20240547 Ver 1_Site Plan_20240415

State of forth Carolina
Department of Environment and Natural Resources
Division of Water Resources
Water Resources p 15A NCAC 02H .0500 — Water quality Certification, Shoreline stabilization
ENVIRONMENTAL ©UALITY FORM: SSGP 02-2017
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
A. Applicant Information [15A NCAC 02H .050 ]
1. Owner Information
Name: „ ehad and Deborah Acfoura
Mailing Address: 3455 BirchL
Fairlawn OH 44333
Telephone Number: [phone] fax Number: NIA
E-mail Address: iV;,-,fnHra1 ynhon corn -
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:ZZwww.saw.usace.armY mil/Portals/59/dots/regulatory/regdocs/Permits/SAMPLE AGENT AUTHORI2
ATION FORM.pdf)
Name: Charlie Washburn
Company Affiliation: Marine Construction LLC
Mailing Address: PO Box 6400
Hickory, NC 28603
Telephone Number: 828-495-3040 Fax Number: N/A
E-mail Address: office 2 marineconstructionilc.corn
B. Project Information [1SA 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.
FORM: SSGP 02-2017 Page 1 of 3

I 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: _ uLkg..-__ Nearest Town: OonnellY-SO��
Lake/ river] ocean adjacent to property: ._---
property size 'acres): 1.01 Acres
Subdivision name or site address (include phase/lot number), 225
_8 Ljiand View n Nily
__5U_ri_nM, NO 2 V Lot 8 at Island.F'ointe at Lake. Vista Suwjvislon
Directions to site - please include read names and numbers, landmarks, etc.:
Ir chided i :1 packet
Latitude {in decimal degrees) Longitude (clecirrral degrees) _$; _� ...,,.,,, ..
S. Describe the existing lard use or condition of the site at the time of this application
(residential, undeveloped, etc.): Residential, Develooed
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
7. Will work be conducted from land? From water? x
8. Total amount of Impacts bellow the normal pool lake level / Normal Water Level
Permanent impact�sy (including all excavation, €]ackfill, rip rani, retaining walls, etc.) in square feet.
Temporary impacts in square feet:
----- o sgft
9. Total amount of impacts above the normal pool lake level / Normal Water i ev,, i and �o feet
land -ward
Permanent impacts (including back fill, excavation, rip rap, retaining walls, etc, i in square feet:
LAqosgft
Temporary impacts (temporary clearing, construction corridor) in square feet:
Construction corridor-- o sgffl
10. Please describe the vegetation above the normal pool lake level/ Normal Water level and 5o
feet landward to be impacted {number of trees, for instance):
11. Signature
141
Agent's Slgn uie [ .', ;CA .0 g0- _Ow
Kati
.Argent's srrgnature ,.s valyd omly ;} an authorization
c.. i.l.
FORK SSGD 02- 01. i ' :

12. Please approximately sketch the following information on this plan and provide dimensions far
each item:
a. All proposed vegetation clearing
b. Location of rip rap or fill to be placed above the Full Pond/ Formal 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
Full Pond/ Normal Water Level
Shoreline
Plan View
Full Po`ncl/�Norrawf�l W*ter L
r
7hdrel ne ­r
2ft. x150ft.
addrt DW dean g
If fl 8 ary
Lr��r
Plan View
La ke
(At full Pond/ Normal Wafter Level)
No "Ovi lmn "
P t1 mmk6al W %ki vt �\Oa a
Lake
(ft FuA ParWNormal water LeA existing Clock
/ 3Q ft 0 rt
FORM: ssGP 02-201.7 Page 3 of 4

► 0 Goo54Wc- -i cx \ caincl d("
Pia 'iemeoyvN tmf0kkS
Pl\ room al 017' be Rdu"
No �T&s reKnoveA
Lake
(At Full Porn1dl Normal Water
dtX11Q,Qfi\C)W
�t]tl �c��►� I�WL �
Side View
3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing
V necessary
Existing bank
10 ft. bank
Side Vi
FORM. SSGP 02-2017 Page 4 of 4

Project Nsme%address. Asr i County,
Owner: Jehed and Deborah Astoura e
Print SignAture
�antra�rJagiw ; ; Cliarli � ' .sh i W MariYl.­ Qnstruction
Print Signature
The approval is for the purpose in your application. Impacts not indicated in the
application violation (f the Sigffer Rule. Sj'an. specific won< should be provided in the application. (1 A NCAC
02H .050G a "1w 1. 5,6, NCACO2$ .0243'8);
Trr;.er are not aljoived 1::) lae r rYlCsve= ' 3ro n Zone I of the Buffer (within 30 ft of the full pond elevaticr:;, zri ;s
approve Except:icn, those trees that are- severely undermined along the immediate shoreline can be ; rr,
Minimal shaping and sloping along the immediate shoreline is allowed.115A NCAC 026 ,0243(6)j
Benching and grading in the buffer is not allowed. Excessive disturbance of ground cover. [1 A NCAC 028 ,0243
(6)]
Beaches, impervious patio, impervious walkways, etc, are not allowed in the buffer unless specifically approved
by the Division. There are limitation on size for decks. JISA NCACO28.0243(4) and {f]j
Work to be conducted from land must indicate an access and indicate anv trees that are to be removed. The
work corridor should be described. The approved access corridor shal, be restored. Staging, spoil, construction
material must be outside the buffer. (15A NCAC t]IH .0502 and 15A NCAC 026 ,0141 (4), (6), f 8jj
5tormwater cannot be piped or channeled' 1:= r dl", -A discharge to the lake. All constructed stoat water
discharges must be at the natural elevaticr::: : _ :'is : ,argecl prior to entering the buffet- directed as diffuse or
sheet flow at non -erosive velocities to the. lake:.
Acnowfedgement of AbW%don
Jetwd-and D111192Efih f , hereby state that 1 have he€�n 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 (CDWR), is a violation and subject to enforcernent. Due diligence will be taken Bitch that the
construction will be built within substantial compliance and intent of the 401 Water Quality Certification and
Buffer Rules, the approvedplan(s) and specifications), and other supporting materials.
Signature (owner)_ �J � � �, � �� l�s�ii�� � U_� �
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Go gle Maps Hickory, North Carolina to 2258 Is VW Ln NE,
Valdese, NC 28690
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0.3 mi
f* 2. Turn right onto 1st Ave SW
0 Pass by dairy Queen (Treat) (on the right in 0.7 mi)
0.9 mi
E i 3. Turn left onto 13th St SW
0A mi
41 4. Use the 2nd from the left lane to turn left onto US-
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0.3 mi
Take 1-40 to Malcolm Blvd in Rutherford College. Take exit
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e 6. Take exit 43 toward 1-40
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t4 9. Take exit 113 toward Connelly Springs
0.2 mi
Continue on Malcolm Blvd. Drive to Is Vw Ln NE in Valdese
10 min (4.4 mi)
A 10. Merge onto Malcolm Blvd
�`1 11. Turn left onto Lake Vista Dr NE
+"1 12. Turn left to stay on Lake Vista Dr NE
r4 13. Turn right onto Is Vw Ln NE
2258 Is Vw Ln NE
Valdese, NC 28690
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230 ft
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AGENiF Ai?;-,r,�,,,GRITZA 4 A FORM
Please note that Multiple forms may be nece . SsatY if there are more than two owner's of the pmperty.
PROPERTY LEGAL DEScp,-jpTj0N:
STRr:ET ADM SS OF EXIS7ING HOME or LATrnJDE/LONG1TUDE OF NEW CONSMUCnON-
2258 Island View Ln NE Connejjy Springs
NC 28612
35-778/-81.533
Parcel ID.. 2744876686
PrOPertlf Owner Name(s) — Pie"* PMW
property Owner. Jehad Asfoura
Property Owner: Deborah Asfoura
The underSigned, registered property Owners of the above rioted PmPerty,, do knleftauthorize
Charlie Washburn
af Marine Construction LLC
(Contra OiMgent) r Marne of company)
to ac''On my behalf and take all actio"Is t1le PY'Oc"'s,' if G, issuance and aomptance of this
permit or Certification and any and all Sl',aildard and s.peciai ccoditions attached.
Owners Mailing Address (if different than PropertV addraw abo")
K-0 �'airlawnOH 44335
A,
..... . .......... ,
Pr oPerty Owner(s) Telephone: [phone] �
33c) q36 -01,4,1, IA-f,
il d
We he certify that the above information -submitted in this application is true and accurate to the
best of our knowledge.
fized
Auftrized Signature
Date