20191725 Ver 1_Shoreline Stabilization_20191216

State of North Carolina
Department of Environment and Natural Resources
N`r�v_ Division of Water Resources
Water Resources 15A NCAC 02H .0500 - Water Quality Certification, Shoreline Stabili
ENVIRONMENTAL QUALITY FORM: SSGP 02 lJ40
Shoreline Stabilization Application Form 7�6
Three copies of the application (including attachments) and the application fee should be sent to:
If sending via US Postal Service
Karen Higgins
DWR - 401 & Buffer Permitting Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
A. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: 1 )e
Mailing Address:
Telephone Number:
E-mail Address:
if sending via delivery service (UPS, FedEx, etc.)
Karen Higgins
DWR - 401 & Buffer Permitting Branch
512 N. Salisbury Street
Raleigh, NC 27604
Fax Number:
TVi 2+439D9mri,1. On
2. Agent/ Contact Person Information
RECEWED/DEWDWR
DEC 16 2019
A signed and dated copy of the Agent Authorization letter must be attached if the Agent has
signed this application form. (A form can be downloaded here:
httD://www.saw.usace.armv.mil/Portals/59/docs/repulatorv/repdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdt)
Name:
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
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: 5SGP 02-2017 Page 1 of 3

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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: Tredell Ne`alrestTown: DiQ�eSYi��P.
Lake/ river/ ocean adjacent to property: or YYIQ.Y�
Property size (acres): D, 8?_ a.creS '
Subdivision name or site address (include phase/lot number): 260 Souhh J-k a bor I&IIIch Dr.
5kaA-e.SvlIle ,NO- 2$6_1:1 Lo+:1`4 31') Hurknr 1 o,+Ch
Directions to site - please include road names and numbers, landmarks, etc.:
See. a+Fachexi
Latitude (in decimal degrees) 35. to6K l Q Longitude (decimal degrees) -SO, 4`lq qo2.
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): 1 .eS k&en--tal
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
l i'zQ% on
7. Will work be conducted from land? ❑ From water? 0
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:
lo' below (iozo S� o� �m�C:l�
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 fill, excavation, rip rap, retaining walls, etc.) in square feet:
Temporary impacts (temporary clearing, construction corridor) in square feet:
10. 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):
d i s}urbar _e_ to boK-er
11. Sign e
12
ner/Agent's Signature* I15A NCAC 02H .0502(f)l Date
`Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 02-2017 Page 2 of 4

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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
Full Pond/ Normal Water
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Shoreline
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Plan View
Lake
(At Full Pond/ Normal Water Level)
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FORM: SSGP 02-2017 Page 3 of 4

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3 ft. below full pond water level 4 ft, above full pond water level 2 ft. additional clearing
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FORM: SSG 02-2017 Page 4 of 4

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Google Maps 610 East Center Avenue, Mooresville, NC to 260 S Harbor Watch Dr Drive 19.4 miles, 35 min
610 E Center Ave
Mooresville, NC 28115
t 1. Head south on Evergreen St toward E Center Ave
17 s (197 n)
Follow NP715 N, Old Mountain Rd and Buffalo Shoals Rd to
Laurel Cove Rd in Fallstown
32 me (1]J mp
r' 2. Turn right onto E Center Ave
0.2 mi
r• 3. Turn right onto N Maple St
0.2 mi
01 4. Turn left onto E Iredell Ave
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260 S Harbor Watch Dr - Google Maps
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CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project
Owner:
Contrac
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 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. 115A 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, TaLmes fQQrl7i n 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. /I
Signature (owner):
Date: