20180279 Ver 1_Shoreline Stabilization_20180223

201 80279
r State of North Carolina
Department of Environment a d N a R sources
Divisi of ltfoces
�f
15A NCAC 02H .OS00 — Water Quality Certification, Shore mne
Division of Water Resources FORM: SSCP 10-2013
Shoreline Stabilization Application Form
Four copies of the application (including attachments)
1.
Division of Water Resources
401 & Buffer Permitting Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
fee should be sent to:
Applicant Information f15A NCAC 02H .0502]
Owner
Name:
Mailing
Telephone Number -7e Fax Number:
E-mail Address:
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http //www saw usace army mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIGATION FORM.pdf) must be attached if the Agent has signed this application form.
Name:
Company Affiliation:
Mailing Address:
Telephone Number: %�a4� r✓ D,D"Jr���Fax Number:
E-mail Address:
Person to receive the Certification Approval:
II. Project Information [15A 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, structures (buildings, retaining wails, docks, impervious surfaces,
FORM: SSGP 10-2013 Page 1 of 4

construction access corridors. You may use the diagram provided at the end of this
application form.
3. 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: I¢. Nearest Town: r3 r n C. i �t
Subdivision name or sit�e^�ad ress (include phase/lot number):
01n►n fly � 0.
Directions to site - please include road names and numbers, land{ as, etc.:
r-,-7 -b PXi+�� rn� - a
A 11-1
RI -80. aJos(p5'
Latitude (in decimal degrees) 3.�i % a3 aq Longitude (decimal degrees)
S. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.):
6. Property size (acres): 0 . U 1, 0res
7. Lake/ river/ ocean adjacent to property: L A 1r Q� r'Y►Q 0
8. Describe proposed work (include discussion as to how hardenin of shoreline has been
avoided, or why it is necessary):
g. Will work be conducted from land? �C] From water? FJ
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool lake level/ Normal Water Level in square feet or acres:
I
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres:
12. Please describe the vegetation above the normal pool lake level/ orm/al Water vel and 50
feet landward to be impacted (number of trees, for instance):
/ V1 , 7 '
Owner/Agents Signature
1-a- 5 )c 3' h'g
Name
f 15 NCAC 02H .0502(fll
authorization letterfrom the owner is provided.
'Agent's signature is valid only if an
FORM: SSGP 10-2013
a.Ilgl i �
Date
Page 2of3

Lake
(At Full Pond/ Normal Water Level)
Full Pond/
A Warm
Level
ore -
hv,4e V lcx-�t
m ti -r 0 �" e-;�,
r rovide dimensions for each
Please approximately sketch the followm�o'iation�YSt is pra p
item, such as 10 ft x 100 ft) *:
1. All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
B. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
4. Location of any proposed structures such as buildings, retaining walls, docks, etc.
S. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
page 3of3
FORM: SSGP 10-2013

91
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CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address:UVm6,*J Y QU CAu County: i I e,�9
Owner: ✓1C I� 6 uu"
Prin tSignature
Contractor/agent: MC
Print 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 02B.0243(6)]
Benching, grading in the buffer is not allowed. Excessive disturbance of ground cover. [15A 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 .0502 and 15A NCAC 02B.0243 (4), (6), (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. 115A NCAC 02B .0243(5), (6)]
Acknowledgement of Notification
I, W k "
J�ne + Va;k5. 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. ..11
Signature (owner):
Date:
State of North Carolina I Environmental Quality I Water Resources
512 N. Salisbury Street ! 1611 Mail service Center 1 Raleigh. NC 27699-1611
919.707.9000

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2/19/2018
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17217 Connor Quay Ct- Google Maps
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OWNER To* 1
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WHITE IRREVOCABLE TRUST
P,O. BOX 3575'
HensonFoley
MOORESVILLE. NC 28117
Londscape Architecture Civil Engineering Surveying
8712 Lindholm Dr. SURS, 202A, Hunlersvllle NC 28078
77 172 17 CONT12a 21111 -T. w
P: 704.875,1615 If: 704.875.0959, WVAW.hen%onfoley.coO,
{ HOR111 CAROLINA BOARD U9 EAAAWERS (IRM LICENSE LA0. PIJBI
UMBER 1001
i SOUTH CAROLINA STATE BOARD CERTIFICATE OF AUIIIORRATION Nn..5R145

B60 - P851 A
FOR REGISTRATION
Fredrick Smith
REGISTER OF DEEDS
Mecklenburg County NC
2017 MAR 09 01:54:14 PM
SK:60 PG:851-851 } (�
FEE:$21.00
INSTRUMENT # 2017030317
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