20200105 Ver 1_Shoreline Stabilization_20200117

02ooZ�o�as
Shoreline Stabilization application Form
Three copies of the application (including attachments) and the appli
should be sent to:
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
• Applicant Information i 15A NCAC 02H .0502(a))
1. Owner
Name:
Mailing Address:
r, 5
/Do/ xa(d'nA v�l%�i�Dr. am:t �/L
Telephone Number: �Or/- / n o�� Fax Number:
E-mail Address: �y�Invr��rC�SQwtt . Co>�-
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be
downloaded here:
b.tLD://uV W W.SaVV.usace.a rmv. mi I/Portals/59/dots/regulato rv/regdocs/Perm its/SAU P L
E AGENT AUTHORIZATION FORM.pdf) must be attached if the Agent has signed
this apDlication form_
Name: K0::ja6Va_(i--
Company Affiliation: 50�I ' /t I f ; , c /,ova s ifuG C_
Mailing Address: ii1-�' 'QiY .
r��uer sG,129;7/0
19�
k Ord

714-S-06-7 oo
Telephone Number: Fax Number:
E-mail Address: f G 6WS 3S
Person to receive the Certification Approval:'wjad 6 v &e t__
o Project Information [ 5A NCAC 02H .0502(a) & (b)l
o 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.
a 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, and construction access corridors.
You may use the diagram provided at the end of this application form.
m Attach a photograph of the shoreline/ buffer proposed to be stabilized.
(Include a scale of some sort- a yard stick, shovel handle, etc.)
o Location of the property (where work is to be conducted)
County: 2CtSrV--%--- Nearest Town: Ae%r -�
Subdivision n me or site address (include phase/lot number):
Directions to site - please include road names and numbers, landmarks, etc.:
``.S'ee.- lXoa/J
Latitude (in decimal degrees) aS I %/ 9D </ Longitude (decimal degrees)
- Z/, 1)32=gs0
o Describe the existing land use or condition of the site at the time of this
application (residential, undeveloped, etc.): U;1 e vezew k'ki e ,5i f,-,of
Aa Property size (acres): / D0O 7
e Lake/ river/ ocean adjacent to property: ���` 4/44�'e
2

Fol
Describe proposed work (include discussion as to how hardening of shoreline
has been avoided, or why it is necessary): ;gk W—,L- Ir hcud�� hoar
W-11 <Q 'erosl o.`.. ':Sec A .tw &
Will work be conducted from land? La,aL From water?
e 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: ACOX X 110 L6 = Z& &$,R
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: Y ieegsIZ4 -t Reeve
//i X &Q L6
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):
9 raA,S
Owner/Agent's Signature` [15ti NCAC 02H .0502(f)l
Date
'Agent's signature is valid only if an authorization letter from the owner is provided
3

�i�: -t'?� `�. - . - - - .... _tt-.•dea dc_c^. 'c�:-i::o.res:at i•_sui�•.mt -
- Hbme Insert Design Animations Slide Shoz: ?. aN . _wed h
jt Leyout - It EliLj
. Cs....•�" 511- `r:7 Delete
Lake:
:• - (AtFuil Pond/Normal VdaterLevel)
_ Full' Pond/
Normal Water Level
Shoreline —_
Slide4 of4 'Olfite Theme'— `-+� —�—�-•
Please approximately sketch the following information on this plan (provide
dimensions for each item, such as 10 ft x 100 ft) ~:
e All proposed vegetation clearing
a Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level
elevation
o Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level
elevation
© Location of any proposed structures such as buildings, retaining walls, docks, etc.
o Location of any excavation or dredging below the Full Pond/ Normal Water Level
elevation
4

e location of construction access corridors

SAMPI E AGENT AUTFiC RIZAnON FOWIi
PROPERTY LEGAL DESCRIP'I ON: P 6t,75-m ®a3y 3W
LOT NO. PLAN NO. PARCEL ID:
STREEt ADDRESS: frFS14 ArFi/l Afb , 2j -
�.elwt�.n.�- N-G• �Fsol�
Please print O/LS,0�D�-�2 f �,
Property Owner• 6#� �
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
'of
(Conn -actor I Agent) (Name of consulting firm)
to act on my behalf and crake all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property OAviner's Address (if different than property above):
JOD( VI 1Ulu�it�at �i��ol 1EJ6• ri %(p�uA-{' k1ol� pl"81"7_0
Telephone: 7Q94- s--al o2
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
-_e/. rs
Signature oflized Signature
rate:Date: - y 0

r
CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project
Owner:
Contractor/agent:
Print Signature
The approval is for the purpose i 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 .024318)]
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 alongthe 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 0213.0243 (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 Notifici tion
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) and specification(s), and other supporting
materials.
Signature (owner). Date:
State oiNorth Carolina f Environmental Quality 1 Water Resources
512N. Salisbury Street ; 1611 Niall Service Center i Raleigh. NC 27699-16U
9t9.707.9000

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CAROLINAS
DESIGN
GROUP,PLLC
-LAND SURVEYING -LAND PLANNING
201 West Sian! Avenue Gastonia, NC 28052
Phony. 704-054-9328 s 704-884-9007 4 fas 704-854-9328
NC LICENSE R-0188
TOPOGRAPHIC SURVEY
a
884 LONER ARMSTRONG ROAD
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THOMAS EDISON
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