PROEM }!M-Tlf LEGAL DESCRIPTION:
'07- �'C` / PLAN NO. — -- PARCEL ID:��-
p9ene;e fir+Plt.:
registered property owners of the above noted property, do hereby authorize
�t N awn ter 1 red — , of _ La P
(ILon(� actor I Agent) (Name of consulting flan)
�:U:J rre &svnaif drId @te all actions necessary for the processing, issuance and acceptance of
Deb spit or certification and any and all standard and special conditions attached.
Akddress (if different than property above):
Wehereby cardy the above information 5ubrillded M this application as tt ue and accurate to the
.iw� -If MPF ir;r ;,Arledge.
d
b]cipare
Authorized Signature
Date:

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project IN
Owner:
Contract
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 an , 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. E.ception, those trees that are severely undermined along the immediate shoreline can be removed.
(Minimal shaping alga sipping 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, imper.ious patios, impervious walkways, etc. are not allowed in the buffer unless specifically approved
by the Division. Tnere are limitation on size for decks. [15A NCAC 02B .0243(4) and (6)]
Work -i:o 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 o,:tsiae the puffer. [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 ce at the natural elevation and discharged prior to entering the buffer directed as diffuse or
sleet flow at non -erosive velocities to the lake. [15A NCAC 02B .0243(5), (6)]
Acknowlealagernent q;-, Notification
1, —rPJG,/1 !'.Gr p )?�f , LL(_ , hereby state that I have been informed of the Catawba
Riparian . '. r;, vvork conducted in the buffer, not specifically stated in the application and approved
by the Division of vva• er Resources (DWR), is a violation and subject to enforcement. Due diligence will be
zai•:e.: such -ci:ac cE:e c3:.s : uc�iar. v✓ill be built within substantial compliance and intent of the 401 Water
Quality Certification and Buffer RuI the approved plan(s) and specification(s), and other supporting
rnaterials. _ , /l %
."ignaiure ;3JV"1e6i / l �! ��/ DateA i 3 Z