20210728 Ver 1_Agent Form-Catawba Buffer Form_20210617

Strickland, Bev
From: [e-mail]
Sent: Thursday, June 17, 2021 1:52 PM
To: Perez, Douglas J
Subject: [External] Re: 144 Summer Shoal Place (DWR#21-0728)
Attachments: David Mayhew Agent Form -Catawba Buffer Form.pdf
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Here you go
Original Message
From: Perez, Douglas J [e-mail]
Sent: Jun 17, 2021 1:31 PM
To: [e-mail] [e-mail]
Subject: 144 Summer Shoal Place (DWR#21-0728)
Hey Randy,
I need a Catawba Riparian Buffer Form for this one. None was attached.
Doug
Doug Perez— Environmental Specialist
NC Dept. of Environmental Quality (NCDEQ)
Division of Water Resources - Water Quality Regional Operations
610 East Center Ave., Suite 301, Mooresville, NC 28115
Phone: [phone] Fax: [phone]
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be
disclosed to third parties unless the content is exempt by statute or other regulation.
1

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO:
STREET ADDRESS:
V-101C
Please print:
Property owner,
Property Owner;
(0
PLAN NO: PARCEL ID:
The undersigned, registered property owners of the above noted properly, do herebyauthorize
Randall Clawson
of Clawsons Pile Driving and
i Construction
G1111111111111111111111 %Wool- %NOV
(Contractor/Agent)
(Name of consulting firm)
to act on my behalf and fake all actions necessary for the processing,,, issuance and acceptance of this
permit or certification and any and all standard and special conditions attached.
Property Owners Address (if different than property above).0
7 SAD (n Kra
Vi I t�z.
Telephone: 70`/4&6
41,
wnm
UVe hereby certify the above information submitted in this application is true and accurate tothe
best of our knowledge.
Authorized Signature
;!-
Date
Authorized Signature
Date
/---'0200ZP

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address
I )IV %
Owner: ie 11
P ri
Contra ctor/agent0
:
Print
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s�
Sig
0
a 57'
Cou
- - r w ti'
Signature
The approval ir, for the purpose and design described in your application. Impacts not indicated in the
application is a violation of the Buffer Rule. Site specific word should be provided in the application. [1
02H .0506 and 15A NCAC 02B .0243(8)]
5A NCAC
Trees are not allowed to be
removed
from Zone 1
of the duffer (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 and grading in the buffer is not allowed. Excessive disturbance of ground ever. [15A NCAC 02B.0243
(6)]
Beeches, 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 mush 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 fake. All constructed stormwater
discharges muss 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 IVoticatior�
J
hereby state that I have been informed of the Catawba
Rip&'-ian Buffer Rude. 4ny 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 indent of the 401 Water
Quality Certification and Buffer Rules, the approved plan(s) and specification(s), and other supporting
materials.
Signature (owner):��.,,��r� �i►_ �....,. Date;?L21 - ...
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