Catawba Riparian Buffer & Agent Authorization Forms

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: \41ll�—�ycX' LD`-P(202Ycau^ C(
Owner:
Contractor/agent:
Print
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Signature
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 028 .OZ43(6))
Benching, grading in the buffer is not allowed. Excessive disturbance of ground cover. 115A 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 .OS02 and 15A NCAC 02B .0243 (4), i6), (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. 135A NCAC 02B .0243(5), (6)]
Acknowledgement of Notlflcatlon
I, , 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 Rules, the approved plan(s) and specification(s), and other supporting
materials.
Signature (owner):
� �— Date: C,5"o(7'20L�

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. VJjfC — PLAN NO. �'12I PARCEL ID: `� b, q I Q z169 1p
4 a
STREET ADDRESS: 1558 St1t-r-Wccb �T
Soe�\LS FsttC� , Ky- a 6 t3
Please print:
Property Owner:iL� —�✓ ���
Property Owner:
The undersigned, registered property owners of the above noted property, do hereoy authorize
' l►r ►+Ao� of y �iLovd aM ra Sc�PE
(Contractor I Agent) (N me of consulting fine)
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 (if different than property above
Telephone: —�U--7Y6- (3'Z'
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
A rite Signature Adft
Date: C)5-0-1-20 L`{ Deft:
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