20220995 Ver 1_Shoreline Stabilization_20220721

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ROY COOPER s r 1 ' ,J n
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Governor _.. r•
MICHAEL S.REGAN ,�� ;a
Secretary ` ww+tva F'
S.DANIEL SMITH NORTH CAROUNA 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)
DWR ID# Version (if applicable)
A. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: Dt,l'e.! (e Ke,H—
Mailing Address: 1-I S3a Swir,47 (cot R,1
Gores l„0.5 A/C, 2$03 (
Telephone Number: 70E(-L(R ,- 19q1 Fax Number:
E-mail Address: 0�74,I tte6r<.e4-4- ,0 j'r0foekJOaii.Ceti
i .D E :4) North CNortharolinaSalisb DepartmenturyStreet1 o1617f EnvironmentalMailService Center Quality RalDivisioneigh. of Water
NorthCarolina Resour27&ces
512 99-Ib17
°oc^"°°�"m Environmental m°et. 919.707.9000

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://wwwsaw.usace.army.mil/Portals/59/dots/regulatory/regdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf)
Name: �rnu��rd (,✓�ge,rY
Company Affiliation: L-u(c �Torr"44 Or24 t Perm(-4—
Mailing Address: 1 YK L.a.%e
Ca ,
Telephone Number: 70cl-L107- Fax Number:
E-mail Address: Jolvg{'.n 1(q)_ )sr .l ,corn
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: McA lay b Ed3 Nearest Town:
Lake/ river/ocean adjacent to property: Lake AI ore,..,
Property size (acres): d, i 7
Subdivision name or site address (include phase/lot number): j a I- 2-c'
Directions to site - please include road names and numbers, landmarks, etc.: 77
lil;o, ex:F aK 5701.11 W Coht.A Ave/ 7'6..rt I^bra- 0-40-0 7`artc.« Cdwpel Rd./ T..rh dr. f fo
Latitude (in decimal degrees) 35- q3 6t Longitude (decimal degrees) '50.8$S'I I 5„h.*, „,
T i 04 m.re
eve-
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): re s;de.4-4 4
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Appl ,+-,,„ 04- LL4ss 6 tip r p l-, cash-°( erarsa,,
FORM:SSGP 09-2020 Page 2 of 5

7. Will work be conducted from land? n From water?
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:
t00
Temporary impacts in square feet:
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:
100 g.ct.4,r
Temporary impacts (temporary clearing, construction corridor) in square feet:
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): L,Afifly 1--coded
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
. '' 77-57
Owner/Agent's Signature" [15A NCAC 02H .0502M 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}
304- t frra fir
Full Pond/ Normal Water Level or.. : err.' o ii i.'i r. r er°'f "" "°
Shoreline ► ird �:Y: griis`' `erifrr f *` MIN
,k r0 •F-1—
Ii4,J P
Plan View
Lake
(At Full Pond/Normal Water Levels Existing Dock
30€1a7 ft
e. s tes .w ahxlsoa
�iir�,' iWitri ass: rsAiir, gepyrfwl aond/Nus,L
Full Pansf/Narma!Water Level',rr `w�;!1����4� y���a~
'-1 ram[;'►• rt—�
—§irmrrnE_s R. rrw_ ON WNW. a fr.150 fr
Ole l, Riprap as 1 sut
�OW.delie sib" .above full pond/NWF i
2 h.r 150 ft �'i!?w�r feed
additional leering++{ I
•If necessary
EAMPLE
fi
Plan View
FORM:SSGP 09-2020 Page 4 of 5

i 1 � Abovt
w Nis �act�F �
ri s)
5 �u Vlf� 4l� a �,
Lake e
(At Full Por*!/Normal Water Level) 1'
/ E E
O
...1-
e
Side View _
u_
3 ft,below full pond water level 4 ft.above full pond water level 2 ft.additional clearing
II If necessary
Existing bank O.
e�y
411111,
10 ft.bank lb*
height 90
4z.,
411111r1o*''''
q4.
al, r
1 ye
Side Vi
FORM: SSGP 09-2020 Page 5 of 5

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: p w/ii t t o S kti f` J��i►�; Co nty: Meek[en d
Owner: Hrnt
A4 Signature
/
Contractor/agent: klu uj4,n ti+7 yewr J�
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 and grading in the buffer is not allowed. Excessive disturbance of ground cover. [15A NCAC 02B.0243
(6)1
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
, 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 uffer Rules,the approved plan(s)and specification(s),and other supporting
materials.
Signature(owner): Date:

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