20181678 Ver 1_Shoreline Stabilization_20181211

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: $ U
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center 2 0 1 8 1 6 7 8
Raleigh, NC 27699-1617
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name:
Mailing
Telephone Number: S26 - 01 1 a - 4 Sgj4 Fax Number:
E-mail Address: She& ' n4 QL10.i1 (' )
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.arm_y.mil/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: CW S�One., p
Mailing Address: to38 �.kr►�
Telephone Number: 1)4- Lbia) - 5111 Fax Number: r[0q- (.0100 - Sq (.o 1
E-mail Address: 01 1ns.5i eaLuO.(1S L W) n ,-S- ,r rY► . ne4--
Person to receive the Certification Approval: Uln,kc 2 F e.n
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: _ho rrU i uS
Subdivision name or site address (include phase/lot number): Lc& 4�
I 4 12 UC- a6621 (Yioa n n V �_ w Qero�.Cr%l
Directions to site - please include road names and numbers, landmarks, etc.: T rJrJ bt
+o exi+ a8. +(Yleroeen-6 0SaI S1 _a_- I L-) 6r. Q 1 ._ -Tor
rth� on+o Te+A-nn 1�$J, A-lae n r� h+ on+a L n kehn�,e- Alnl r,
Latitude (in decimal degrees) 35. 4 '13 3 t)!4 Longitude (decimal degrees) $Q. 9al�p a I�
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): _i�,Z�s �der��►c�
6. Property size (acres):
7. Lake/ river/ ocean adjacent to property: rYYlaan
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Trslsi.Ll 3r nAtr 6,r a_ 6a„Ider IXIQll nn i56',n V Sknref lYw
Shafe - , lope- ,anal a.nd i mile -t l heuld r r) 9 ra p an S � � o1 8'rnrP(; na ,
9. Will work be conducted from land? Rr 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:
I-ITRIVA"JAMMRA•.
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: j` dome6n all 2 -GI "
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): q r0.SS 'LoV�er
no�b
YeeS +n 2 hLIEge- '
Own gent's S nature` (15A AC 02H .0502(f)j Date
'Agent's signature is vali on y an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

La ke
(At Full Pond/Normal Water Level)
wa 1 I
ri� rc;,nlYS,Eeow $ ` 6e.lo�
Full Pond/ a1""� `�
Normal Water Level
Shoreline J bone. i ck'66ve.
I � i6oue.
D-5 f ' Len8H-)
houses (-�CC��S
13rerrE � Shedd Iii i n5
I a tic!
Co rne.l I v5, t\lC d8o31
�xi � ► ng
�c K
■ � � � �
No +ree5 removcd
( j n'i n 0j d j t)+o Lna
+o 6 opv-er
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 Pond/ Normal Water Level elevation
6. Location of construction access corridors
FORM: SSGP 10-2013 Page 3 of 3

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Polaris 3G Map — Mecklenburg County, North Carolina
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This map or report is prepared for the inventoryof real property within Mecklenburg County and is compiled from recorded deeds, plats, tax maps, surveys, planimetric maps, and other public records and data.
Users of this map or report are hereby notified that the aforementioned public primary information sources should be consulted for verification. Mecklenburg County and its mapping contractors assume no legal
responsibility for the information contained herein.

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CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: IUis-.h SC -2s,rAke SUP_ _•,rCounty: (� 'Cmbf_' 1��Yt7
Owner:
Contract
The approval is for the purpose and design described in your plication. 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 0213.0243 (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 Notificotion
I,1re&i SN. r -V j, YV-1 , hereby state that I have been informed of the Catawba
Riparian Buffer Rule. Any work co6ducted 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:
0
State of North Carolina I Environmental Quality I Water Resources
512 N. Salisbury Street 1 1611 Mail Service Center I Raleigh, NC 27699-1611
919.707.9000

I
CBC Stone and Recycle, LC./Natural Gree .
5capes, LLC authorization to n
obtain the
necessary information for stabilization and
dredge permits.
I agree;
Date:
give