HomeMy WebLinkAbout20230457 Ver 1_Shoreline Stabilization_20230329ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Director
NORTH CAROLINA
Environmental Quality
(�)&) cq, ?)6L(S4—
State of North Carolina
Department of Environment Quality
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Shoreline Stabilization Application Form
FORM: SSGP 09-2020
Three copies of the application (including attachments) and the application fee should be sent to:
If sending via US Postal Service
Paul Wojoski
DWR — 401 & Buffer Permitting Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
If sending via delivery service (UPS, FedEx, etc.)
Paul Wojoski
DWR — 401 & Buffer Permitting Branch
512 N. Salisbury Street
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)
RECENM
DWR ID # Version (if applicable)
MAR 2 9 2023
A. Applicant Information [15A NCAC 02H .0502(a)] i]EQ 11VATrR fiESOUROM
1. Owner Information G1 & BUFFER PERWTINAii
Name: A n , t4 S hC
Mailing Address: 6 H 1Ae l) e cv'
cull; ervAYIq 000
Telephone Number: 307 - YJJ -13 4� Fax Number: 14A
E-mail Address: /}eS�trr✓agm,yrl,cc�
D EQ�� North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 1 1617 Mail Service Center I Raleigh, North Carolina 27699-1617
r�avi�cniuxinr�
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://www.saw.usace.army.miI/Portals/59/does/regulatory/regdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM. df)
Name: S f�rn
Company Affiliation: I,Ake Not- ^ 0'-eJJ;6j
Mailing Address: Po Rex 315,6
M 0 e C5v:141NC/ >f-J
Telephone Number: 209- 6S$-4114 Fax Number: /)/'9
E-mail Address: Stevza deck.9-JIreJle,com
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: L*rr+r-6H Nearest Town: fer re I l
Lake/ river/ ocean adjacent to property: �^,4 H cr11?✓1
Property size (acres): ,13
Subdivision name or site address (include phase/lot number): ol�
s,,c: esrhte
Directions to site -please include road names and numbers, landmarks, etc.: Hwy ISo l� off
Latitude (in decimal degrees) 35, 5 S l j 3 Longitude (decimal degrees)-yd,995 31
5. QgscrUxJhe existing land use or condition of jhe site at the time of this application
C(residentia)undeveloped, etc.): A es ft a f
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): nPr; ntm*vice- of ex6rin j Shorel'pt_for- ere3l m ce4ro)
FORM: SSGP 09-2020 Page 2 of 5
7. Will work be conducted from land? ❑ 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:
20 16 0
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:
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): On e-
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 CW 401 certification request within the applicable reasonable period of time
Q�vw Z3
Owner gent'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
Full Pond/ Normal Water
Shoreline
Plan View
La ke
(At Full Pond/ Normal Water Level)
Lake
(At FUN POW Nom al wain u,Ml Existing Dock
/30fta 7ft
•R•.••�,•,•.•.••�.•.•A 1. •
�ar,�,�r��� •i aiir���Abme full pond/ NWL
�����i�• �� ti at•
E AMP E
Plan View
cam
A'k pard
FORM: SSGP 09-2020 Page 4 of 5
3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing
'if necessary
Existing bank
10 ft. bank a
height 0
OQ
Q�
MPLE
Side Vi -
FORM: SSGP 09-2020
Page 5 of 5
Project
CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
("-I c( 5�C `/L 1 ,( F dal ,a County: C A6%y + 13 A
Owner: ,&� I T-A, 5 � YV
Print
Contractor/agent: &Ake PsrM o n o r4'1 i o
Print 51 ophcn �/ rq' Signature
ture
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)]
Acknowledgement of Notification
I, PCl4 vs -A sk� , 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 les, the approved plan(s) and specification(s), and other supporting
materials.
Signature (owner): Date: C3—r^'`#4TkZ2-3
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