20200297 Ver 1_Shoreline Stabilization_20200225

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State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
1SA NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization,
FORM: SSGP 02-201
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Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the - should be sent to:
If sending via US Postal Service If sending via delivery service (UPS, FedEx,
etc.)
Karen Higgins Karen Higgins
DWR — 401 & Buffer Permitting Branch DWR — 401 & Buffer Permitting Branch
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC 27699-1617 Raleigh, NC 27604
A. Applicant Information [._ i',!C;6,C 02H .0 .02(a,j
1. Owner Information
Name: —Ct 0 ��
Mailing Address: I o 1 R
Dn )AD
Telephone Number: _Wy -sol — n_,3 V 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:
�6ocs�Pe� r 1 s; Sx.IdrPi C `,r��,� !
Name:
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Fax Number:
B. Project Information [_S, i,r ,r -i .C!507
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

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) L ' I
County: r'
_ `-s(a.5� N T
Nearest Town: _M
Lake/ river/ ocean adjacent to property: Chi sIp.t� j [ n xp
Property size (acres): O , 015
Subdivision name or site address (include phase/lot number):
Directions to site - please include road names and numbers, landmarks, etc.:
Latitude (in decimal degrees) S l 54n35 Longitude (decimal degrees) " 8U , q $ 6 a
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): , a S i AP- ` [.
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): -LQ,c L i
7. Will work be conducted from land? ® From water? ❑
8. Total amount of impacts below the normal pool lake level / Normal Water Level
ent 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, 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):
nrr; SS V r—iced
11. Signature
/ G
Owner/A ent's Si ature' [i -, i rw0?:' C? ;;:i' Da e
Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 02-2017
Page 2 of 4

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)
BE
full Pond/ Normal Water ev
Shoreline
I I
V
Plan View
Lake
(At Pull POW Normal Water I-d)
Existing Dock
Full Pond/ Normal Water L
Shoreline
2 fc x 150 f:.
a�iccnat clearing
:` necesury
i
Plan View
FORM: SSGP 02-2017
3h.lwft
Beta•, NO Ppn<u rrtan
A It K 150h
Ah— full po:d/ tAVL
Page 3 of 4

La ke
(At Full Pond/ Normal Water Level)
I �
L
0
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Side View
3 ft. below full pond water level
10 ft. bank
height
Side View
4 ft. above full pond water level 2 ft. additional clearing
'if necessary
FORM: SSGP 02-2017
Page 4 of 4

V binq ..
A Mooresville, NC
705 Island Point Rd, Mount Holly, NC 28120
A Mooresville, NC
'I" 1 Head southeast on W McLelland Ave toward S Broad St
't 2 Keep straight onto NC-115 / W McLelland Ave
3. Turn right to stay on NC-115 / S Main St
4 Turn right onto Langtree Rd
Take ramp left and follow signs for 1-77 South / US-21 South
5 s Minor Congestion
39 min, 26.7 miles
Light traffic (6 min delay)
Via 1-77 S, 1-485 S
Unpaved roads
246 ft
82 ft
3.6 mi
1.1 mi
11.3 mi, 11 min
6
At exit 19B-A, take ramp right for 1-485 South toward Pineville
6.6 mi
7
At exit 16, take ramp right for NC-16 toward Newton
0.4 mi
f
8.
Turn right onto NC-16 N / Brookshire Blvd
3.0 mi
9•
Turn left onto Horseshoe Bend Beach Rd, and then immediately turn
left onto Nivens Cove Rd
0.5 mi
j 10. Turn left onto Island View Rd 495 ft
Turn left onto Island Point Rd 427 ft
11. . Unpaved Road
Arrive at Island Point Rd
12. The last intersection is Island View Rd

B 705 Island Point Rd, Mount Holly, NC 28120
These directions are subject to the Microsoi't a Service Agreement and are (or informational purposes only. No guarantee is made regarding their completeness or accuracy.
Construction projects, traffic, or other events may cause actual conditions to differ from these results. Map and traffic data © 2020 HERE'.

�...... .............. ... Notary County .A
�=UHTY OF
I, .....,�"?�.. , a Nota Public �n and for the Coun and State afore-
said, do hereby certify that
Carroll G. Wright
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personally appeared before me this day and acknowledged the due execution of the foregoing (or annexed) Fti,
instrument.
WITNESS my hand and Notarial Seal, this the day of ....�f �L .............. 196.. ...
.... yak
Notary Public
My Commission Expires:
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Wright
Printed On: 1/17/2020
Disclaimer: The information provided is not to be considered as a Legal Document or Dec -
The Map 8 Parcel Data is believed to be accurate, but Gaston County does not guarantee its accuracy. Values sh

Wright
Printed On: 1/17/2020
Disclaimer: The information provided is not to be considered as a Legal Document or Description.
The Map It Parcel Data is believed to be accurate, but Gaston County does not guarantee its accuracy. Values shown are as of January 1, 2019.

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: County:
Owner: —A 4-
nt
Contractor/agent:
Print
Signature
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 NCA
02H .0506 and 15A NCAC 02B .0243(8)] C
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 028 .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)]
Aclrno wledgement of ivotifictation
U Q� --__, hereby state that I have been informed of the Catawba
Riparian Buffer ule. Any wok 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 willbe
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: 40
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