20190457 Ver 1_Shoreline Stabilization_20190411

State of North Carolina
Department of Environment and Natural Resources
DWR 1-00* Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources FORM: SSGP 10-2013
Shoreline Stabilization Application Form
Three copies of the application including attachments) and the application fee should be sent
to: PA I
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center \� G 2 9 0 4 5 7
Raleigh, NC 27699-1617 4 \\
lk�
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: Tnhn �e_rCu Vr�nn
Mailing Address: Q5bCb Wo cyAYoiYIg-RA,
I l i i 10 -sin n SCL`cm KC- 31110 44 - oZ 1 d10
Telephone Number: 3&j- qOS - (p-7Ua Fax Number:
E-mail Address: S�r►nClln 4ma►1.Com
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:
�111110"HiII111W.-Ir-11L�
Telephone Number: rJocl- (glop - 5111 Fax Number: 16q - totol) - S cl to
E-mail Address:r1�{-
Person to receive the Certification Approval: �TCj_n► C e Esq
I1. 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: Trrripll Nearest Town:
Subdivision name or site address (include phase/lot number):
� P_) N r � Rt. I `l �f i � 2r (-i % � � s�CIes i nd +4 a,
Directions to site - please include road names and numbers, landmarks, etc.:
I -f-
Latitude
Latitude (in decimal degrees) 35 . VI 9 9 g'I Longitude (decimal degrees) — FAO. Rtp R (o 8a
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.):
6. Property size (acres): 0- S acreS
7. Lake/ river/ ocean adjacent to property: No r rna n
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Shy S�nr'P __ �na.�anti jnS+n ((
res _
J
9. Will work be conducted from land?IA
] From water? EI
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:
YJ210W i c100 S� ac Im c�+)
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: l L-L6nVe_
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): Cd rz2gS _E>0��r,
Or) -Tues rey-roved, m',Kkmal (iis+urbanc +06olP'cr
3/a8hg
Owner/Ag nt`s Si nature` 15A CAC 02H .0502(f)) Date
`Agent's signature is valid onl ' a authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

Full Pond/
Normal Water Level
Shoreline
La ke
(At Full Pond/Normal Water Level)
H 1 Le_I ou')
I i above,
100 t l e rn ct-h
houSG 10 I
WID�
iI C CESS
John and Sherry Frino
163 River Ridge Ln.
Statesville, NC 28677
■011111111111011 IM 111M
No + ees iremovej
nl0.�Oo slur ance
Please approximately sketch th—e-foAowing inl`orma ion no this—plan (provide dimensions for each
item, such as 10 ft 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

4/3;2019 Mooresville, NC to 163 Riper Ridge Ln, Stetmille, NC 28677- Google Maps
Go gle Maps Mooresville, NC to 163 Drive 21.3 miles, 33 min
River Ridge Ln, Statesville, NC 28677
Mooresville
North Carolina
Take E Plaza Dr, 1-77 N, NC -115 N/US-21 N, Old Mountain Rd
and Buffalo Shoals Rd to Laurel Cove Rd in Fallstown
30 min (19.2 mi)
t 1. Head southwest on N Main St
0.1 mi
it 2. Turn right onto W Iredell Ave
0.9 mi
41 3. Turn left onto E Plaza Dr
O
Pass by Zaxby's Chicken Fingers & Buffalo Wings (on
the right in 2.1 mi)
2.6 mi
4. Turn right onto the Interstate 77 N ramp to
Statesville
0.2 mi
5. Merge onto 1-77 N
5.2 mi
i 6. Take exit 42 for US -21 /NC -115 toward Troutman
0.2 mi
'1 7. Use the left 2 lanes to turn left onto NC -115 N/US-
21 N (signs for 1-77 S)
Pass by Fifth Third Bank & ATM (on the left in 3.1 mi)
3.9 mi
41 8. Turn left onto Old Mountain Rd
3.2 mi
4/3/2019 Mooresville, NC to 163 Riper Ridge Ln, Statesville, NC 28677- Google Maps
41 9. Turn left onto Buffalo Shoals Rd
3.0 mi
Continue on Laurel Cove Rd. Drive to River Ridge Ln
5 min
(2.1 mi)
'1
10.
Turn left onto Laurel Cove Rd
1.5 mi
'1
11.
Turn left onto Island Terace Rd
0.2 mi
t
12.
Continue straight onto Island Terrace Rd
243 ft
t
13.
Continue straight onto Island Terace Rd
0.1 mi
1
14.
Slight left onto River Ridge Ln
0.2 mi
163 River Ridge Ln
Statesville. NC 28677
These directions are for planning purposes only.
You may find that construction projects, traffic,
weather, or other events may cause conditions to
differ from the map results, and you should plan
your route accordingly. You must obey all signs or
notices regarding your route.
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Project Name/addre;
Print
Contractor/ager :
41- 4, A- L
I:ATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Print
� q.:"
The approval is for the purpose and design described in your abdication. 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 028.0243(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)1
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 028.0243(5), (6)]
Acknowledgement of Notification
I, Sk rrq , hereby state that I have been informed of the Catawba
Riparian Buffer Rule. Ay work conducted in the buffer, not specfically 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 approvedMs) and specification(s), and other supporting
materials. i
Signatu owner):
St; is o: Wt -i: C1rc2ra . Ert;irormwmai Crjatty ,a,:r Rcsour ccs
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