20200076 Ver 1_Shoreline Stabilization_20200113

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State of North Carolina
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
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: H In
Mailing Address:
Telephone Number:
E-mail Address:
2. Agent/ Contact Person Information
:• 38
If sending via delivery service (UPS, FedEx, etc.)
Karen Higgins
DWR-401 & Buffer Permitting Branch
512 N. Salisbury Street
Raleigh, NC 27604
Jp
7Q
3 2020
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:
htto://www.saw.usace.armv.mil/Portals/59/docs/reizulatorv/reedocs/Permits/SAMPLE AGENT ALITHORIZ
ATION FORM.pdf)
Name: Sylice_ FS-lv-,7
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Fax Number: '704-(o(o0-59LA
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: Tre del) Nearest Town: ao ceSV t 1\e-
Lake/ river/ ocean adjacent to property: tAp rm0_n
Property size (acres):
Subdivision name or site address (include phase/lot number): 1 tog mar nS 11:ocd t)r.
mno ,NC aBill lr,4 #5b0 Oresee_nk (arid reii m6er Co rQJ.
Directions to site - please include road names and numbers, landmarks, etc.:
Latitude (in decimal degrees) 35. 511 aka. Longitude (decimal degrees) + Sa.935811
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): s ; rle,nA Wa.1
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): ='nr,11 ri � rrb . n grin o
e.ki 51:1 na u)a11 , e y}am; nnof un I 1
7. Will work be conducted from land? Q 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:
9.5 V)e1nuu ( 3VI-5 SF of trnpoct�
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:
I' Qlr.rP_ llt-Z`SIP o�;rnoar+)
Temporary impacts (temporary clearing, construction corridor) in square feet:
10' x SO access Corr dor ( SOO 5�
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):
d151urbance to
11. Sig re
Owner/Agent's Signature [15A NCAC 02H .0502(f)] PF Igo
bate
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 02-2017 Page 2 of 4

1

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
Lake
(At Full Pond/ Normal Water Level)
2.5 X l a7 below a •5' Y. AO below
Full Pond/ Normal Water Level 64
Shoreline %I;L7' a60\j2. i'x ao'7` boo4
abe v -e ramp
)o
WkDt
5A-roc o res
Demo' d
Plan View
Lake
Exiging Dock
...............
._..
GE
FORM: SSGP 02-2017 Page 3 of 4

dH
ve
Lake
(At Full Pond/ Normal Watei Level)
3.5'
h gh v
0
L
N
C
Side View
7
FORM: SSGP 02-2017 Page 4 of 4

12AXIM a10Eeet Carter ArapB Moo'aJNa, INC to CrlrmaapNOr, Nostri IM NC M17-G0pyM Mara
Google Maps 610 East Center Avenue, Mooresville, NC to 169 Gainswood Dr, Mooresville, NC 28117 Drive 12.0 miles, 24 min
610 E Center Ave
Mooresville, NC 28115
t 1. Headsouthon Evergreen SYtoward ECenter Ave
17. (197 th
Take NC-1100 to Gainswood Dr in Donaldson
23 mn (11.7 m)
1' 2. Turn right onto E Center Ave
o5 mi
-1 3. Turn left onto S Church St
o.ami
re 4. Turn right onto E Wilson Ave
1 s mi
f 5. Continue onto NC-1 1 0018rawley School Rd
56m[
f 6. Continue straight onto NC-1100
I7mi
O 7. At the traffic circle, take the 2nd ea0 and stay on
NG7100
2.0mi
41 B. Turn left onto Gainswood Dr
Destination will be m the left
1 mn (C3 m)
169 Gainswood Dr
Mooresville, NC 28117
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V4'dQ0 810 East Caper A1mue, MmaMlle, NC to 1e3(3arerwptl Dr, Marrs411e, NC M117- C¢gle M}c
These directions are for planning purposes pry
You may find Ilan ccostructon aojacts, traffic.
weather, a other slants may cause condnldns to
tldier from the map plants, and you should plan
your loops accad'n9ly You must pheyal sons or
notices regarding vpur nxta.
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18335 OLD STATESVILLE ROAD
SUITE A
CORNELIUS. N.C. 28031
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NOTES:
4624-1&,9762
1. NO NCGS MONUMENT PHILIPSARVL•R
FOUND WITHIN 2000. DB. 23S5, PG. 1518
2. PROPERTY MAY BE SUBJECT TO OTHER
COVENANTS, RESTRICTIONS. EASEMENTS OR
RIGHTS -OF -WAY THAT MAY BE OF RECORD.
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3.
SETBACKS SHOWN PER PLAT (MB. 34,
F PG.19):
FRONT: 30' 4
SIDES! 10'
REAR: 50' FROM 760 CONTOUR
CURRENTLY ZONED R-20 PER N
IREDELL COUNTY ZONING:
FRONT: 35' 2
SIDE: 15'
REAR: 50' FROM 760• CONTOUR
u
4. CONSULT WITH GOVERNING AGENCY FOR
PREVAILING LAND DEVELOPMENT AND =
ZONING REQUIREMENTS PRIOR TO DESIGN OR
CONSTRUCTION OF ANY IMPROVEMENTS.
LEGEND:
#5 REBAP. FOUND
CALCULATED POINT
HVAC UNIT AND PAD
TELEPHONE PEDESTAL
POWER POLE
SUBJECT PROPERTY LINE
ADJOINER PROPERTY LINE
BUILDING SETBACK
OVERHEAD ELECTRIC
FIELD LOCATED 760' CONTOUR
SD' BUFFER tr1FFCFT FRnA •rcrrr
FIELD LOCATED
WOOD 76000NMUR
�.\ • •50' BUFFER
REAR YARD
p
p ,r
MOBILE HOM
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WOOD HOME
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LOT 508
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PUMP
HOUSE 31726—F
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FN
0.728Acres ..1 f .IAMB BRA.\CH
_
_ J DB. 4938, PG. SR5
30'SETBACK
J N 32'07'2W
153.50'
N 3706'08" W 154.58' (TIEONLY)
EDGE OF PAVEMENT
GAINSWOOD DRIVE
60' PUBLIC RJW
(MB. 34, PG.19)
0 20' EP TO EP
O
Graphic Scale
SD 25 0 50
Scale of Drawing !inch = SO Feat
Physical Survey of Lot 508 of Recreation Lots, Section 6
Professional
IProperly
sOn�eynrs.,nt:.
Survey For:
As Recorded in:
Site Address:
16335 Old Statesville Road Ste. A
169 GAINSWOOD DRIVE
Cornelius. N.C. 28031
04.765-3134 Phas one/1•
ALAN SICA
DB. 2614. PG. 2499
MOORESWLLE, NC 28117
Firm License: C-3B66
M8.34, PG.19
IREDELL COUNTY
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169 Gainsviwd Dr - Goog le Maps
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CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/add
Owner: A
Pri
Contractor/agent:
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
11Ig IaLn S I C (2.'l_ , 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): 0" � _F � Date: