20200329 Ver 1_Shoreline Stabilization_20200302

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State of North Carolina
Department of Environment and Natural Resources
DWRDivision of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources FORM: SSGP 10-20
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resources ,
401 & Buffer Permitting Unit
1617 Mail Service Center 1, -�
Raleigh, NC 27699-1617
Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information _
Name: --
Mailing Address: i (v 4 0
Telephone Number: zit-'Z314[ Fax Number: ti//1q
E-mail Address: �` , -To f+rk 0--(2t4 AQ_Y'E2 ;A, --T
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http://www saw usace army mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name:
Company Affiliation: ""`�_ rk E—,— Tt {_�� -:-IAJ C�_
Mailing Address -
Telephone
E-mail Address: S ',A.i7Dy�
Person to receive the Certification Approval: �e f,rv, �� �►�;C7�!
II. 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
4
respect to local landmarks such as towns, rivers, and roads. �G
2. Provide a detailed site plan showing property boundaries and proposed locations of 7_
vegetation clearing, structures (buildings, retaining walls, docks, impervious surfaces,
FORM: SSGP 10-2013 Page 1 ofXfj

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.
Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale
of some sort- a yard stick, shovel handle, etc.) f r- l
4. Location of the property (where work is to be conducted) %l
County: C (--I -T lcPwN;�, Nearest town:
Subdivision name or site address (include phase/lot number): 4 K K L V�>.
Directions to site - please include road names and numbers, landmarks, etc.: _
Latitude (in decimal degrees)
Longitude (decimal degrees)
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): LVy0,*%11*Lo �
6. Property size (acres): I . vZ 4 S c..2=,5
7. Lake/ river/ ocean adjacent to property: L A K c cz ,••L J
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): S"GP...9L LA)i� AJ -rt�� Tip t�3tr
9. Will work be conducted from land? © From water? ❑
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool lake level/ Normal ater Level in square feet or acres:
Ate e s
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 nd 50 feet land -ward in
square feet or acres: �' ( OCR �0CAO
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): _ire
ocnc� A uIJ arc 6
Li-
Agent's Signature ,
Printed Name
[15A NCAC 02H .0502(f)]
Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10 2013
3/0_ .0
Date
Page 2 of.? Y

La ke
(At f ull fond/Normal Water Level)
Full Pond/
Normal_Water_Level
— � PW S i i f✓
Please approximately sketch the following information on this plan (provide dimensions for each
item, such os 1oft x 100 ft) *:
1. All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
3. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
4. Location of any proposed structures such as buildings, retaining walls, docks, etc.
S. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
FORM: SSGP 10-2013 Page 3 of /g

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Geos atial 'T
_catawba county Information Services Real Estate Search 7
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Parcel: 470002997668, 1658 KALE RD CATAWBA, 28609
Owners: WILEY CHRISTOPHER JOHN, WILEY MARY JONES
Owner Address: 1640 KALE RD
Values - Building(sy $0, Land: $168,700, Total: $168,700
This map/report product was prepared from the Catawba County, NC Geospatial Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling information contained on this map or data on this report Catawba County promotes and recommends
the independent verification of any data contained on this map/report product by the user. The County of Catawba. its employees. agents, and
personnel, disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct.. indirect or consequential which arises or may
arise from this map/report product or the use thereof by any person or entity.
Copyright 2014 Catawba County NC
02/26/2020

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AL,UTATED EXCEEDS 1:,Dr10; T4AT THIS PUT
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ROBERT DEDMON, PLS 3899
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RrGISTRATION NUMBER AND SEAL -MS > DAY
3704 NC HIGHWAY #16 BUSINESS NORTH
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P.O. BOX 494 — DENVER, NC 28037
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PHONE: [phone]
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FAX: [phone]
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DATE: AUGUST 7DATE: AUGUST 20188 Ds. 3265 PG: 15393265 PG: 1539
DB. PG:
SCALE, 1" = 40PB 49 PGA 134
CATAWBA TOWNSHIP
CATAWBA COUNTY. NC
SURV. BY: KELLYDRAWN KELLY 1108#SLN I
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MAKE
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GRAPHIC SCALE - FEET
Now11ANDALL 1G� ARDNER
ALL OF LOT 1 OF SADDLEBROOK OF LAPk NORMAN
01658 KALE RD, CATAWBA, NC 28609
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50' LAKE
BUFFER
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ANY DOCKS, PIERS OR OTHER-
--IMPROVEMENTS BUILT ON LAKE -
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CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
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Project Name/address: IDS E 044� County: ��PI
Owner: -SvhAN VJi,L—S C (J1,
Print Sig ature
Contractor/agent: tAk C <C 54 S' ZVD2•� -97
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 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, . -SC) Nwil, L , hereby state that I have been informed of the Catawba
Riparian Buffer Rule. Any work condu ted 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: