20220649 Ver 1_Shoreline Stabilization_20220511

e) d k
cXKCA
ROY COOPER 6 t,
Governor
MICHAEL S.REGAN
Secretary ` a""'"
S.DANIEL SMITH NORTH CAROLINA State of North Carolina
Director Environmental Quality
Department of Environment Quality
Division of Water Resources
15A NCAC 02H.0500—Water Quality Certification,Shoreline Stabilization
FORM: SSGP 09-2020
Shoreline Stabilization Application Form
Three copies of the application (including attachments)and the application fee should be sent to:
If sending via US Postal Service If sending via delivery service(UPS, FedEx, etc.)
Paul Wojoski Paul Wojoski
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
NOTE: Before submitting this form, please ensure you have submitted the Pre-Filing Meeting Request
Form as we will not be able to accept your application without this important first step. The Pre-Filing
Meeting Request Form is used in accordance with 40 C.F.R. Section 121.4(a)which states "At least 30
days prior to submitting a certification request, the project proponent shall request a pre-filing
meeting with the certifying agency." In accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5), all
certification requests must include documentation that a pre-filing meeting request was submitted to
the certifying authority at least 30 days prior to submitting the certification request. Click here to read
more information on when this form is needed prior to application submission or here to view the
form.
Attach documentation of Pre-Filing Meeting Request to this application.
Date of Pre-filing Meeting Request: / / (required) RECEIVED
DWR ID# Version (if applicable) MAY 1 1 2022
DEO-WATER RESOURCES
401 &BUFFER PERMI7TlNG
A. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: 30b 13 rck z.ek u
Mailing Address: 1410 l_ i(t Slur,- P . 5.
Dtvvcr , Ale_ 11037
Telephone Number: ZN'-$)5 -`(6 Sa- Fax Number:
E-mail Address: Bob, Dray oay le yea;I i coM
^ ,North on of onmental Qualit I of e Rerc
512 NorthCar Salisbury Streetartment 11617 Mail
Envir Service Centery I Raleigh,Division NorthWat Carolinar sou
2769es9 1617
irca,uNa
u.P.N nm,,tmc .�mo.wO..1; 919707.9000

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:
http://www.saw.usace.army.mil/Portals/59/dots/regulatory/regdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf)
Name: Uc i3Ini my c acl-
Company Affiliation: 1.-Aki Nor AN, Drc.5;M5 Perms, -t.
Mailing Address: I$YK ((estrc-t VaR.e
«+c vim / Afe, vbc6q
Telephone Number: 70c1-'I -3 Fax Number:
E-mail Address: dota5tnn c-oA
B. Project Information [15A NCAC 02H .0502(a) & (b)]
1. Attach a vicinity map (i.e. street map) clearly showing the location of the property with
respect to local landmarks such as towns, rivers, and roads.
2. Provide a detailed site plan showing property boundaries and proposed locations of
vegetation clearing, buildings, retaining walls, docks, impervious surfaces, rip rap, excavation
or dredging below Full Pond/Normal Water Level elevations, and construction access
corridors. You may use the diagram provided at the end of this application form.
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale of
some sort-a yard stick, shovel handle, etc.)
4. Location of the property (where work is to be conducted)
County: Ltncolh Nearest Town: D cover
Lake/river/ocean adjacent to property: L,fr,
Property size (acres): 6.3 76
Subdivision name or site address (include phase/lot number): Wes{—porgy
Directions to site- please include road names and numbers, landmarks, etc.: Fr. Nay 16
ferh 1.a� dal. laace- 56w-t. {d. S. / +take. w,fL'I ya, rr.+CM 2q11 ,,,, 44.e n'Sal-
Latitude (in decimal degrees) 35. 447°1 Longitude (decimal degrees) "$d•9$1°y
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): f?5idM f iq
6. Describe proposed work(include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Appl;cooiv,, o$" class eqP for /r+a;n'I'eha.kt
d fi ex�5+,► 51,•.e..1:,-R- and repo;r cA,Srh•ny
FORM:SSGP 09-2020 Page 2 of 5

7. Will work be conducted from land? n From water? 114
8. Total amount of impacts below the normal pool lake level/ Normal Water Level
Permanent impacts (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
Oast.
Temporary impacts in square feet:
0
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:
0
Temporary impacts (temporary clearing, construction corridor) in square feet:
U
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):
(P3k4-I y 1r►oodcd / 'ru.•++d t
11. Signature
By signing below, I, as the project proponent, certify to the following:
• The project proponent hereby certifies that all information contained herein is true,
accurate, and complete to the best of my knowledge and belief
• 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
q,„4.,, -6A L//g/ &,A
Ow er/Agent's Signature* [15A NCAC 02H .0502(f)] Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
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
FORM:SSGP 09-2020 Page 3 of 5

Lake
(At Full Pond/Normal Water Level)
ekoak
Full Pond/ Normal Water Level ``- ; °vr ps'FO✓ I
MN i MIN MEI MEM Mk Ma gala,
Shoreline
cx:i+rAg oral(
(kr'P
Plan View
Lake
(At Full Pond,Normal Water Level) Existing Dock
301tx7ft
. •tenj v !� 3hx150h
/ �,,5��o. ttit7v Al* full Pond/NV.'L
Full Pond Normal Water level ?T�i=*—rl�• �=T: gkx150 ft
nhorellne iriirii��:�t: =2 ii •
��SS7�y�Le�w+ Riprap i• At, Oft xPond/NwL
2 ft.x„oft, i:4":i:=WV w 1�'�i"�
additional clearing '
if necessary
Ei(AM P E
Plan View
FORM:SSGP 09-2020 Page 4 of 5

c- ea4
as
a)
Lake
(At Ful Pond/Normal Water 101
ax
0 c
ni=
a
Side View
3 ft.below full pond water level 4 ft.above full pond water level 2 ft.additional clearing
I I ( if necessary
•
Existing bank 5
•,
�,r
10 ft.bank a
height dil\q/r' °y2
41111 impLE
Side View M• 41*%
FORM:SSGP 09-2020 Page 5 of 5

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: (o b aro Z K hare/1;42. County: (�"n G4 ( h
Owner: !,(� 6 € 1 . v (fit
Print
Contractor/agent: \lout ky (Ai/ —
Print Signature
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 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)]
Acknowledgementfof Notification"
I, ,) w1,% e V ra-Z'e ct(/(.4 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):

• ' • ---"A MIAMI LA
I Ail1A ‘‘' 10,0 ‘10.
114t‘ -••-
• 1
•

Go gle 2920 Lake Shore Rd
9
,a,s'i,ote So
- 444
Mav data Wan loch
2920 Lake Shore Rd S
Bulk
0 ® 0 0 0
Lorections Save Nearby Send to your share
phone
() 2920 Lake Shore Rd S, Denver, NC 28037
Photos

Go gle ,''..t: 2920 Lake Shore Rd S
.90,. , , i....•
/ '• ., .
/
I ..
' ,,-.;-.:*•• ,Alt,41:i 7 . . .,
• .-.-5, ',
s" ..t.'" ' 4*
.. ''''''''aLadka—"' -41044 t"-•
`.-4,&"...>. . '• N-...N74 ' s
... -
..
• - 2p5,
,ice•-....-..., 44. ...,..„.',
•
t" i:,.: . y• e.T. ,,,
. .I. .
$,,, .. ., ;4- • • . .. .
.. . .. _ ...
,..,
'' ' on..c 0-ey.1
. .
c..
,..!..' ' '. ...''''''''$., A .1.4',14,
..1 (:. ' ..• '''''•A%.0A.• ':''...4 ,y. , ' '0—1 ' .. • '
r Ailk
. ... <A,. , -..,II"` .. , 7-.4...... 4,45". 1, ' .A.11,,, -"...!,"1..-z4.:," • ..1.:4,, -..'" . P.'
...:.- r .
, ., , ..,.,*..,....... '.V• 1.+...-,,, -
. .- :Li . ' '-'^•
• -
. - .• , 04.,
4 '- , •, •,..... -.41;.'...;;- .- ..,.../...1.:'
4? i,... Ni,.. .•.-, -.„.".:iitz,... -.-•";.; ,,,,,'-' ,- .
„.
--,.
. - •
''-,5,- .,,' '.7---..,_44' •...44,,:,1;--- . ',,e, ,, , ..• 5.'
At .7,,,,I.J.A a-% .. '.'''o. v ''....c.!,,. ,a,.., • , -
_ _. .:. ... ..- .
N-'-'• .. 5 — • • .
• • .' 4/'' ' . •-
It*.•Nt to'.•• 4 ,.,.., - .....:.-4,',,,or.!.• lk,' 4,4
,.,
• • ..„,,-- ,.. . Googie
. A ' •,.."1,,.. r,
?
to-,
2920 Lake Shore Rd S
0 (D C) ® CD
Deechons Save Nearby Send a)your Shave
phone
0 2920 Lake Shore Rd S,Denver.NC 28037
Photos

C-131
•0
M1N1M UM Cl6ArlreeNCGS,
Felt, V" LOT8'.
b10f LeMSb -- lemn.T
F601.11" LOT l\NG -- 4of.►T
F06ew"1OT61
5196 l33tS --1e F66T
F .AMT l0T \-rNG--LO F.6T
6ST6d.C.. F60M rs6002.1pT UM* - SOFSST
Co.lota tLtVlrfl0N,ft.\oula toWt4C0. N4L0. �n4T
%00.0NISNT Fors 10L000l30 UP TO CONT000-
Slav ^Tlori 130 FYGT.
,s-oe
0e.
er
U
34
3
9.Id
-34 E.
,!I•Kde
9.9S-14' 1e
33
70,
!r4 dd
!'s N .�
o
7 rr i
e6
d.
31.20-00Sr
312.23
a
.2
W
199W
rl
al
/'
LG otfi�d
0.04
f„ mrw.e
a9.••.
Jr,OW— de dike.
oe WWI a M 0.0k1., a W.a he.
unto. Cooney. h am.....n,(�_ r.a..13L
rnr_ � a .der a
STATE Or NORTN, CNN0l NN •
COUNT! Of�Jn(Q1lf---
The deri ed 1ae.,M. MN ddd fans
dream end fade do 1n. da ego aka ea
evYlaN stir ^ w:. crewed is.aodaa
0.40 6. S. R130 nmt:d0. if n re mdeta
mud er01.nt If we bey Of WI boa.,
eM 00d. ad woL 000 Foreen Reel
ea./� cede a Mrn ea Or� gas
---""/I - 1t6.0 na
r ln,Ynen l:-.Rr enr:I eb:ee a /Z•,wo
end a R.rolurn INC area tread, Conn
sY eLG3,dQ�
N. C. R.di d Se^wya
OTOS Or RROI7"S'N'`CAP.0rLLIti ,--
cam
ars fere(aln. cartttl0`.ts o}(�l�t
Potato to and roe the ..id aount> and .tute t..y.4ad
to be oornnt. Let thn tn.tnuent and the oertifloate
.n r..i.tered.
threw, y hand thl.._ LIaIL__ ,. i11.4
alma" Clerk of N.o.fj'pj 0ocre,
....n I..e ree emery ernettgJ wwee
M /�N�r4sg �rename du ker.0, ae�n�l((f� 14
l_cYs1y N.C. aea. he.eeem,
MnmeNe eOYeeed V ea err he eel
eekunvLdend M1n elee eedeane nl
adeR nnilkeee e d "ma W no, strata 1e
dx lydh of the .R,i.mnnl we Innh hem.
tM 3N4. me nd erd newel reel II ,J3 ..i
--2.l�arw..•..••,�iezz�-
Na.ee veer,
771')
WEST PORT E TIO"
roue, I . 100
.amu G-1- Lei
D.D.
&MINN It
LAKE 1\1O2MAN CORP, , ow Nell
PH!L11P DE 00e¢¢Y, 2.L.S.
wr.e.+
700.7
lemons. VO.