20191293 Ver 1_Shoreline Stabilization_20190925

State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
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(x)]
1. Owner Information
Name: 1 Y \ %cba,,A CX�nc� �a�-r'�c►
Mailing Address: 31
2 0 1 9 1 2 93
"m ig
Telephone Number: '7o4 - 5112 - 5137 Fax Number:
E-mail Address: dr d rU LA (A CSO . Cb M
2. Agent/ Contact Person Information J
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/PermitsZSAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name:
Compar
Mailing
Telephone Number: 1014 - h6c) - 5l 1I Fax Number: r7pr4- U40- 59 loo
E-mail Address: 0 6t7 Seuu )a,( IS ai w`, nA S+rep_nn . ne—+
Person to receive the Certification Approval: Vivi-ice- ESA e4
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: QCK'en harp, Nearest Town: _ l�_orr�el u5
Subdivision name or site address (include phase/lot number): a 051 �-�anses
l
*1r1 11C3n21 I _..L 4 1/N '1 , -- I —a - . . 1J L.1 -1
Directions to site - please include road names and numbers, landmarks, etc.:
see 0_+kL fd
Latitude (in decimal degrees)35, HigQ U a5 Longitude (decimal degrees) $d�l 1-I y
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Ee-5%den-,&I, Io+ -6\c>e Claarced Pr new souse_
6. Property size (acres): d —15 2 aC rr5
7. Lake/ river/ ocean adjacent to property i-Ao r moLn
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): =mall VIA )rield_&AorU)oAL ijrl-h
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:
6eJoLu i a50 SF c9 ImRaC+l
11. Total amount of disturbance (including all clearing, backfill, 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: t I (3_�ye_
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): q rays beer
. f n 1 a J.
8;5-�ur6ance +o bu
r
C'
Own er/Agent's--Signat e A NCAC 02H .0502 f Date
Agent's signature is valid only if on 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)
a , 5 , Le -low
I , C -bo ve.
100' Len9fh
U nd eveloped
Io+ ,
=,6e CVP-ared °
dor vlew house..
RCC€SS
V A v1d 65-6n.2
Uja.1!
No +rces remov0d
tYl'� n � ma..l d � s�ur�cince
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ftx 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
Micael and Patricia Druzbik
20514 Hansel's Way
Cornelius, NC 28031
FORM: SSGP 10-2013 Page 3 of 3

9/19/2019 610 East Center Avenue, Mooresville, NC to 20229 River Chase Dr, Cornelius, NC 28031- Google Maps
Google Maps 610 East Center Avenue, Mooresville, NC to 20229 Drive 10.5 miles, 21 min
River Chase Dr, Cornelius, NC 28031
610 E Center Ave
Mooresville, NC 28115 ' t
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t 1. Head south on Evergreen St toward E Center Ave Q /�
-- _-_ --- -.. - ----- - - -- - 14s (197ft) Z pV3�
Corhet � u�,1\1C
Take S Main St, NC -115 S and 1-77S/US-21 Sto Bethel
Church Rd in Cornelius 4 re aY'G �d
- - - - - - - ---- -- --- 18min(9.5mi)
N 2. Turn right onto E Center Ave �j Vel CVIOL6c )E. ansel0S
----•-- 0.6mi U� u,j ll r1o"'� shoal 6n
'1 3. Turn left onto S Main St j S . 2b 5 f 4
--
--- -- --- - - - - -- 1.6 mi 1'e l
t 4. Continue onto NC -115 S i 5 -4-WQ
--- - - 2.1 mi -
r 5. Turn right onto Langtree Rd OV er .t- r hT
1.1 mit o - VNc*,j
6. Use the left 2 lanes to turn left onto the Interstate OP 262.251 River -
77 S/US 21 S ramp
0.2 mi
7. Merge onto 1-77 S/US-21 S
2.9 mi
8. Take exit 28 for US -21
- - - - -- -- - - - 0.2 mi
9. Merge onto W Catawba Ave
_- - _- — --a -- 0.7 mi
Follow Bethel Church Rd and Walter Henderson Rd to River
Chase Dr
- -r- -- - 3 min (1.0 mi)
N 10. Turn right onto Bethel Church Rd
-- - - _ - 0.5 mi
N 11. Turn right onto Walter Henderson Rd
-- -- - - - --- - - - - 0.4mi
N 12. Turn right onto River Chase Dr
0 Destination will be on the right
_- - -- ._ _ _. _ _ - - - - ---_____ _ _- _.. -. - _. - _ _ 423 ft
20229 River Chase Dr
Cornelius, NC 28031
https://wm.g oog le.com/maps/c it/610+East+Center+Avenue,+Mooresville,+NC/20229+Riwr+Chase+Dr,+Cornelius +NC+28031/@35.5379451,-80.8845096,1... 1/2

REFERENCE:
LINELETIG-FH
BEARING
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BEING ALLOF LOT 10 - KEEL BAY- PH" I - MAP 2 -
AS RECORDED IN MAP BOOK 61, PAGE 068 - MEOOFNBURG
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mIINfY REGISTRY.
N77 -47 -SO -W
/
19.95
SIZ-21-56-W
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SETBACKS:
S40 -17'05-W
PROPERTY IS SUBJECT TO A 25' FRONT YARD (FY) -10'
SIDE YARD
6 50' IAKE YARD (LY) - MIMMUM BUILDING SETBACK ONE
PAGE SIR - MECKLENBURG COUNTY REGISTRY.
PER MAP BOOK 61, /
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PIN: 00113235
KANEELBAY DEVELOPMENT LLC
13.B.31936,PG.561
LOT9 - M.O. 61, PG. 858
ZONED: GR
LEGEND:
PSDE - PERMANENT STDRM DRAIN EASEMFM
TRF - IRDN REBAR FOUND
TRS - IRON REBAR SEI
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RAV - RIGHT OF WAY
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WATER METER
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KANEFI.561BAYDEVEID OC
D.B. 31936, FG. 561
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SURVEYOR CERTIFICAT ON
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PIN: 00/13235
KANEEL BAY DEVELOPMFM LIC
O.B. 31936, PG. 56/
LOT 10 - M.B. 61, PG. 060
ZONED: OR
10, SY
PIN: 00113236
KANEEL DAY DEYEIDPMENT LLC
O.B. 31936, M. 561
lDT 9 - M.B. 61, PG. MR
ZONED: G0.
LINE TABLE
LINELETIG-FH
BEARING
LI100.19
SI2'90'22'W
L2
10.66
N77 -47 -SO -W
L3
19.95
SIZ-21-56-W
L9
19.33
S40 -17'05-W
VldNtY Map - Not to Saalu
NOTES:
PROPERTY SUBJECT TO ANY FACTS MAT MAY DE
DISCLOSED BY A FULL AND ACCURATE TIRE 5EARO,L
PROPERTY SUBJECT TO EASEMENTS AND RIGHTS OF WAY
OF SWORD AND THOSE NOT OF RIWRO, IF ANY E%1ST.
AREA BY COORDINATE ODMiWATON.
PROPERTY MAY BE 5r1BIECT TO GOVERNMENTAL ORDINANCES,
ZONING AND OTHER REGULATIONS CONCERNING THE DWSION
AND DEVELDPMEM OF REAL ESTATE
NO SUBTERRANEAN SURVEY PERFORMED ATTHIS SITE
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Polaris 3G Map — Mecklenburg County, North Carolina
Date Printed: 9/5/2019 11:22:10 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 records and 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.

9/19/2019
GC?c)gle MapS River Chase Dr
River Chase Dr - Google Maps
Imagery ©2019 Google, Imagery ©2019 Maxar Tech nologies,Orbis Inc, U.S. Geological Survey, Map data ©2019 200 ft
https://wwuv.goog!e.comlmaps/p!ace/River+Chase+Dr,+Cornelius,+NC+28031/@35.4900026,-80.8934117,513rrVdata=! 3m1! 1e3! 4m5! 3n-411sOx8856abf9a748a7ed:We17b7a937a656cO! 8m2! 3d35.4918628! 4d-80.89... 112

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Polaris 3G Map — Mecklenburg County, North Carolina
Date Printed: 9/19/2019 9:26:05 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 records and 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.

Polaris 3G Map — Mecklenburg County, North Carolina
Date Printed: 9/19/2019 9:50:21 AM

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CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: 2015'11A agNse, 'S WA A • L� 10 county.
Owner:
Print
Contractor/agent:
Print
MQCAL '.
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 0213.0243 (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
tCIA* G` rXkZ 6 t K _,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):lam( Date: q Le - 201
. - If JUV V/
State dNorth Carolina rnvlronmenral Qualify ! Vliater Resources
SU N. Salisbury Street f 1611 Mai? Service Center i Raidgft NC 27,699-1611
919,707.9000