20190532 Ver 1_Shoreline Stabilization_20190423

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources ISA NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
Shoreline Stabilization Application Form PAID
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 1 9 0 5 3 2
1617 Mail Service Center
Raleigh, NC 27699-1617
+-�
I• Applicant Information [15A NCAC 02H .0502(a}j 1-�,
1. Owner Information
Name: ��'i7/►f ('}- �iTr ll
Mailing Address 4uA
0C;,/f '( 111 C 41
Telephone Numb* -_7o (� 6i' Fax Number:
E-mail Address:
2. Agent/ Contact Person Information C ��
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http://www.saw usace army.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE
ORIZATION FORM pdf) must be attached if the Agent has signed this application form. AUTH
Name: <� . A/I I I I f=1/_-' / ( _m2� H ��
Company Affiliation. ) k 1
Iwz't��,N16riltr( C'u✓i�7_
Mailing Address: r-7 SGS
s c ANE-
lu L 9,
Telephone Numb1r:74 57s.-
% Fax Number:
E-mail Address: ���qc�� - D
Person to receive the Certification Approval; —t-0
ll• Project Information [15A NCAC 02H 0502 a) & (b)1
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: I L Nearest Town:
Subdivision name or site�s�Cilude phase/lot number): fi i
Cc rSe/tl Iold % kiry-
Directions to site - please include road names and numbers, landmarks, etc.:
Latitude in decimal degrees)_ S__,,, 5 O' '
( � ���� Longitude (decimal degrees)_ -� ��U, Ct, �U 79Z
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): 51 Dj:- 7
6. Property size (acres): j
7. Lake/ river/ ocean adjacent to property: t j OLA 5oNZ I 7A -W A
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):_V_1' p i&Ar) <),-ib✓,- (, -/1 ,; 12
9. Will work be conducted from land? 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:
of 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 or acres:wml l% - 'n (jC7
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):
- , - .o-• ' 7 -b-Lul �- LL21.1 ivk.Hk. ULM .UJUZ(T) I U 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
La ke
{At Full Pond/Normal Water Level}
C;
0
�- A ( VC
2C;M61 Qq
p�6 c -Atv —r6 (_7 13 kiZ-�,
Please approximately sketch the following information on this plan (provide dim ensionsfor 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
I 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

Project 1
owner;
Contract
The appr
application is a violation of the Buffer Rule. Site specific wok should beiprro'videdn the Impacts not indicated in the
application. 115A 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
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 Pond elevation), unless
[ NCAC 026 .0243(6))
Benching, grading in the buffer is not allowed. Excessive disturbance of ground cover.
Beaches, impervious patios, impervious walkways, etc. are not alto [15A NCAC 026.0243 (6)]
by the Division. There are limitation on size for decks. [15A NCAC 02B i
n
uand u6 less s ecificall approved
p Y
Work to be conducted from land must indicate an access and i ) ()]
work corridor should be described. Theaccess indicate ancorridor shall be y trees that are to be removed. The
material must be outside the buffer. [15A NCAC 02H .0502 and 15A NCAC 02B .0243(4 ging, spoil, construction,
Stormwater cannot be ()� (6), (8)]
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 or Notification
T1
i
Riparian uffer Rule. Any work conducted in the buffer, not specificallyhereby state thave been informed of the Catawba
by the Division of Water Resources (DWR), is a violation and subject to enforcement. Du
taken such that the construction will be built within substantial stated in the application and approved
Quality Certification and Buffer Rules, the compliance and intent of the'401cWa will be
materials, approved plan(s) and sp ecification(s), and other supporting
5i9n2tUre (owne
Date: b---1

GIVE
LAKE NORMAN DREDGING INC. AUTHORIZATION TO OBTAIN THE NECESSARY
INFORMATION FOR STABILIZATION AND DREDGED PERMITS.
I AGREE: X
DATE: I,,15 1 ) c%
mor

From TAMARA HAGER [e-mail]
Subject Gray pic
Date Apr 16, 2019 at 9:51:53 AM
To TAMARA HAGER [e-mail]
Thank You
LaKe PeRmiT LLC
hager lakepermit.com
Tamara Hager
704-575-2227

I J�ADON ALLZN 3URVSYORB, INC.
1J lb� S Rt 7 BOX 203 MOOREaVILLE , N.C. 26116 (70*) e0�7020
1 certify that this map was drawn under my supervision from an actual
survey made under my supervision recorded In deed book 3022 page 295 ,.gnd/or
plat book 11 page 159 that the ratio of precision Is 1':10,0000 ,map
was prepared In accordance with the General Statutes of North Carolina Cpa �id4 .
my hand and seal on the 15th day of JULY A. D.
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NORMAN SHORES DR.
(PAVED) 60' R/W
1) This propertymay y be subject to any easements
and/or Rights—of—way of record.
2) Area comouted by the coordinate emthod.
3) 760 & 761 based on Lake Norman lake
level at Cowan's Ford Dam.
(Reading on 7/14/93 Elev 757.7) C-1 %1 y
PH SICAI SURVEY "T' +
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20415 NORMAN SHORES DR_
SCALE 40'
LOT 4 & A PORTION OF LOT 3 'BLOCK A' NORMAN SNORES SUBD.
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LEMLEY TWSP., MECKLENBURG CO., N.C.
ACQUIRED BY. G. BENNETT GRAY & BARBARA Y. GRAY FM -
Es -37
TAX MM No: 001-431-14

Go
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Cowans Ford Dam, Stanley, NC to 21405 Drive 9.6 miles, 20 min
Norman Shores Dr
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21605 Norman
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Map data ©2019 Google 1 mi
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Cowans Ford Dam
Stanley, NC 28164
1 1. Head southwest on Eastlake Ln toward Republic
Ln
A Restricted usage road
2 min (0.5 mi)
Continue on NC -73 E to Cornelius
13 min (7.4 mi)
'1 2. Turn left onto NC -73 E
4.3 mi
♦1 3. Turn left onto W Catawba Ave
BPass by Regions Bank (on the right in 2.5 mi)
3.0 mi
Follow Knox Rd and Torrence Chapel Rd to Norman Shores
Dr in Cornelius
4 min (1.8 mi)
41 4. Turn left onto One Norman Dr
400 ft

r' 5. Turn right onto Knox Rd
0.5 mi
~1 6. Turn left onto Torrence Chapel Rd
0.5 mi
r' 7. Turn right onto Norman Shores Dr
0.6 mi
01 8. Turn left to stay on Norman Shores Dr
®Destination will be on the left
66 ft
21405 Norman Shores Dr
Cornelius, NC 28031
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.

M�topo
A TRIMBLE COMPANY
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21405 Norman Shores Drive, Cornelius, NC, USA
W.�,�`..lY` -<'y d`Y�}i't^R{M1. '•.:k f. .9 be ',<T i�.�1i :3p R'"i' �Y
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From TAMARA HAGER [e-mail]
Subject Gray google earth
Date Apr 16, 2019 at 12:09:45 PM
To: TAMARA HAGER [e-mail]
Thank You
LaKe PeRmiT LLC
[e-mail]
Tamara Hager
704-575-2227