20190947 Ver 1_Shoreline Stabilization_20190716

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Division of Water Resources
State of North Carolina
Department of Environment and Natural Resources
Division of WateLkesources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline biliiat
FORM: SSG15'10.2013
Shoreline Stabilization Application Form 2 0 1 9 0 9 T
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
r
I. Applicant Information [15A NCAC 02H .0502(a)] 1
1. Owner Information
Name: GlLee
Mailing Address:
Telephone Number: -tpy - toao - GS1, Fax Number:
E-mail Address: +M n�f! �, S u rci tsec��'c�t rnS . Co
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/`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: -7 09 - Colon - 5111 Fax Number: "1011- to g0 - 5q C-09
E-mail Address: 1`S sea-,L)aA( sn-) i,nds4recl m. rw_i-
Person to receive the Certification Approval: -31r1'►ce F'S} -
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: (fleCYi ke_(A6U rQ Nearest Town:
Subdivision name or site address (include phase/lot number): 1-101 C614,n palC Ln.
C'orys. QVC x8031 Loi- -4 y0 T 11)1* 00 ►31 a3�
Directions to site - please include road names and numbers, landmarks, etc.:
See a�_O_ChRd
Latitude (in decimal degrees) 35. �g q 0 y y Longitude (decimal degrees) — 8o _ 4 Stn 33[7
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): les Aee)4 ►a..[
6. Property size (acres): 0 . I K h
7. Lake/ river/ ocean adjacent to property: j\ or rnoLn
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):, 1 nsk-Gj1 fru-4, nq
1 I , I
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:
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:
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and
SO feet landward to be impacted (number of trees, for instance): gra5S 6vp&�r-
Me—
FORM:
ICS
Owner/Agent's5ignature` [j5A NCAC 02N .O5Ll?- f?1 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)
lb,
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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
Olee and Tonje Olsen
17701 Cottonpatch Ln.
Cornelius, NC 28031
FORM: SSGP 10-2013 Page 3 of 3

7/11/2019 610 Fast Center Ave m MooresNlle, NC to 17701 Cotlonpeich Ln, Candles, NC 28031 - C,00gle Mape
Go gle Maps 610 East Center Avenue, Mooresville, NC to 17701 Drive 13.9 miles, 29 min
Cottonpatch Ln, Cornelius, NC 28031
610 E Center Ave
Mooresville, NC 28115
t 1. Head south on Evergreen St toward E Center Ave
14 s (197 ft)
Take S Main St, NC -115 S, Langtree Rd, 1-77 S/US-21 Sand
Jetton Rd to John Connor Rd in Cornelius
22 min (11.8 mi)
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2.
Turn right onto E Center Ave
0.5 mi
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3.
Turn left onto S Church St
0.5 mi
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4.
Turn right onto College St
0.1 mi
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5.
Turn left onto S Main St
12 mi
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6.
Continue onto NC -115 S
2.1 mi
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7.
Turn right onto Langtree Rd
1.1 mi
8.
Use the left 2 lanes to turn left onto
the Interstate
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0.2 mi
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9.
Merge onto 1-77 S/US•21 S
2.9 mi
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10.
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A
11.
Merge onto W Catawba Ave
1.0 mi
r 12. Turn right onto Jetton Rd
2.0 mi
Follow John Connor Rd and Belle Isle Dr to Cottonpatch Ln
5 min (2.1 m)
41 13. Turn left onto John Connor Rd
1.1 mi
r' 14. Turn right onto Belle Isle Dr
0.9 mi
'1 15. Turn left onto Cottonpatch Ln
0.1 mi
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7/112019 610 Fast Certs Avenue, Maoreswlle, NC to 17701 Coltorpatch Ln, Carelius, NC 28031 - Google Maps
17701 Cottonpatch Ln
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
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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
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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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CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: ( W-fyw?a. � kv, County: C
Owner:
Contract
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
1, =1d d /Uhit W.0`1 TZ14-, hereby state that I have been informed of the Catawba
Rip rian Buffer R e. 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): (f�Date: �2� 17
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APn,�
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