20180820 Ver 1_Shoreline Stabilization_20180614

Shoreline Stabilization Application Form 2 0 1 8 0 8 2 0
Three copies of the application (including attachments) and the application fee
should be sent to:
Division of Water Resources P
401 & Buffer Permitting Unit ICp E;'E,
1617 Mail Service Center
Raleigh, NC 27699-1517 JUN � 4 208
STp M 'LAND QUALITY
• Applicant Information [15A r ICAC 02K.�t5U2,a;] wAER
PERM/TT/NG
1. Owner Information 22
Name: �i��' : n ►J�'nct� N{
Mailing Address: a I Q LY nbr. Joie ire .
C,v-\.a,JU G ayQ-7 ,n
Telephone Number: (4 l9 - 3q5- QgY Fax Number:
E-mail Address: k br-oc4i Al. a-19 5' rncL (: C o m
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.miI/PortaIs/5S/docs/regulatory/regd0cs/Permits/SAMPL
E AGENT AUTHORIZATION FORM.pdf) must be attached if the Agent has signed
this application form. n \ -
Name: 1�C4 < CVt4JSl0
Company Affiliation: buu &10 nS Ntf 0611104"C-1 ConS4rucA-con
rj
Mailing Address: 5 r 0 S VA C4'+ ?-Daj
c� �-� (L S -C' L4 -7 I �

Telephone Number: 463- 9!?,I - 9'3 f �. Fax Number:
E-mail Address: 1-(� S5rntj.J , )-I 4 5 ��-r I , '-.nm
Person to receive the Certification Approval:
• Project Information [15A NCAC 02H .0502(a) & (b)]
• 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.
• Provide a detailed site plan showing property boundaries and proposed
locations of vegetation clearing, structures (buildings, retaining walls,
docks, impervious surfaces, etc.), 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.
• Attach a photograph of the shoreline/ buffer proposed to be stabilized.
(include a scale of some sort- a yard stick, shovel handle, etc.)
• Location of the property (where work is to be conducted)
County: Ge, satin Nearest Town: `3e Mon+
Subdivision name or site address (include phase/lot number):
a ka CA e- 4,Iguc+ Pkzre , (Jp I m(in+ JUG o2,'6 I -A
L., CA 4i� 3
Directions to site - please include road names and numbers, landmarks, etc.:
See AA:iA€.�n�eoi M."Q
Latitude (in decimal degrees) .3 Co 13 Longitude (decimal degrees)
—gi. o3ss��
• Describe the existing land use or condition of the site at the time of this
application (residential, undeveloped, etc.): /1/�,✓ ow�� sib orn�
61.+1 d,ac a ad, S-tir qwfiJ
• Property size (acres): , 9t; -
0
t
• Lake/ river/ ocean adjacent to property:
2

• Describe proposed work (include discussion as to how hardening of shoreline
has been avoided, or why it is necessary): MCI -e4- 6oAf5
cv L Z iD i.u, S e fe _ Zin `e .
• Will work be conducted from land?AV-S From water?
• 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 -t. 3'kl(x YD jc 3
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 squareD
feet or acres: 73
2 1 / fa 1Z X ,�I6;u; YaLiLkL
12. Please describe the vegetation above the normal pool lake level/ Normal
Water Level and 50 feet landward to be impacted (number of trees, for
instance): R -e— 02- ��•'a. - `� 1111-e4y %k,
jr
I, C,
70' of the /M"5hnrr—Iin,_,
Owner/Agent's Signature' [15A NCAC 02H .0502(f)]
(1-7
Date
`Agent's signature is valid only if an authorization letter from the owner is provided.
3

a
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Home Insert Design Animations Sfitfe Sho•r Remtvr view laserti:h2
j Lay El
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Slide Delete
7iCUt--Hid .VEILS Fui".
..- _. - ..
_f 4.
- Lake
(At Full Pond/ Normal water Level)
A ,
10
_ Full Pond/ z 3
Normal Water Level
min
-if,Shoreline_ — _ _ — J�� X 2olr-
piq f -'X
4,
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Alt
Slide of - 'Office Theme' ---
Please approximately sketch the following information on this plan (provide
dimensions for each item, such as 10 ft x 100 ft) *:
• All proposed vegetation clearing
• Location of rip rap or fill to be placed above the Full Pond/ Formal Water Level
elevation
• Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level
elevation
• Location of any proposed structures such as buildings, retaining walls, docks, etc.
• Location of any excavation or dredging below the Full Pond/ Normal Water Level
elevation
4

• Location of construction access corridors

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SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 3 g
REFCC, VSD
JUN 141018
�tllt�
PLAN NO. PARCEL ID: %�
STREET ADDRESS: C E
2,ek rna,, 4- >uc: o 1
Please print:
Property Owner: �y , n r-0
Property Owner: �—
The undersigned, registered property owners of the above noted property, do hereby authorize
?cxn1'a1 CVA ' P ,
klS6 n of Ck44JSo n S P, lc Qr� ✓� „r -C C0-"r'4-''c� c o/o
(Contractor / Agent) (Name of consulting firm)
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):
a U� Lyn �T1�� �� Ck�r lo� JJ'G aea-7 o
Telephone: y I q- 34 5,-- S 3 g a
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature
Date: '�-O l g
Authorized Signature
Date:

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: k;,l Cn ()f-, �� Yet Ce County: Gqslo n
Ga Mu C-
�a'GS 1 �-
Owner: 2 y i nrz�itJ,!✓ �� ✓'"
Print nature
Contractor/agent:nc�o�
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 026 .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 026 .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. [15A NCAC 02B.0243(5), (6)]
Acknowledgement of Notification
I, <eJ t r,) &ro Cc% 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: LIS
State of North Carolina Environmental Quality Water Resources
512 N. Salisbury Street 161141ai1 Service Center Raleigh, NC 27699-1611
919.7079000

NOTES
THE PROPERTY MAY BE SUBJECT TO ANY EASEMENTS AND/OR RIGHTS -OF -WAV.
AREAS COMPUTED BY COORDINATE METHOD.
THIS SURVEY IS OF AN EXISTING PARCEL OR PARCELS OF LAND AND DOES NOT
CREATE A NEW STREET OR CHANGE AN EXISTING STREET
THE SUBJECT PARCEL IS SHOWN TO BE IN ZONE AE ON THE FEMA F.I.R.M. PANEL
NO. 3710359100L. EFFECTIVE 09/02/2015 AND MAY BE IN A SPECIAL FLOOD
HAZARD AREA
5 UTILITY
LINE CHART
CURVE CHART
CURVE
RADIUS
ARC
CHORD
Cl
725.00'
32.85'
S 25'01'34" E 32.85'
C2
25.00'
30.54'
S 11'15'52" W 28.67'
C3
60.00'
102.22'
S 02'32'59" E 90.30'
5 UTILITY
LINE CHART
VICINITY MAP NOT TO SCALE
LINE
BEARING
DISTANCE
Lt
N 71'00'45' W
21.07'
L2
N 81'46'40" W
6.25'
L3
N 49'29'18" W
11.50'
L4
N 66'52'48" W
29.07'
L5
S 74'32'49" W
20.53'
L6
N 5610'37" W
11.64'
L7
N 8333'55" W
9.36'
L8
S 12'00'57" W
3.98'
L9
N 78'09'43" W
1 0.98'
5 UTILITY
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VICINITY MAP NOT TO SCALE
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BOUNDARIES NOT SURVEYED ARE CLEARLY INDICATED AS DRAWN FROM INFORMATION FOUND IN BOOK SEE .
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PAGE MAP THAT THE RATIO OF PRECISION AS CALCULATED IS +1:10,000; THAT THIS PLAT WAS PREPARED
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