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Home My WebLink About20191494 Ver 1_Shoreline Stabilization_20191028/1�qY" State of North Carolina Department of Environment and Natural Resources DWR Division of Water Resources 15A NCAC 02H .0500 - Water Quality Certification, Shoreline Stabilization Division of Water Resources FORM: SS P 10-2013 ,� Shoreline Stabilization Application Form Three copies of the application (including attachments) and the application fee should brent to: Division of Water Resources 401 & Buffer Permitting Unit 1617 Mail Service Center Raleigh, NC 27699-1617 I. Applicant Information [15A NCAC 02H .0502(a)] 1. Owner Information Name: Jeffrey C Bailey Revocable Trust Mailing Address: 2748 Ocean Shore Ave Virginia Beach, VA 23451-1455 Telephone Number: 752-Y9L /a69Fax Number: E-mail Address: beachbailev@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.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH ORIZATION FORM.pdf) must be attached if the Agent has signed this application form. Name: Beth Mostelle Company Affiliation: Dale & Beth Lake Use Permit Service Mailing Address: 988 Clear Creek Circle Lincolnton NC 28092 Telephone Number: 704-996-3245 Fax Number: E-mail Address: sbmosteller icloud.com Person to receive the Certification Approval: Beth Mosteller 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 Lake (At Full Pond/Normal Water Level) 0000000000000000000000000000000000000000 0000000000000000000000000000000000000000 Full Pond/ 0000000000000000000000000000000000000000 Normal Water Level 00000000000000000000oo000000000000000000 am � Ulu amShoreline o 0 0 0 90.30' to follow contour of shoreline, one foot above full pond, and 3-4 feet below full pond Jeffrey C Bailey Revocable Trust 3966 Cedar Wood Tr Terrell, NC'28682 Please approximately sketch the following information on this plan (provide dimensions for each item, such as 10 ft x 100 f0 *: 1. 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. 5. 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 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: Catawba Nearest Town: Denver Subdivision name or site address (include phase/lot number): 3 Directions to site - please include road names and numbers, landmarks, etc.: see attached Latitude (in decimal degrees) 35.584080 Longitude (decimal degrees)-80.95943 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): .540 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): Due to wave action. 9. Will work be conducted from land? ® 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: 90.30 along shoreline 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: 90.30 along shoreline 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): „Fa&& Fese- tiUANUCAL TaEeS Axin LE�aF nnptrm_ f.Y-n&-.7pJ Beth Mosteller f D -,? �i -1 9 Owner/Agent's Signature* Printed Name Date [15A NCAC 02H .0502(f)) *Agent's signature is valid only if an authorization letter from the owner is provided. FORM: SSGP 10-2013 Page 2 of 3 CATAWBA RIPARIAN BUFFER NOTIFICATION FORM Project Name/address: Cedar Wood Tr, Terr,W28682 County: Catawba Owner: Jeffm C Bailey Revocable Trust Print Contractor/agent: _ Print ure 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 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, Jeffir.y C Bailey Revocable Trust 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 plans) a specification(s), and other supporting materials. Signature (owner): Date: j& .N 9 AGENT AUTHORIZATION FORM PROPERTY LEGAL DESCRIPTION: LOT NO. 3 PLAN NO. PARCEL ID: 461704734235 STREET ADDRESS: 3966 Cedar Wood Trail Terrell, NC 28682 Jeffrey C Bailey Revocable Trust Please print: Property Owner: JefFti Property Owner: lie The undersigned, registered property owners of the above noted property, do hereby authorize Beth Mosteller , of Dale & Beth's Lake Use Permit Service (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): 2748 Ocean Shore Ave Virginia Beach VA 23451-1455 Telephone: 7S i — 4194 - �01-9 We hereby certify the above information submitted in this application is true and accurate to the best of our knowledge. Authorized Signature Date: m 00 Sam,' �p '�$ g• � � a``�:. �d,fd ,' k'?�wY '➢ �:.. ; y�� ,91�h' n d�'{y'Jy (! ,�" pW-1 - ry„��d'd C r� o� O $ 's�6P m'�u �� ` _ ETH . 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