20191411 Ver 1_Shoreline Stabilization_20191014

State of North Carolina
C' zz L] ) 1 Department of Environment and Natural Resources
Division of Water. Resources
Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
ENVIRONMENTAL QUALITY FORM: SSGP 02-2017
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent to:
If sending via US Postal Service If sending via delivery service (UPS, Fed Ex, etc.)
Karen Higgins Karen Higgins
DWR — 401 & Buffer Permitting Branch DWR — 401 & Buffer Permitting Branch
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC 27699-1617 Raleigh, NC 27604
A. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information 1
Name: / homa6 M 6,ell,
Mailing Address: f73ZE3Wind
Telephone Number:
E-mail Address:
2. Agent/ Contact Person Information W,t®r pasources
p rrnitwg sect
A signed and dated copy of the Agent Authorization letter must be attached it the Agent has
signed this application form. (A form can be downloaded here:
httD://www.saw.usace.armv.mil/Portals/59/do(;1regulatory/regdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.Ddf)
Company Affiliation: I pulcn r C(shm DC.h1 y i R
Mailing Address: 15& e-rfh Rd
Rou+mar)' IVC. 61 toto
Telephone Number: al -iD2�l�g(O Fax Number: _3
d E-mail Address: bf na. k0.nCa5+e_rdor_K:5 (5-0 CA ala'► I
B. 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, buildings, retaining walls, docks, impervious surfaces, 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.
FORM: SSGP 02-2017 Page 1 of 3

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: \Jkn co' n Nearest Town: Denver -
Lake/ river/ ocean adjacent to property: Norman
an
Property size (acres): • 13 QCre5
Subdivision name or site address (include phase/lot number): L.o f IFJeon 35
er�SCPr��' 7328 W:e7dy Pine C;rde, _/)enyer. NC 28037
Directions to site - please include road names and numbers, landmarks, etc.: 5rorKA)U4251f5
r,c.ie, PY-0 per+y "*I-& o
titude (in decimal degrees)
Longitude (decimal degrees)-(50.ClQ(aj29 )
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Ret:idewhal
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or whyitis necessary): Ehp*'ek lVie" r e-Ere-6VA w►+)l C.1455 B
Y_t'� i� TY'G�nr 5"n0ire.li✓1e -hCA31 17AAinY1 � ey'DStbyl CUY%+_6i
7. Will work be conducted from land? a, From water?
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:
Temporary impacts in square feet:
9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet
land -ward
Permanent impacts (including back fill4,excavation, rip rap, retaining walls, etc.) in square feet:
Temp,oprary impacts (tempgq�rary clearing, construction corridor) in square feet:
1'('n•^r;Aor_
10. Please describe the vegetation above the normal pool lake level/ N7TO
I Water Level and 50
feet landward to be impacted (number of trees, for instance): /7co
11. :2X�
%�—•T '/!
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 02-2017 Page 2 of 4

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
Pull Pond/ Normal Water L
Shoreline
Plan View
FORM: SSGP 02-2017
Lake
(At Full Pond/ Normal Water Level)
��i�'►sl(��m.►(v'a1.�l.asjwa ,. L-..r�..w>Aii+=�R�r �n'..i!%�.s.�!?}„a.�a - � .w.=�p �'�
Lake
(At Full Pond/ Normal MW Levey ' Existing: Dock
30ftx7ft
3ftx 150ft
ae[=full .pond/ NWL
Full Pond/ Normal Water Level
a� m ® 4ftx 150ft
°®'rho rei ne Ri pra p Above full pond/ NWL
2 ft.x 150 fL
addidonal clearing
if necessary
EX,AMPLE
Plan View
Page 3 of 4

Lake
(At Full PonO/ Normal Water Le el)
c
Side View
CL
FORM: SSGP 02-2017 Page 4 of 4

CATAWBA RIPARIAN BUFFER N0TIFICATI0N FORM
Project
Owner:
Contractor/agent..
L'>7i^D�n
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 026.0243(6)]
Benching, grading in the buffer is not allowed. Excessive disturbance of ground cover. 115A NCAC 028 .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
1, pn1 ��'I A rel 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 Vyater
Quality Certification and Buffer Rules, the approved plan(s) and specification(s), and other supporting
materials. `
Signature (owner): Date;

0
r-� �
THOMAS CHRISTIN W
BURKS JENNIFER
HORBELT JOHN L
MI
SPANGLER CLIFFORRD E
7309
BANKER CAROL J
HAGER HAROLD DEAN
ViEATHE.R1v1AN IvARTFIA H
25.8
73,46
UTARELLI THOMAS 19
7" 0
September 3, 2019 0 100
Esri- Inc., Lincoln County, NC I I
1 inch = 58 feet