20230896 Ver 1_Wagner Buffer Notification_20230809

CATAWBa RI1 aRIaN BUFFER NOTIFICATION FORM
Project name/address.
Owner,, ..-k6(rm,
Print
Contractor/agent:
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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. 115A NCAC
02H .0506 and 15A NCAC 02B .0243(8)l
"frees 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, grading in the buffer Is not allowed. Excessive disturbance of ground cover. (15A NCAC 02B ,0243 (6)l
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)j
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)j
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(S), (6)j
Acknowledgement of NotifIcatian
I, ( I X
, hereby state that I have been informed of the Catawba
Riparian Buffer Rule. Any w rk co ducted 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) Dater

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION: Se c H 3
LOT No. PLAN NO. PARCEL ID:
aTREETADDRESS: _ U �QCL
Please print:
Property owner:
Property Owner;
The undersigned, registered property owners of the above noted property, do hereby authorize
VL,-, .B...- of�r" _ c
(Contractor 1 Agent) (Name of consulting
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 Owner's Address (€f different than property above):
Telephone�ai1 '
We hereby certify the above Informat€on submitted in this application is true and accurate to the
best of our knowledge,
Authorized Signature
Date:., agSi!_ b
Authorized Signature
Date.