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CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
�� S 5 j ►� w44
project Marne/address:_ County:
,weer: rX", [- ar 7rLM- V—&AJ jt �ti
Print
Contraftr/agrent! LeVU
P
Print L A k-t e' � T' LI C Sig
_ne 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
02t-..0505 any 13A NCAC 028 .0243(8)]
Trees are not alkswed to be removed from Zane 1 of the Buffer (within 30 ft of the full pond elevation), unless
approved. EAception, those trees that are severely undermined alongthe immediate shoreline can be removed.
;u:irjrr,al snaping ano soaping along the immediate shoreline is allowed. (15A NCACO28.0243(6))
3enching, grading In the buffer is not allowed. Excessive disturbance of ground cover. 115A NCAC 02B .0243 (6))
aaacnes, Impar.ious patios, impervious walkways, etc. are not allowed in the buffer unless specifically approved
dy the Divls.ort. Tr*�e are limitation on size for decks. [15A NCAC 028 .d243(4) and (6))
%,,6rk ;o be wnclucted 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
r;�aiehal must cue aot-;ide the auffer. (15A NCAC 02ti .0502 and 1SA NCAC 028 ,0243 (4), (6), (8)]
Stormwrater car.rwot a piped or channeled for direct discharge to the lake. All constructed stormwater
ulscharges r,-,jEt ae at the r.atural elevation and discharged prior to entering the buffer directed as diffuse or
sheet flow a` neon-eroslve delocities to the lake. 115A NCAC 02B .0243(5), (6)]
ACkrronadedgeixtenf f+ NoilPcONorr
11 _304 ka t ill'7Q &.F eti3O- hereby state that I have been informed of the Catawba
Riparian 5u e. .,-e..'.ny wort cons acted in the buffer, not specifically stated in the application and approved
oy the aivisior. cf Water Resources (oWR), is a violation and subject to enforcement. Due diligence well be
::.L- 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
�aterlais. _1
Signature (uwiy�r T� Date:

.0
.................
0 1
4VAM. ,3 S, C-"O * C,
je!�- g!n3bal
Tw --runder, registered proWfq/ owners of #* sbm Y*W props'", do hereby authanze
or r i, c
Agent) (Name & maw" fkm)
w,.0 cLi beW and bice all actbas recessay for the ProandnJ6 MRW= MW DOWPtar "I
tft parr it or cwtNkadon and any and aM sUrdrd and spMW OWMM aMMJW-
P.Tqwtv Owe in's P-dciress (tf diffwerit than property above);
oereb,,r the above iribmwitkM stauliDed in this appkzCOn is bw bM acOlratc to the
Aubvrtmd Si
Date: