20181307 Ver 1_Shoreline Stabilization_20180925

2 0 1 8 1 3 07
State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
SEP '252018
I. Applicant Information [15A NCAC 02H .0502(a) I D -M -WATER Krs�
4 1BUFFED
1. Owner Information
Name: Laura Colwell
Mailing Address: 105 Morrows Ridge Ln
Mooresville, NC 28117
Telephone Number: 8029998323 Fax Number:
E-mail Address: Iraecolwell(a)-gmail.com
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.miI/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: Dean Fisher
Company Affiliation: President, Lake Norman Custom Dock & Pile Driving, Inc.
Mailing Address: PO Box 1439
Denver, NC 28037
Telephone Number: 7044832144 Fax Number:
E-mail Address: Ikndock(cDgmail.com
Person to receive the Certification Approval: Laura Colwell
II. Project Information [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 detailed site plan showing property boundaries and proposed locations of
vegetation clearing, structures (buildings, retaining walls, docks, impervious surfaces,
FORM: SSGP 10-2013 Page 1 of 3

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.
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: Lincoln
Nearest Town: Denver
Subdivision name or site address (include phase/lot number):
7967 Water Oakes Dr., Denver, NC 28037
Directions to site - please include road names and numbers, landmarks, etc.:
Take NC -16 Bus S. towards HWY 73. Turn left onto Water Oaks Dr. Property is 0.5 mi on left.
-Ie,-1
Latitude (in decimal degrees) 35.4588133 Longitude (decimal degrees) -80.9862311
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): residential
6. Property size (acres): 0.27 acres
7. Lake/ river/ ocean adjacent to property: Lake Norman
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): I r1 S�G�� L �-� ..►� 0 S- r j e rC-�
9. Will work be conducted from land? ❑X From water? ❑
10. 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:
fi v ,- - 5 k- G t om. Sh��� 1 s _.n
11. Total 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:. Or I S �_' �_ c l U r. � S ho^ -z 1 kr"- 0,°` I 5 � V\& -r)
12. 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): �'LiSA-(e-)�
l C w el rex s S -J V'M try 0 CI -I d C L(,�­ �,A b(`, in IC
kAJ_ CAUXV, 61 52-018
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.
FORM: SSGP 10-2013 Page 2 of 3

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 3 PLAN NO. PARCEL ID: 34433
STREET ADDRESS: 7967 Water Oakes Dr., Denver NC 28037
Please print:
Property Owner: Laura Colwell
Property Owner: Dean Colwell
The undersigned, registered property owners of the above noted property, do hereby authorize
Dean Fisher of Lake Norman Custom Dock & Pile Driving, Inc
(Contractor / Agent) (Name of consulting firm)
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):
106 Mop—"ws { Dire L.Q , M0&p-e�,VII-l.F NL llfi
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature
Date: 5I� J xi e)
a- - 0, (' � �/
Authorized Signature
Date: 5 / 5 / zo ( 8

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: 7967 Water Oaks Dr, Denver NC 28037 County:
Lincoln
owner: Laura Colwell ��' P'a''
Print Signat re
Contractor/agent: Dean Fisher
Print �,Igpraiure
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)]
Acknowledgement of Notification
I, Laura Colwell 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): 4AU*Vk--' PJ_-) ck�Date: 5 �in
State of North Carolina Environmental Quality Water Resources
5r2 N. Salisbury Street 1611 Mail Service Center Raleigh. NC 27699-1611
919.70T9000

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5/31/2018 Your location to 7967 Water Oaks Dr, Denver, NC 28037 - Google Maps
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