20201162 Ver 1_Shoreline Stabilization_20200904

RECEIVED
SAMPLE AGEN T Alrt OKRA 110N FORM S E P 0 4 2020
PROPE.RW LEGAL DESCRIPTION:
NCDEQIDWRINPDES
LOT NO. 2 z PLAN NO. PARCEL ID:
Si REEF ADDRESS: '�lZ 1'2- j� Q g o iZ �J CST
Please print:
Property Owner: Esc-- r%%&b�
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
11r►,,,. (�tt C 1/1. / �, of C/0-t(/ �, s a1'GDr-. ✓ ; ✓►� �U'u'2i
Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if diferent than property above):
Telephone: ��3',2 2 !2' 0 (o O
We hereby certify the above Information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature Authorized Signature
Date: - Z-y - z-o Date: `? %- -2-
020

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: ► % 212 A Abe%-P> P-0 County: 4 s �►'t -
Owuner. 1GQ-�- �Qj.►1►c.ObJ
Contracuir/agent: 1)c&-. Sa,(l "J, L
Print Sighature
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 speck work should be. provided in the application. [15A NCAC
02H .0506 and 15A NCAC 028.0243(8)]
Trees are not allowed to be. removed from Zone 1:of the Buffer (wirhin`30 ft of the full pond elevation),•unless
approved. Exception, those trees bat are severely undermined. along the immediate shoreline can be.rempVed.
Minimal shaping and sloping at the immediate shoreline is allowed. [15A NCAC 02B .0243(6)j
Benching, grading in the buffer is:not allowed. Excessive disturbance of ground cover. [15A NCAC 02B _0243 (6)]
Beaches, impervious patios, impervious walkways, etc. arenot allowed.in the buffer unless specifically approved
by the Division. There are limitation on size for decks. [15A NCAC 028.0243,(4) and (6)]
Work to be conducted frorn 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 .0S02 and 15A NCAC 02B_ .0243 (4),(6)1(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
sheetflow at non -erosive velocities to the lake. 115A NCAC 02B .0243(5), (6)]
Acknowledge►hent of Nottficotlan
1, e-VAc . ZLF_¢r.» %AP. - , 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): Date: to 2A ZO
State aMor di Caralina i Errvi wmergal Quality ; Water Resources
532 N. Salsbury Street 1 t611 Wa1Swvlce Cmw PAeiph NC 27699-1611
919.7079000

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 RECEIVED
Raleigh, NC 27699-1617 S E P 0 4 2020
• Applicant Information [15A NCAC 02H .0502(all NCDEQIDWRINPDES
1. Owner Information 1
Name: ,r� c e h1L1 o'Lt_! &rr�
Mailing Address: q;Z1I A -born
Telephone Number: Fax Number:
E-mail Address: P17-cZ�*rv6 4vj a gnct;.I • C0AA
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be
downloaded here:
htto://www.saw.usace.armv.mil/Portals/59/docs/regulatory/`regdocs/Permits/SAM PL
E AGENT AUTHORIZATION FORM.pdf) must be attached if the Agent has signed
this application form.
Name:
Company Affiliation: 6We"Q-t'
t GohS4
Mailing Address: 5g05 Res -�' Z
r.[©v,e,- , S .0 • Zq-i 10
1

Telephone Number: 7oy-Sot,-7yd o Fax Number: 4303- 831- Ste $5
E-mail Address: fcLa%,js 35 /> e�.�dkl�►tk -+
Person to receive the Certification Approval: HowUowyL¢r d- a,,4 *,cLr
Project information [15A NCAC 02H .0502(a) & (b)]
• 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.
• 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.
• Attach a photograph of the shoreline/ buffer proposed to be stabilized.
(Include a scale of some sort- a yard stick, shovel handle, etc.)
• Location of the property (where work is to be conducted)
County: Nearest Town: I eI mo n+
Subdivision name or site address (include phase/lot number):
14;Uc,1 -on j�o i ,ti+ - Lol 7 /
Directions to site - please include road names and numbers, landmarks, etc.:
�� S« ii✓Ja�O ``
Latitude (in decimaidegree,) 3S. lSS G `% Longitude (decimaidegrees)
• Describe the existing land use or condition of the site at the time of this
application (residential, undeveloped, etc.):
• Property size (acres): 16.2
• Lake/ river/ ocean adjacent to property:
2

• Describe proposed work (include discussion as to how hardening of shoreline
has been avoided, or why it is necessary): � � !: n.� 11a s , �ec rL
e t,O G_ i ._c LID ` J&a r S . ZaAl ; .s hO K0 bh , c ; u � (a h 119 c4
wad
• Will work be conducted from land?4�,,J_ From water?
• 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: o?Y so �t
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: 9;7S
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): A o JrµsA— wJ! 6e-
Owner/Agent's Signature* [15A NCAC 02H .0502(f)l Date
'Agent's signature is valid only if an authorization letter from the owner is provided.

F�... tJ ° _'•E 'icrcx't A,;:crPc:nt
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Lake
(At Full Pond/Normal Water Level)
Full Pond/
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Please approximately sketch the following information on this plan (provide
dimensions for each item, such as 10 ft x 100 ft) *:
• All proposed vegetation clearing
• Location of rip rap or fill to be placed above the Full Pond/ Formal Water Level
elevation
• 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.
• Location of any excavation or dredging below the Full Pond/ Normal Water Level
elevation
:i

• Location of construction access corridors

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020
3990 Charlotte Hwy, Clover, SC 29710-8083 to 4212 Arbors Ford Ct Directions - MapQuest
YOUR TRIP TO:
4212 Arbors Ford Ct
ISMIN 1 10.71111111
Est. fuel cost: $0.80
Trip time based on traffic conditions as of 11:55 AM on June 23,
2020. Current Traffic: Heavy
Print a full health report of your car with HUM
vehicle diagnostics [phone]
O1. Start out going northwest on Charlotte Hwy/SC-49 toward Blucher Cir.
Then 2.63 miles 2.63 total miles
r+ 2. Turn right onto Highway 274/SC-274.
Highway 274 is 0.1 miles past Latitude Ln.
Then 0.91 miles 3.53 total miles
3. Turn slight right onto Pole Branch Rd/SC-279 (Crossing into North Carolina).
Pole Branch Rd is 0.1 miles past Blue Rock Rd.
Then 1.92 miles 5.45 total miles
T 4. Pole Branch Rd/SC-279 becomes S New Hope Rd/NC-279.
Then 0.92 miles 6.38 total miles
T5. Enter next roundabout and take the 1st exit onto Armstrong Rd/NC-273.
Then 2.37 miles 8.75 total miles
r+ 6. Turn right onto Southpoint Rd.
Then 1.20 miles 9.95 total miles
r+ 7. Turn right onto Reflection Pointe Blvd.
Reflection Pointe Blvd is 0.5 miles past Reese Wilson Rd.
If you reach Boat Launch Rd you've gone about 0.1 miles too far.
Then 0.29 miles 10.24 total miles
8. Turn left onto Lake Pointe Dr.
Lake Pointe Dr is just past Beauhaven Ln.
If you reach Hermitage Ct you've gone about 0.3 miles too far.
Then 0.37 miles 10.61 total miles
https:llwww.mapquest.com/directions/listll /us/south-carolina/clover/29710-8083/3990-charlotte-hwy-35.106974,-81.040643/to/us/north-carolinalbelmo... 1 /2

6020 3990 Charlotte Hwy, Clover, SC 29710-8083 to 4212 Arbors Ford Ct Directions - MapQuest
9. Take the 3rd left onto Arbors Ford Ct.
Arbors Ford Ct is just past Beechwood Spring Ln.
If you reach The Bluffs Way you've gone a little too far.
Then 0.09 miles 10.69 total miles
10. 4212 Arbors Ford Ct, Belmont, NC 28012-6755, 4212 ARBORS FORD CT is
on the right.
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THIS IS TO CERTIFY THAT ON THE 21 St DAY OF JULY 20 08 I. SURYBYSD THE PROPERTY
SHOWN ON THIS PLAT AND THAT THE TITLE LINES AND THE WALLS OF THE BUILDINGS IF ANY ARE
SHOWN HEREON.
LAKE WME IGNED
� "ORS
�P BobbyJ. Ra e, Surveyor
Y
s� - _ , S a,. W 627 Eastway Drive
' q s 5dti araatte, NC 28205
NOTE TO SCALE ��• ts� / �� O EJ.P. ��v r A a,,
viol
PLOT PLAN
Of
LOT 71, REFLECTION POINTE
SCALE 1 "=30' _ CITY OF BELMONT GASTON COUNTY, N.C. G o2 c-
i
THE PROPERTY OF FLAVIUS & GIGI TAYLOR
MAP RECORDED IN BOOK 067 AT PAGE 063 DEED RECORD$D IN HOOK PAGE