20191292 Ver 1_Shoreline Stabilization_20190925

State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
15A NCAC 02H .0500 - Water Quality Certification, ShorelineStabilization
Division of Water Resources 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:
Mailing Address:
20191292
E l_i1/E0 ►�-tD,WR
SEP 25 2019
Wafer � o���r,y,,-
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Telephone Number: 10t{ - U 1cl - 3986 Fax Number:
E-mail Address: �5'11yerh0,.mme.r'I oCZa©10M
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
htto://www.saw.usace.armv.miI/Portals/59/docs/reRulatory/reRdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name:
Company Affiliation:_1L)Y-a1 (,A ret A Scales'Sery ices LLC.
Mailing Address: 638 00.1hr i c1Q'e
Telephone Number: "101-1- tal,00- 5111 Fax Number: rJnLJ- lalo()- 5gUq
E-mail Address: 0b0 Sa) w`, n655 r -e -g- nl . oe-+
Person to receive the Certification Approval: 7 Jar► s ce Lbk .Q
II. Project Information [15A NCAC 02H .0502(ai & (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.
I 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; �'r_IFcyhle n % >yra Nearest Town: rnei; us
Subdivision name or site address (include phase/lot number): 9,olq2 "i -6c r_'56n Rd,
i.111 nQ„:2, 1 __.4 "l V_a,'a..... _DLI -r
Directions to site - please include road names and numbers, landmarks, etc.:
See a. -A- .c heA
Latitude (in decimal degrees) -3 5 y8813, Longitude (decimal degrees) - RD, eq i qb5
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Be5tde► Vi I wood lo+ -
6. Property size (acres): 0-1 a Orr -5
7. Lake/ river/ ocean adjacent to property: go rvMcxan
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): V_t (dd5-} n -e waJI c h
1110-n�Cor ore fl i n 5+�1 C_LZ._a'+ I O n
9. Will work be conducted from land? Vj/ 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:
1_
a.5 UeIQLQ `A6J1Ynn(.i' c+I JI
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: __ ( / "6ye,
11 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). a ra6s jap'ei-
o -�rvve r movM M, n- m .l d; si-o rino vnee +a
_7 J
VOwner/Agent's.SignatCre* [15A NCAC 02H.0502(f Date
4 -
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSCP 10-2013 Page 2 of 3

Lake
(At Pull Pond/ Normal Water Level)
Vel Fields.+onE-
Full Pond/ i-�' 1 1(
Normal Water Level
Shoreline C' Of i No +re -es rernaved
1 �ov c�; s�ucbance,
ldo.81' t� +r) �00�Fe�
W 10 F—
Access
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
Lake Property Investments, LLC
20148 Walter Henderson Rd.
Cornelius, NC 28031
FORM: SSGP 10-2013 Page 3 of 3

9232019 610 Fast Center Avenue, MooresNlle, NC to 20142 Walter Henderson Rd - Google Maps
Google Maps 610 East Center Avenue, Mooresville, NC to 20142 Walter Henderson Rd Drive 10.3 miles, 20 min
610 E Center Ave
Mooresville, NC 28115
t 1. Head south on Evergreen St toward E Center Ave
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Church Rd in Cornelius
- - - -- - - - -- 18min(9.5m)
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Turn right onto E Center Ave
--
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Turn left onto S Main St
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---
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Usethe left 2 lanes to turn left onto the Interstate
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--
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Merge onto 1-77 S/US-21 S
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Take exit 28 for US -21
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0.2 mi
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9.
Merge onto W Catawba Ave
-
- - - - -
0.7 mi
Continue on Bethel Church Rd. Drive to Walter Henderson
Rd
- - - - - 2 min (0.8 m)
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9232019 610 Fast Center Avenue, McoresNlle, NC to 20142 Walter Henderson Rd - Google Maps
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20142 Walter Henderson Rd
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These directions are for planning purposes only.
You may find that construction projects, traffic,
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notices regarding your route.
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Polaris 3G Map — Mecklenburg County, North Carolina
Date Printed: 9/23/2019 8:45:29 AM
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This map or report is prepared for the inventory of real property within Mecklenburg County and is compiled from recorded deeds, plats, tax maps, surveys, planimetric maps, and other public recordsand 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.

9/23/2019
Google Maps 20142 Walter Henderson Rd
20142 Walter Henderson Rd - Google Maps
Imagery ©2019 Google, Imagery ©2019 Maxar Technologies, Orbis Inc, U.S. Geological Survey, USDA Farm Service Agency, Map data @2019 200 ft
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9/23/2019
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The approval is for the purpose and design described in your appiicatio' a Impacts not indicated in the
application is a violatiori.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 02B4O243(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 021.0243 (4), (6), (8)]
Stormwater cannot be piped or channeled for direct discharge to the lake. All constructed storm -water
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
, a.,�«acd-mx&1&6'. r'l 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 Ind Buffer Rules, the approved plan(s) and specification(s); and other supporting
materials. /---, t
____01� -
Signature,(oner):. . ` Date: 12 I R
Stat of North Carolina i EnOronme:stat Quality J 'vziter resources
'i' N. Salisbury Street 'uu Nial Service iFrnerJ R.ale!gh, N1C2':699-tb1?
9M707.9000