20190778 Ver 1_Shoreline Stabilization_20190611

State of North Carolina
Department of Environment and Natural Resources
DWR 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
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
20190778
Raleigh, NC 27699-1617®®
Applicant Information [15A NCAC 02H2- a ]_
1. Owner Information cee
Name:
Mailing
boG10.+� an
Telephone Number: `1OL4 - (9t(, - I-jl.ol Fax Number:
E-mail Address: b)ma45 n7 J oU6. 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/repdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name:
Company Affiliation:
Mailing Address:
l� saar•-��fir��w�trrt����.
Telephone Number: -TO'-I -0100 " 5111 Fax Number: '-1py- (nkn O - 'Sq loci
E-mail Address: C60 EL) ru►ruJS-Vre M,t3e-k-
Person to receive the Certification Approval: Tn_n',Ce F_
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: Nearest Town: Char 1C74
Subdivision name or site ad ress (include phase/lot number): 38M fflounba.0 G-br,
i'. )ariO4f_ APIC_ 1$a,llg 1�# ID0x319 a1 0,4 1'he Overtook, a� C��.T'S1ar�d La.Ke_
Directions to site - please include road names and numbers, landmarks, etc.:
See a_q=b eA -
Latitude (in decimal degrees) -A 3q 378 Longitude (decimal degrees) - , 95bdo3
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): { ebi Aeri-Iial Common Afea I Waltr 1ACCCSS
6. Property size (acres): t o . d 5 l ae re.S
7. Lake/ river/ ocean adjacent to property: CG,6V nk,!A , ,nZ5k0.nd
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): �jh � `o��.. In b�cdl MCi.-1-4-', na
and Cuss 11 Iv" C J 0 raft
9. Will work be conducted from land? From water? CA
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:
0.h0Jf S� off- ►mfr i
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: 31 �pe1 nu.)
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): (Irri: S,'S
Ob -Tees rtmovecl . rn'► d, mal I slur %nanc.e 60E- e r
Owner Agent's Signat r [15A NCAC 02H .0502(f)] Date
'Agent's signature is va id only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

La ke
(At Full Pond/ Normal Water Level)
Full Pond/
Normal Water Level
Shoreline O- -
r`lo -i-reeS t�e`�1pVe�
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dor
AWG -SS
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
Overlook Owners Association
Thomas Blomquist, President
3800 Mountain Cove Dr.
Charlotte, NC 28216
FORM: SSGP 10-2013 Page 3 of 3

53M19 610E Center Ave, Mooresville, NC 28115 m 3800 Mo rtdn Cos Driva, Charlotte, NC - Google Maps
Google Maps 610 E Center Ave, Mooresville, NC 28115 to 3800 Mountain Cove Drive, Charlotte, NC Drive 24.5 miles, 42 min
610 E Center Ave
Mooresville, NC 28115
Get on 1-77 S/US-21 S in Davidson from S Main St, NC -115 S
and Langtree Rd
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t 1. Head south on Evergreen St toward E Center Ave
197 ft
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0.5 mi
41 3. Turn left onto S Church St
0.5 mi
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1.2 mi
t 6. Continue onto NC -115 S
2.1 mi
f 7. Turn right onto Langtree Rd
1.1 mi
B. Use the left 2 lanes to turn left onto the Interstate
77 S/US 21 S ramp
02 mi
Continue on 1-77 Sto 11, Long Creek Take the Oakdale Rd
exit from 1-485 Outer
15 min (16.2 mi)
9. Merge onto 1-77 S/US-21 S
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11.1 mi
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5130'2019 610 E Center Ave, Mooresville, NC 26115 to 360D Mountain Cos Drive, Charlotte, NC - Google Maps
r 10. Use the right 2 lanes to take exit 198-A toward I-
85 S/Pineville
1.1 mi
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3.7 mi
N 12. Take the Oakdale Rd exit
3800 Mountain Cove Dr
Charlotte, NC 28216
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 accordingy. You must obey all signs or
notices regarding your route.
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0.2 mi
Take Mt Holly-Huntersville Rd and Overlook Mountain Dr to
Mountain
Cove Or in Charlotte
5 min (2.6 mi)
13.
At the traffic circle, take the 1 st exit onto Oakdale
Rd
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Q
14.
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Holly-Huntersville Rd
1.6 mi
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15.
Turn right onto Overlook Mountain Dr
08 mi
41
16.
Turn left onto Overlook Cove Rd
440 ft
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17.
Turn right onto Mountain Cove Dr
0 Destination will be on the left
125 ft
3800 Mountain Cove Dr
Charlotte, NC 28216
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 accordingy. You must obey all signs or
notices regarding your route.
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Polaris 3G Map — Mecklenburg County, North Carolina
Date Printed: 5/30/2019 11:39:33 AM
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This map or report is prepared forthe inventoryof real property within Mecklenburg Countyand 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.

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Overlook Owners Association
Thomas Blomquist, President
3800 Mountain Cove Dr.
Charlotte, NC 28216

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CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: 3ft a :n Cw T)r.(ffc.NG pl . l" County:
Owner: O
Print
Contractor/agent:
Signatu
Print ( Signature
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 026.0243 (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
1, , hereby state that I have been informed of the Catawba
Riparian Buffer Rule. Any rk 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): r Date: S L�
State of North Carolina I Environmental Quality I Water Resources
512 N. Salisbury Street 11611 Mail Service Center I Raleigh, NC 2 76 9 9-1 611
919.707.9000