20191141 Ver 1_Shoreline Stabilization_20190826

State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
15A NCAC 02H .0500 — Wat@�eQuality Certification, Shoreline Stabilization
Division of Water Resources I
'da FORM: SSGP 10-2013
Shoreline Stabilization Application Form
One copy of the application (including attachments) and the application fee should be sent to:
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: _oe
� ��a.l-�r ► C.�(1
Mailing Address: l0 3 V e.n W - i - l _rw ►�
�or�resu',lle, N.0 x43117
20191,4'
Telephone Number: IQg - 811 - 3yggFax Number:
E-mail Address: Ae.r %l-CO'� I m', 061.1,:� un . Chrn
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/Portals159/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: IJOLl-Uot)-511( Fax Number: r10(4-liU0-520
E-mail Address: Clo C SeUu )oJkS 01� w',ndZr�reu ren . ne+
Person to receive the Certification Approval: TIn-►C e-
11.
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,
etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
FORM: SSGP 10-2013 Page 1 of 3

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: ZrZAel( Nearest Town: f`(ir,n res— IIP
Subdivision name or site address (include phase/lot number): 11.5 InSS -Rd
.
Ime ce"v',1lej`C a8 l 111 Lm+ # ��`j_ tr Sip } 1 Ar16 E Um_6f
Directions to site - please include road names and numbers, landmarks, etc.:
ScPp, rl-►p rl
Latitude (in decimai degrees) a-5– (.9 Q� 0 ] [ Longitude (decimai degrees) 1 jD q (q 4-U
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Unde\re_6C
6. Property size (acres): _ I . 0 Lo a-e–re S
7. Lake/ river/ ocean adjacent to property: So r fn6.,n
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Sha e�p Yl kn k1 m 4, n
9. Will work be conducted from 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:
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: ( r &\-3 6 t
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): Cf rRS', ,,) �� r,
no reo–s remove MI LV5� r)Onrte4-m b IP' r. onAe eloptd 10+
nt's Signature` [15A NCAC 02H .05O2(f))
P,�Tq
Date
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)
143' len9+h
M
ACCESS
N s � s � �
No -Free S r ern6ved
M; n'I rno, l d I r k-alic
-I C:> 6 U � �Cr
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
Derik Baltich
165 Ross Rd.
Mooresville, NC 28117
FORM: SSGP 10-2013 Page 3 of 3

8/152019 610 East Carter A�, M=m ill., NC to 165 Ross Rd, Mooresville, NC 28117- Google Maps
Go gle Maps 610 East Center Avenue, Drive 8.5 miles, 22 min
Mooresville, NC to 165 Ross Rd, Mooresville, NC
28117
610 E Center Ave
Mooresville, NC 28115
t 1. Head south on Evergreen St toward E Center Ave
14 s (197 ft)
Take NC -150 W to Waddle Rd in Davidson
18 min (7.8 mi)
FO 2. Turn right onto E Center Ave
0.2 mi
FO 3. Turn right onto N Maple St
0.2 mi
«1 4. Turn left onto E Iredell Ave
1.1 mi
*1 5. Turn left onto NC -150 W/E Plaza Dr
e Continue to follow NC -150 W
0 Pass by Zaxby's Chicken Fingers & Buffalo Wings
(on the right in 2.1 mi)
6.2 mi
Follow Hermance Ln to Ross Rd
2 min (0.7 m)
r' 6. Turn right onto Waddle Rd
236 ft
r 7. Turn right onto Hermance Ln
0.3 mi
8/152019 610 East Carter Avenue, Mcaresvlle, NC to 165 Ross Rd, Mooresville, NC 28117- Google Maps
r' 8. Turn right onto Ross Rd
e Destination will be on the left
0.3 mi
165 Ross Rd
Mooresville, NC 28117
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.
htlps:#w google.corNnwe/dr/610+Easl+Carter+A%e",+M=wAlle,+NC/165+Ross+Rd,+Mo wAlle,+NC+281171@35.5931217; 80.8967547.13zJ r t/... 1/2 hVsJAw ..google.conVnws/dir/610+Fast+Carter+A�m+Mooresulle,+NC/165+Ross+Rd,+Moo wAIIe,+NC+28117/@35., 931217; 80.8967547,13r/errFU... 2/2

p,�pDON ALLEN &. ASSOCIATES, P. A.
"Since 1971"
Commercial * Residential * Mortgage Surveys * Multi—Family
Construction Staking * Subdivision Design * Topographical
[phone] [phone] Fax
I, certify that this map was drawn under my supervision from an actual
survey made under my supervision recorded in deed book 1085 page 237 and/or
plat book 14 page—_T_ that the ratio of precision is 1':10,000, that this map
was prepared in accordance with the General Statutes of North Carol' ter 89C.
my hand and seal on the 4TH . day of NOVEMBER
MLL CROSS OMS
WIWA bA 41. PI
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I.P.S. SET 5' ON UNE
FENCE 0.81'
OVER PROPERTY UNCb
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PROPERTY UNE
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142T4500"E 65.57
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x80.55 — —
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76'1'CONTOUR
LOT 227
1.05 ACRES
L-1
ROSS ROAD
A 60' R/W
DoT zzs / I.P.S. SET
0.72` ACRES 5' ON LINE
EIP. N24'22�00_E I.P.S. LOT 225
60.50' MB. 14, PC. 51
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LP.S
_ ELP.
EIP.
0' 30' 60' 100'
I i I I
NOTES SCALE IN FEET
1) THIS PROPERTY MAY BE SUBJECT
TO ANY EASEMENTS AND/OR
IMM OF WAY OF RECORD.
z) ACREAGE COMPUTED BY TME
COB O U N D A R Y S U R VE Y
ORDINATE METHOD.
3) UNDERGROUND POWER
4) NO GRID MONUMENT FOUND WITHIN 2OW. OF
LOTS 226 & 227 CRESCEAND & UMBER
SCALE 1" = 60' NT LDAVIDSON TWSR.. IREDELL CO.. NC
ACQUIRED BY: ALTON E. MITCHELL
LEGEND
P.P. - POWER POLE
O - DUKE POWER TRANS
E.I.P. - EXISTING IRON FOUND
IPS. - f4 RFBAR SET
R/W - RIGHT-OF-WAY
® - WELL
BTL = BUILD TO LINE
- LP - LIGHT POLE
POE - PUBLIC DRAINAGE EASEMENT
FIELD BOOK:
FRE 10844
DC FI.E
TAX MAP NO.

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8/15/2019
Google Maps
165 Ross Rd - Google Maps
165 Ross Rd
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1165 Ross Road
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Mooresville28117
a

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address:
Owner:
Print
Contractor/agent:
Print
ure
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 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 02B.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, �er► �i�C)..��'► ck1 , 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.
Signature (owner): Date:
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