20190115 Ver 1_Shoreline Stabilization_20190123

20190115
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 W� PAIL)
1617 Mail Service Center 1 C
Raleigh, NC 27699-1617
• Applicant Information [15A NCAC 02H .0502(a)] 1
1. Owner Information
Name: '� �,tc�j__ jan,.j-e4-S
Mailing Address: � l ��3 alyt mess
a�<<b jos
Telephone Number: �S�/" �s�� ���00 Fax Number:
E-mail Address:gOia; G �•-�
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be
downloaded here:
hi p://www.savv.usace.arm�/.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPL
E AGENT AUTHORIZATION FORM.pdf) must be attached if the Agent has signed
this application form.
Name: �\6',A & I I _ S.
Company Affiliation: Cla
Mailing Address: _25' Cc.S1a
1

Telephone Number: 263-K3/'T(.31r_ Fax Number: g3 - EJ'
E-mail Address:
I i JS�3S/� r4l f i 4� n C-4.
Person to receive the Certification Approval: Ili r✓ �1 i Cfe,,�S --\._
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: Ga S1 oyy Nearest Town: AJ."t "fi
name or site address (include
number): &,c;rkL
'L'f� e�l7i
Directions to site - please include road names and numbers, landmarks, etc.:
Latitude (in decimal degrees) LT -D7 89 Longitude (decimal degrees)"�(• 0
• Describe the existing land use or condition of the site at the time of this �)
application (residential, undeveloped, etc.): rr_S�r.�v+�-f'Ja.� cti�oCP�/e%K_
• Property size (acres): • �/ SSG a c �'� S
• 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 necessa ): j1_5 /o-f"is er` main Ch" It c
J pp rr r , L L
('� lir tf.*i a,AIL l.r...l./ �he)a+ trca.Tl 'C' i �IGA 1.k'. /il/.i/ &C, ."Chi
I �
• Will work be conducted from land?laHL 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: A 3 ' X 2/ fil s (, V), I k/ IR 54.E � Ac le ve
ylofWlal ��I �A•r�lu 'f"OI•(��S �'o� D� ..5���9.L.
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 Y.
�et or acres: /a'fa 1(x /O3'%��, X 3f%I'���',3%�
oafll X /03'lrna X YX'(% B^*w = yfL {�`• t 3aO � t 37b8'sf. �:, ; 5�,
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): f G ogoo�-, Z-42 "fifes
/-/a - /9
Owner/Agent's Signature` [15A NCAC 02H .0502(f}j Date
"Agent's signature is valid only if an authorization letter from the owner is provided.

Nome Inselt Design Animations Slide ShO:: Rtnrr- iieev Lasettiche
-J Layout El
—� tj Reset
Paste - . vjy
Slide' ..J Delete
=::: bi 3:C �•..le: F3 -n -13P!'
Lake
(At Full Pond/Normal Water Level)
Full Pond/
Normal Water Level
M=1111®s.r.
Shoreline
Slides of 'Otlice Theme"
r�
I I
S'p
I
vv
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
n
3�

f
• Location of construction access corridors

South Point High School to 3249 Lake Pointe Dr Directions - MapQuest
OUR TRIP TO: MCDQJOW
�~ 3249 Lake Pointe Dr
13 MIN 1 5.9 MI >�
Est. fuel cost: $0.47
Trip time basad on traffic conditions as of 12:29 PM on January Print a full health report of your car with HUM
16, 2019. currant Traffic: Light vehicle diagnostics (Boo) 9o8 -25o2
Imoi 1. Start out going northeast on Nixon Rd toward Southpoint Rd/NC-273.
Then 0.21 miles 0.21 total miles
2. Take the 1st right onto Southpoint RdINC-273. Continue to follow Southpoint
Rd.
If you are on RL Stowe Rd and reach Township Pkwy you've gone about 0.1 miles
too far.
Then 4.58 miles 4.79 total miles
I* 3. Tum right onto Reflection Pointe Blvd.
Reflection Pointe Blvd is 0.5 miles past Reese Wilson Rd.
If you reach Boat Launch Rd you've gone about 0.1 miles too far.
Then 0.29 miles 5.07 total miles
4. Tum left onto Lake Pointe Dr.
Lake Pointe Dr is lust past Beauhaven Ln.
If you reach Hermitage Ct you've gone about 0.3 miles too far.
Then 0.94 miles 5.91 total miles
5. 3249 Lake Pointe Dr, Belmont, NC 28012-5749, 3249 LAKE POINTE DR is on
the left.
If you reach Watermead Ln you've gone a little too far.
Use of directions and maps is subject to our Terms of Use We don't guarantee accuracy, route conditions or usability. You assume all risk of use.
Page 1 of 2
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South Point High School to 3249 Lake Pointe Dr Directions - MapQuest
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SAMPLE AGENT AUTHORIZATION HORtZATION FORM
PROPER P1 LEGAL DESCRIPTION:
LOT NO. v _ PLAN NO. PARCEL ID: -Z03 P7
STREET ADDRESS: -3 % FL4 a k fe,
Please print:
Property Owner: I&4w 7•
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
S. C 1'd', L7V _ of L N/ s ViI £ �l�t Z
(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):
inY-ss
Telephone: _ /75 L � S %— /,;2 0 (1)
tr,`skxr4 �/G
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
AFA�'
Authorized Signature
Date: /% Pee, &/ g
12". , , " � �— o — — — —
u orized Signature
Date: / O

.14 CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: ?,& 9 Lakc l oinife_, "o -,Up �Ey County: 60St'cs�'�
Owner:
Contractor/agent
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 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,t rr�c ���t rXr�f 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. 0
Signature (owner):
��. ��i Date:
State of North Carolina ; Environmental Quality Neater Resources
512 N. Sallsbury Street 1 1611.Mail Service Center Raleigh. NC 27699-1611
919707-q000

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TANNER AND MGC0MVo4Mc5HL-Y P.A.
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M04) b66-&421 OR [phone]
DE. 461_ P5 —12 -0-1-0t* 107 efoU___
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