20180075 Ver 1_Shoreline Stabilization_20180112

Shoreline Stabilization 9pplicationform
Three copies of the application (including attachments) and the ap
should be sent to:
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: MA4k . ;1�
2 0 1 80 0 7 5
JAN 1 2 2018
Mailing Address: AR 1 Go Ras 4- PU Tie�(,►,�.o 41-G
Telephone Number: y07 -57d- fssi 1 Fax Number:
E-mail Address:—M"'Xg(v (,V -!q M;6 I. t.,a nn
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be
downloaded here:
http•//www.saw.usace.army.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPL
E AGENT AUTHORIZATION FORM.pdf) must be attached if the Agent has signed
this application form.
Name: ;tia4y OltrvJ5en /�iia�So�tis %G2- �1r � Co-•..
Company Affiliation: Qwne r
Mailing Address: SgZS rW to Vq-V-.0 �; C-1 �2g Z to
1

Telephone Number: Fax Number: fw-TV- M G;
E-mail Address: : r_lrL ;s-5502 �L►1� �nl`. � "
Person to receive the Certification Approval: �et,�
C Q
• Project Information [15A NCAC 02H .0502(a),& (b)]
• 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.
• Provide a detailed site plan showing property boundaries and proposed
locations of vegetation clearing, structures (buildings, retaining walls,
docks, impervious surfaces, 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.
• Attach a photograph of the shoreline/ buffer proposed to be stabilized.
{ (Include a scale of some sort- a yard stick, shovel handle, etc.)
• Location of the property (where work is to be conducted)
County: rMd.2kQa Nearest Town: _.Q,(.w�or--�
Subdivision nam or site address (include phase/lot nu ber):
ou�l-h o 2 ( a u.S+-
)DI, N�, aceta
Directions toC site - please include road names and numbers, landmarks, ettc.:�. `
S�-r.�si'.•.�-� i►+ i �eOIII'�Llii►1 .T� ONfO cSou7� IDlnf /��l �""� �f 'G\J
ot�to/c s�ii [�f�n S S �'l,•c jet 'i�lf�cn n� _ 1�fo•
h'f [ n to C aJ?f= kT s7 �(
Latitude (in decimal degrees) 5- l5(a7> Longitude (decimal degrees)�8Ir
O-I4qO
• Describe the existing land use or condition of the site at the time of this
application (residential, undeveloped, etc.): RAI tctxokit`«�(
• Property size (acres): .`lO cuaxt-
• Lake/ river/ ocean adjacent to property: I-Alu-
FA

• Describe proposed work (include discussion as to how hardening of shoreline
has been avoided, or why it is necessary):
oal�
• Will work be conducted fro land? From water?
• 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: FA 1 0 1 to V% S of, f2t X3 a- (t sc`a�z s
11 `To al 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:
`td ` S o or'�dlrt)
12. Please describe the vegetation above the normal ool lake level/ Normal
Water Level
2 e i
and 50 feet landward to bmpa d (number of trees, for
instance): ,flush (s c ru ljre-s
�r"to /(2 `d� 4, ll r��k..rs to ✓e- Save--,
Owner/Agent's Signature* [15A NCAC 02H .0502(f)] Date
`Agent's signature is valid only if an authorization letter from the owner is provided.
3

3
- Home Insert Design :+nimaLons SBile Shoo Rentz, lite, Lasertiche
LayoutR
-L �
vase_ gid - x.1 Delete -- - _ _ _ .. ...- v 1 i }
_... .......
Lake
(At Full Pond/Normal Water Level)
Please approximately sketch the following information on this plan (provide
dimensions for each item, such as 10 ft x 100 ft) *:
• All proposed vegetation clearing
• Location of rip rap or fill to be placed above the Full Pond/ Formal Water Level
elevation
• Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level
elevation
• Location of any proposed structures such as buildings, retaining walls, docks, etc.
• Location of any excavation or dredging below the Full Pond/ Normal Water Level
elevation
Iv
nr.ie— �1u�
i7 Z�

• Location of construction access corridors

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. -21 PLAN NO. PARCEL ID:
STREET ADDRESS: -1.21
ar yAc� }�I
' 1 5-1
Please print: nA
Property Owner: IVIo.4 btg^
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
4t&! Of U01Wson 5 �?; lx- hri

Project f
Owner:
Print
Contractor/agent: _
CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Print // Signature
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 alongthe 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
1, R41 Dw 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(, roved plan ).-and specification(s), and other supporting
materials. �� _� 1
Signature (owner): ! Date: /
State ofNorth Carolina I Environmental Quality I Water Resources
512 N. Salisbury Street ; 1611 Mail Service Center ! Raleigh, NC 27699-1611
919.707.9000

I, WILLIAM T. POWELL, JR. , CERTIFY THAT THIS PLAT WAS DRAWN UNDER MY SUPERVISION FROM AN ACTUAL SURVEY MADE
UNDER MY SUPERVISION (DEED DESCRIPTION RECORDED IN BOOK —__ PAGE ETC)(OTHER); THAT BOUNDARIES NOT
SURVEYED ARE CLEARLY INDICATED AS DRAWN FROM INFORMATION FOUND IN BOOK $4, PAGE 39-42 ; THAT THE RATIO OF
PRECISION AS CALCULATED IS 1:7.500+ ; THAT THIS PLAT WAS PREPARED IN ACCORDANCE WITH G.S.47-30 AS AMENDED.
WITNESS MY ORIGINAL SIGNATURE, REGISTRATION NUMBER AND SEAL THIS 14TH DAY OF NOVEMBER. A.D., 2017
•l�ll�l l 1 1�YY
Not To Scale
WILLIAM T. POWELL, JR. NC LS L-3981
.EGEND `Ro',��':
:.I.P. EXISTING IRON PIN.............4/11-
i
:.C.M. EXISTING CONCRETE MONUMENT �O',pF ESS/.,I
Q.I.P. SET IRON PIN
I.O.E. PUBLIC DRAINAGE EASEMENT -Q
'.U.E. PUBLIC UTILITY EASEMENT SEAL
Q.S.E. SANITARY SEWER EASEMENT -
.P.E. FLOOD PROTECTION ELEVATION L-3981 c
:LL OSURE EXCEEDS 1' IN 10,000'y0 � `
PROPERTY LINE
---- ADJOINER PROPERTY UNE BY DEED OR PLAT %:/ SUR „
LAKEWYLIE PROJECT UKE ENERGYBOUNDARY
Ll C ti��P111116111
1 1 (ELEV.=569.4 MSL) �wi
(FOLLOWS PROPERTY LINE)
FEMA FLOODWA�
S.I.P.
100 YR FEMA
FLOODPLAIN
200
J0•\ 20' 0/S
E.I.P
\ R0
Y
I 50' RIPARIAN BUFFER
21 <I
�I
ml IMPERVIOUS SURFACE AREA
39,038 S.F.i DESCRIPTION AREA
0.90 Ac.t
HOUSE w/ PORCH 4,229 S.F.
PAT10/HVAC/MISC 390 S.F.
DRIVEWAY & WALKS 2.
TOTAL (ALLOWED)= 10,
n f
I ^
LOT AREA =
{I
I
TOTAL (AS—B(
Li
I M
N
Z.
I 3
P
10
00
Z°
I N
I a
M
00
IU)
25.1
7
904 S.F.
500 S.F.
038 S.F.
423 S.F.
I I
I
10.6' I MB. 84 PGS. 39_42 Z
I 20' SEIBgCK
E.LP N01'0607" 5 UTILIITY EAy�
E 100.98 E.I.P
50' PUBLIC R/W
#221 CAPE AUGUST PL.
THIS PROPERTY MAY BE SUBJECT TO ANY AND ALL APPLICABLE DEED
RESTRICTIONS, EASEMENTS, RIGHT—OF—WAY, UTIUTIES AND
RESTRICTIVE COVENANTS WHICH MAY BE OF RECORD OR IMPLIED
60 0 60
SCALE: 1" = 60'
FASTOVER
LAND SURVEYING COMPANY, PA
LAND SURVEYORS — PLANNERS (C-1833)
10430 PARK ROAD, SUITE #300
CHARLOTTE, NORTH CAROLINA 28210
PHONE [phone]
FAX [phone]
PHYSICAL SURVEY
FOR
LOT 21, MCLEAN - SOUTH SHORE, PH 1 MP 1
South Paine Township, City of Belmont, Gaston County, North Carolina
PROPERTY OF: DANIEL DRAGOO & DEAN MATTHEW
MAP BOOK 84 PAGE 39-42 DEED REFERENCE
DRAWN BY: BUI DATE: 11/14/2017
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