20220251 Ver 1_Shoreline Stabilization_20220214

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO: 4 PLAN NO:
STREET ADDRESS:
164 Brer Fox Trail
Troutman, NC 28166
Please print:
Pro a Owner: Leslie Kausch
Property Owner:
PARCEL ID: 44730309386
The undersigned, registered property owners of the above noted property, d❑ herebyauthorize
DONNA P HRKO
(Contractor/Agent)
of LANCASTER'S CUSTOM DOCK & LIFf SYSTEMS,
INC.
(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 Owners Address (if different than property above):
1309 Lakewood Drive
Greensboro, NC 27410
Telephone: [phone]
We hereby fy the above information submitted in this application is true and accurate tothe
f w Ie
orized Signatur Authorized Signature
2/10/22
Date
Date

Full Pond/ Normal Water Level
.. _ .. , M
Shoreline
Plan View
FORM: SSGP 09-2020
Lake
(At Full Pond/ Normal Water Level)
4
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Plan View
Page 4 of 6

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Side View
LL.
FORM: SSGP 09-2420 Page 5 of 6

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
ProjectName/address: l f'J� County: reC
r
Owner: L��7 11 P r3 ■ I N I■ ■
Print
Contractorlagent: _
Print
Sig
ature
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 .050E 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 and 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, 1 f r 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 B V
ules, he approved plan(s) and specifications), and other supporting
materials, ll t 1
Signature towner] zDaA Date: — �-

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219122, 3:19 PM ConnectGJS Feature Report
https:Iliredell,connectgis,com/DownloadFile.ashx?i=_ags_map6cae468973a9484pa46951 c954608de2x. htm&t=print t ��

2/9122, 3:17 PM Property Data
Iredell County
Property Data
Parcel Number: 4730309386,000
Inquiry Date: 2/9/2022
Disclaimer: While every effort is made to keep information provided over the Internet accurate and up-to-date, the County does not certify
the authenticity or accuracy of such information. No warranties, express or implied, are provided for the records and/or mapping data
herein, or for their use or interpretation by the User.
Property Map
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b• 210
108
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175
Owner/ Property Info
Tax Account Number: 80052852
Old Parcel Number: I503F040008004
Owner Name: KAUSCH CAROLE
Mailing Address: 1309 LAKEWOOD DR GREENSBORO NC 27410
Property Location: BRER FOX TRL
Lot Number: 4
Legal Description: ALLISON ACRES 2 PBS-7
Municipal Information
Township Code: is
City Code: ao
Neighborhood Code: 15033
Value Information rent Ye r Property Re rd I PAC}
Building Value: 76600
Other Building Features: 11420
Land Value: 261250
Talc Assessed Value: 349270
Deferred: NUII
Land Information - Register of Qeed5.Online,$earch
web 3. mo bi le 311. co m!l redel I Repo rt/repo r•t. aspx?PIN =4 730 3 093 8 6.O 0o
H
1/2

219122, 117 PM
Date Recorded
20170530
Tax In€orrnation
Exemption
Null
Document Type Deed Book Deed Page
DO 543 573
Tax Code 1. Tax Code 2
C ADVLTAX Null
Property Data
Plat Book & Page
8-7
Tax Code 3
FR06ADVLTAX
Land Area Land Type Zoning
i LT R20CUD
Tax Code 4 Tax Code 5
Null Null
Current Zoning Contact Inib,
Iredell County
704.878.3118
Harmony
704.878.3118
Love Valley
704.879.3118
City of Statesville
704.878.3575
Town of Troutman
704.528,7600
Town of Mooresville
704.662.7040
Village of Davidson
704.892,7591
QP
web3. mobi1e311.comllredel I Reportlreport.aspx7Pl N=4730309386.000 2I2

Submission Form
I. Applicant Information [I5A NCAC 02H .0502(a)]
...................................................................................................................................................................................................................................................................................................................................................................
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all
mandatory questions are answered.
Primary Contact Email*
Owner Information:
Name: *
Email: *
Phone Number:
Mailing Address: *
[e-mail]
Please provide an email address for payment and requests for more information here.
Leslie Kausch
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
1309 Lakewood Drive
Address Line 2
City
Greensboro
Postal / Zip Code
27410-4441
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: *
Company Affiliation:
Email: *
Phone Number:*
Donna P Hrko
State / Province / Region
NC
Country
US
Lancaster Custom Dock and Lift Systems, Inc.
[e-mail]
[phone]
(xxx)xxx-xxxx

Mailing Address:* Street Address
1156 Perth Road
Address Line 2
City
State / Province / Region
Troutman
NC
Postal / Zip Code
Country
28166-8640
US
A signed and dated copy of the Agent Authorization letter:
Kausch Signed Agent Authorization Form.pdf 151.18KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Kausch Shoreline Stabilization
If your project has a formal name please use this. If your project does not have a formal name, please identify your project
by the owner name and proposed activity (Jones Property Access Road, Smith Guest House, etc.) List in parentheses
any other names that have been used to identify the project in the past.
1. Provide 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.*
Upload File
Look up address
Property Address Lookup: * Street Address
164 Brer Fox Trail
Address Line 2
City
Troutman
Postal / Zip Code
28166
Latitude: * 35.659406
State / Province / Region
NC
Country
us
Longitude: *-80.905629
2. 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 under
section 12.normal pool lake level/normal water level *
Kausch Detailed Site Plan.pdf 1.2MB
Please use the diagram at the link below:
https://edocs.deq.nc.gov/WaterResources/0/edoc/616616/ShoreIine%20Layout.docx
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale of some sort- a yard
stick, shovel handle, etc.)
Kausch Shoreline Photo.pdf 252.23KB
4. Location of the property (where work is to be conducted)
Nearest Town: * Troutman
County: * Iredell

Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address:* Lot #4 Allison Acres #2, 164 Brer Fox Trail, Troutman, NC 28166
Include phase/lot number
Directions to site: *
From I-77 NB, Exit 42, Left onto US-21 NB toward Troutman, Left onto
Wagner Street(Perth Road), Right onto State Park Road, Left onto
Honeycutt Road, Right onto Brer Fox Trail. Property is on the right.
Please include road names and numbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:
Residential
Residential, undeveloped, etc.
6. Property Size .447 Acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Shape, slope and mat shoreline. Install Class B Rip Rap for stabilization
and erosion control.
8. How will the work be done?* ✓ From Land
From Water
9. Total amount of disturbance below the normal pool lake level/ normal water level: *
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
110 sf
square feet
10. Total amount of disturbance above the normal pool lake level/ normal water level and 50 feet land-
ward: *
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
720 sf incl.
construction
corridor.
square feet
11. 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)
NONE
Sketch:
Application Fee:
Once the application has been accepted. You will need to send a corresponding fee in with the appropriate DWR#. The
application fee is as follows (pursuant to G.S. 143-215.3D):
a $240.00 for impacts to lake (below normal water level) of less than 1 acre
a $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:
a I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the best
of my knowledge and belief
a I, the project proponent, hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time.

o I agree that submission of this Shoreline Stabilization online form is a "transaction" subject to Chapter 66, Article 40 of
the NC General Statutes (the "Uniform Electronic Transactions Act');
o I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act');
a 1 understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
o I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:* Donna P Hrko
Signature:
Submittal Date: 2/12/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20220251 Version: *
Select Reviewer:*
Select Reviewing Office:
Has payment been received?*
What amount is owed?*
Doug Perez:eads\djperez
Mooresville Regional Office - [phone]
No Payment Needed
Fee Received
• Need Fee - send electronic notification
• $240.00
$570.00