20181613 Ver 1_Shoreline Stabilization_20181126

State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resources
401 & Buffer Permitting Unit ` 2 0 ] 8 1 6 1 3
1617 Mail Center S rvice
Service
Raleigh, NC 27699-1617
I. Applicant Information [15A NCAC 02H .0502(a)] `� a
1. Owner Information D
Name: NOV 2 9 201$
Mailing Address:
j' [4:L!0 $ FFER P S� j11T1
Telephone Number: 48n- U a4- ()5`73 Fax Number:
E-mail Address: _1ca1f\Q"1r)C n7 �ncftcs o+h . rl(t+
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/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Jod- ia(pt)-,5,111 Fax Number:
E-mail Address: C_6C Seat oa_1 La n7 nd5lreary�. neA-
Person to receive the Certification Approval: 7FIn , ce 'LSk e..0
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 walls, docks, impervious surfaces,
FORM: SSGP 10-2013 Page 1 of 3

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.
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: Nearest Town: ��nerri <<S �orC
Subdivision name or site address (include phase/lot number): J?:("u4 LAuLgb 13'159(144
Saod B �daewood Ind. Ford .-Kie- c� Blo q3
Directions to site - please include road names and numbers, landmarks, etc.:
4wq 150 W. Cur% nga ontosiw eakFond d. Curr, r^ighi on}o Dlellut5 13a kbana-ici
T r�hk orn}n Ate lec. P,�A- 4ven lam!-nn6 Leo'Rd _ IPA on _?Jnwnd_- 6n o _ � 56n -ah{- o n Lo - kV,
Latitude (in decimal degrees)_ 3S , L.5 1 A L{'1 Longitude (decimal degrees)" 80, 9 739 I5 lad{ o o
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): j e s t de a-ki A
6. Property size (acres): I R.Oq ae.reS
7. Lake/ river/ ocean adjacent to property: t-Ao rnw_r)
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Sha -pe a nd -nAn 51nnre.1 ► r\_e
9. Will work be conductedyrom land? Er From water? ❑
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:
y ' �n e,lau,
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: ` 0_\nnvP
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):
no - ote-s re.mo v ed , m n ► m al A %Sk L) r1_-,ri ne-e. in 60 V-- Fey-
r/Agent's Signature` [15A NCAC 02H .0502(f)] Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

Full Pond/
Normal Water Level
Shoreline
Lake
(At Full Pond/ Normal Water Level)
L4 1 6j ow
►' A6ove-
ado' len3+-'
0
J
I � � � ��
t,o gees removed
Y'2, n i mal 1�► 5�ur6anc L
+o bo �r-
3arne S £, moa c, l.o�n 2
8aoo % %'C c�ew
Sherr,115 Ford J AC 3803
Please approximately sketch the following information on this plan (provide dimensions for each
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
3. 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.
5. Location of any excavation or dredging below the Full Pont!/ Normal Water Level elevation
6. Location of construction access corridors
FORM: SSGP 10-2013 Page 3 of 3

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address:
Owner:
Print
Contractor/agent:
as, r73
LC—County: 0 4a -w
Print _J "
enature
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, �mPs F Slac.W LLn Q 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.
4!!gnature
(owner). H_ ate: 3
1/18
State of North Carolina ! Environmental Quality I Water Resources
512 N. Salisbury Street 1 1611 Mail Service Center ! Raleigh. NC 27699-1611
919.707.9000

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