20191650 Ver 1_Shoreline Stabilization_20191202

State of North Carolina
Department of Environment and Natural Resources
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
One copy 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 WC6ve-/aENRJD WR
Applicant Information [15A NCAC 02H .0502(a)] DEC 0 2 2019
Owner Information Wator Resources
Name: 02%10'rleS Eos % n c
Permitting 3Qc00r
Mailing Address: 350 -Pa+h IICI.
_00.nnreSy't 1\e . NC 2 811-7
Telephone Number: qAb - 21y3 - 8-J(o0 Fax Number:
E-mail Address: C k rnanl E) iui nd-,4--re_c►m. ne-�-
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/reguIatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name:
Company Affiliation:
Mailing Address:
Telephone Number: g014 -UUt) - 5 it I Fax Number: 7()y - 6(.o U - 5G to 9
E-mail Address: ChCw t nd S+ream . net
Person to receive the Certification Approval: Aari, ce ES-��_3
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,
etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
FORM: SSGP 10-2013 Page 1 of 3

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: j ,rPr;e.l l Nearest Town: MMr-eSy I l I e
Subdivision name or site address (include phase/lot number): 35U�e—ar�er� �h Rd,
Moog "v'►I I,-_ KC 28111 ice+ 4 qq CreSren4- Ln Yti F .mk.,r ( own_
Directions to site - please include road names and numbers, landmarks, etc.:
Latitude (in decimal degrees) .5_5 S5 9 q Z Longitude (decimal degrees) — 80. 919 d (o _3
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): �ies �c�e n�ia
6. Property size (acres): p . Q,9�,1 o.cres
7. Lake/ river/ ocean adjacent to property: t�nr m2n
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): (in A ILn RLC i<, WTI l tn Prr n-[ nF'
of Shen�IIan RIa kwall on each
9. Will work be conducted from land? Q From water? ❑ '3 1d e 0 00} mrn
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:
5' Le-Iv_o ( 10-3s S� 0�, lmoackl
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: c��,oye. ( 20-1 5� oJP i myrl o,-
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):
Owner/Agent's Signature' [15A NCAC 02H .0502(f)]
IILI Iq
Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

La ke
(At Full Pond/Normal Water Level)
"pocl�i
Boct� 1�`.� ► �o�lc�w
Full Pond/ y
Normal Water Level j
��.�
990.1
Shoreline®Vs
I' a,6o.re-
to
hov se.
(access
1�0 - -reeS re-ff-o\jcd
M ► r\' ► n-04 d 5to r6xna
to 6J-�te-
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ft x 100 ft)*:
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
Charles Kosior
350 Beaten Path Rd.
Mooresville, NC 28117
FORM: SSGP 10-2013 Page 3 of 3

llr25 019 610 East center Aworus, Mooresville, NC to 350 Beaten Path Rd, Mooreewlle, NC 28117 - Goog le Maps
Go<cgle Maps 610 East Center Avenue, Mooresville, NC to 350 Beaten Path Rd, Mooresville, NC 28117 Drive 8.7 miles, 20 min
610 E Center Ave
Mooresville, NC 28115
t 1. Head south on Evergreen St toward E Center Ave
197 f l
r► 2. Turn right onto E Center Ave
05mi
h 3. Turn left onto S Church St
04-
r► 4. Turn right onto E Wilson Ave
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t 5. Continue onto NC-1100/Brawley School Rd
a.a ml
r► 6. Turn right onto Blume Rd
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4, 7. Turn left onto Beaten Path Rd
8 Destination will be on the right
1.1 mi
350 Beaten Path Rd
Mcouavdle. Nc: 2ic1
These directions are for planning purposes only.
You may find that construction projects, traffic,
weather, or other events may cause conditions to
differ from the map results, and you should plan
your route accordingly You must obey all signs or
notices regarding your route.
tttps>MMw.googlacw nape/d rtolO+Esst+Cwtw+A%win,+Maresrlle,+NCt350r•Begari+PattwRd.+Mooresville,+NC+281171@M57415M,-M8963072.13rlar Vdats=14ml414ml311m91m111smB853fe4lc4 tl1

Surveyed By: Ban M. Flowe & Son-
11316 Brief Rood
Charlotte, N.C. _ r
28227
[phone]
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Matthew J. Johnftn
2368 / 444
AM 14 / 100
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350 Beaten Path Rd - Google Maps
Go gle Maps 350 Beaten Path Rd
Imagery ©2019 Google, Imagery ©2019 Maxar Technologies, Orbis Inc, Map data ©2019 100 ft
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CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: 3 5 V 12Jeakex, (�e��-h Ad .
Owner:
1-:v V_ 4 S fcY
Print
Contractor/agent:
Print
2elI-i
_County: = r 1 .(1
ure
The approval is for the purpose and design described in your aWication. 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 026.0243 (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 026 .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, Ck�'U a V- V s 1 LT"I'" , 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): Date:
State of North Carolina I Environmental Quality I Water Resources
512 N. Salisbury Street 1 1611 Mail Service Center I Raleigh. NC 27699-1611
919.707.9000