20191560 Ver 2_Shoreline Stabilization_20200117

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N`r�# 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
1. Owner Information
Name:
Mailing Address:
If sending via delivery service (UPS,
Karen Higgins
DWR - 401 & Buffer Permitting
512 N. Salisbury Street
Raleigh, NC 27604
11 Irr�rPCV��I`P I� ai='il[�
Telephone Number: `1011- 43LI - 11-71 Fax Number:
E-mail Address:
2. Agent/ Contact Person Information
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:
http://www.saw.usace.army.miI/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf)
Name:
Compai
Mailing
Telephone Number:
E-mail Address:
Fax Number: r1O4 - ULOC) - 5q Uq
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.delI Nearest Town: IM-ooresv'itIZ
Lake/ river/ ocean adjacent to property: IAmrrnn_n
Property size (acres):
Subdivision name or site address (include phase/lot number): aaa. (Areer�6cu lid.
C�ooresvllle W. asl1J Lnr '* INO Cre,Sceon LUn eTrnbe - CorF-
Directions to site - please include road names and numbers, landmarks, etc.:
Latitude (in decimal degrees) 35. SCkIt,-15 Longitude (decimal degrees) - 6MOA585I
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): : eSLT Tien -Via -I
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): SV)a pr . np.A SIoD2 nniaLt ma +'%E9
anti a rr�lX nF Molder ancj o.tas5 "3 r',rain
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:
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, excayation, rip rap, retaining walls, etc.) in square feet:
Temporary impacts (temporary clearing, construction corridor) in square feet:
►o' `� PS()' 2cceSS Cbrr,dof (S�- mo. t pac+)
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):
rIP r0.1) to
11. Signa�tu
Owner/,
'Agent's
FORM: SSGP 02-20:
iro I
Signature' [15A NCAC 02H .0502(f)]
ITlan
Date
is valid only if an authorization letter from the owner is provided.
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 dredeine below the Full Pond/ Normal Water I PVPI PlPvntinn
Lake
(At Full Pond/ Normal Water Level)
B 6otu
a .5, X lam' trcY,
S700reline
101 Liz,- C �ea f-ed
WIDE For new hoyn2
Plan View WES5 Con &kru c%t o n
FORM: SSGP 02-2017
Lake
Existing Dock
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Page 3 of 4

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above
a5,
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Lake high
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(At Full Pond/ Normal ater Level)
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Side View
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FORM: SSGP 02-2017 Page 4 of 4

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Google Maps 610 East Center Avenue, Mooresville, NC to 222 Greenbay Rd, Mooresville, NC 28117 Drive 7.9 miles, 18 min
610 E Center Ave
Mooresville, NC 28115
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Recombination Survey
222 Greanbay Road
CRESCENT LAND & TIMBER CORD
LAKE NORMAN SECTION 10
LOT 1140
Davidson Township, IredeU County, NC
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Raymond May
' 222 Greenbay Rd..
' Mooresville, NC 28117
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Project
Owner:
Contrac
CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Tre e- U
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, hereby state that I have been informed of the Catawba
Riparian Buffe Rule. Any work c6nacted 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: l 3