20190164 Ver 2_Cass dredge disposal form signature_20230816

DREDGE SPOIL DISPOSAL FORM
Project Name/address: Cass 555 dredge (Cass 555 Lake Wylie Rd)County: Gaston
Location Address: 555 Lake Wylie Road, Belmont, NC 28012
Parcel #: 191820
Parcel/lot size 1.75 acres
Disposal area required (sq ft and/or acreage) 1260 sq ft (21 ft x 60 ft)
Acknowledgement of Notification
1, Jeffrey J. Cass am aware that the site must adhere to all state regulations
and rules regarding sediment and erosion control and water quality. And give permission for
Jeffrey J. Cass
Name of Individual and Company
to dispose of their dredge material at the above stated location
Owner:
J. Cass
Print
Date: August 16, 2023
Along with form, please provide:
Aerial of parcel/lot (County GIS)
Photo of proposed spoil site
Identified proposed spoil site