20181730 Ver 1_Shoreline Stabilization_20181219

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H.0500 —Water Quality Certification, Shoreline Stabilization
Division of Water Resources
FORM: S5GP 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 $ PAID
401 & Buffer Permitting Unit �\
1617 Mail Service Center �\ " Ck \0
Raleigh, NC 27699-1.617
1. Applicant Information [
1. Owner Inform tion
Name: Y14 At 411 e. Pi
Mailing Address: /&U/
Z:4,0 co
2 0 1 8 1 7 3 p
Telephone Number: 0''73 �" �,Wl l Fax Number:
E-mail Address: S2dru
2. Agent/ Contact Person Informa ion
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
�!! __ ) must be attached if the Agent has signed this application form,
Name: }'adv favi S
Company Affiliation:
M alling Address:
`}
akO3'7
Telephone Number: :00gl / 1' 61 Fax Number: -Jh q- q61,
E-mail Address: 6 1411 u�c�to� Cvy�
Person to receive the Certification Approval: AV'4....D4 Jt S
11. Project Information [ )
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 Pagel of 3

etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Levelelevations,
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 he 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: e46" Nearest Town: 0 n r
Subdivision �me-or site address (include phase/lot number):
J ' . a.. a i ./7
--
Directions to site - please include road names and numbers, landmarks, etc.:
Latitude rin decimal degrees)_ '3.Sb6( qd Longitude (decimal degrees)
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): TCSi
6. Property size (acres): 571
7. Lake/ river/ ocean adjacent to property: i' ai
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):. s5 6412rb )C. r .
9. Will work be conducted from land? Er F4 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:
v o
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: . bo
12. Please describe the vegetation above t e normal pool lake level/ Normal mater Level and
50 feet landward to be impacted (number of trees, for instance):_A__ ro <
�t a-6
Owner/Agent's Signature. [ Date
Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSCP 10-2013 Page 2 of 3

p mFull Pond/
No
5
La ke
(At Ful I Pond/ Normal `.,Vater Level)
�,�.n Z CLfrir�
e- rwzr-
Please approximately sketch the following information on this plan (provide dimensions foreach
item, such as 10 ftx 100 ft)*:
I. All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/ Normal 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.
S. 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 FORM
Project Name/address: J
Owner: CLGFQI'YI !
Print
Print / Signature
The approval is for the purpose and design described in your application. Impacts not indicated in the
application is a�iriofation of the Buffer Rule. Site specific work should be provided in the application. [i5A NCAC
02H .0506 and,M ICAC 026.0243(8)]
Trees are nota lowed to be removed from Zone 1 of the Buffer (within 30 ft of the full pond elevation), unless
approved.. Exc tion, those trees that are severely undermined along the immediate shoreline can be removed. .
Minimal shapi g and sloping along the immediate shoreline is allowed. [15A NCAC 02B.0243(6)1
Benching, gradfing 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 028.0243(4) and (6))
Work to be coh, ducted from land must indicate an access and indicate any trees that are to be removed. The
work corridor hould be described. The approved access corridor shall be restored. Staging, spoil, construction
material must e:outside the buffer. [15A NCAC 02H .0502 and 15A NCAC 02B .0243 (4),(6)j (8))
Storrnwater �'nnot; be piped or channeled for direct discharge to the lake. Ail constructed stormwater
discharges mu#t be at the natural elevation and discharged prior to entering the buffer directed as diffuse or
sheet flow at +n -erosive velocitlesto the lake. [15A NCAC 02B.0243(5), (6))
Riparian Buffe
by the Divisior
taken such ft
Quality Certifi,
materials.
Signature (
of Notification
hereby state that I have been informed of the Catawba
Rule. Any work conducted .in the buffer, not specifically stated in the application and approved
of Water Resources (DWR), is a violation and subject to enforcement. Due diligence will be
the construction will bebuilt within substantial compliance andintent of the 401 Water
ation and Buffer Rules, the approved plan(s) and speclflcation(s), and othersupporting
er): �i+ /� �(�r Date, " I ` 1 Y

ON 0 aa�°��'�' Real Estate Search
s[iiS. titraz. r¢r-E�. nformation Services
Parcel: 460803001009, 6952 LOCKE DR SHERRILLS FORD, 28673
Owners: BROOKS ROBERT ALFRED, BROOKS SUSAN WILLIAMS
Owner Address: 6940 LOCKE DR
Values - Building(s): $500, Land: $106,400, Total: $106,900
1 i n=75ft
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Copyright 2014 Catawba County NC
08/20/2018