20180955 Ver 1_Shoreline Stabilization_20180709

201 80 955
State of North Carolina
Department of Environment and Natural Resources
DW NIV Division of Water Resources
AN 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division ofer esour
FORM: SSGP 10-2013
Shoreline Stabilization Application Form
Three copies 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)i D
1. Owner Information
Name: SalisburyElks Lodge #699
f,
Mailing Address: 508 S. Main Street 9 2018
Salisburv, NC 28144
Telephone Number: 704-636-1161 Fax Number:
E-mail Address: fre. dmi c<rrail.com F 4
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.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.0 ) must be attached if the Agent has signed this application form.
Name: N/A
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Person to receive the Certification Approval:
Fax Number:
II. Project Information [15A NCAC 02H .OS02(a) & (b)l
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,
FORM: SSGP 10-2013 Page 1 of 4

etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
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: Rowan Nearest Town: Salisbury
Subdivision name or site address (include phase/lot number):
390 Lodge Trail, Salisbury, NC
Directions to site - please include road names and numbers, landmarks, etc.:
1-85 S to Lone Ferry Rd exit, east on Long Ferry Rd, R on Lodge Trail, L at fork in the road,
property is at end of road.
Latitude (in decimal degrees) 35.6633 Longitude (decimal degrees) 80.3127
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): existing elks lodge and park with trailers
6. Property size (acres): 21.8 acres
7. Lake/ river/ ocean adjacent to property: High Rock Lake
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): To stabilize and existing eroded shoreline and protect
It from further erosion.
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:
800 Sq. Ft.
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: 4050 Sq. Ft.
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): Numerous trees of
varvine size and condition will be impacted by the proposed shoreline stabilization.
Owner/Agent's ignature' [15A NCAC 02H .O502(f)] 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
SI
Lake
(At Full Pond/ Normal Water Level)
SEE ATTACHED SITE PLAN AND DETAILS
Please approximately sketch the following information on this pian ('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
FORK SSCP 10-2013 Page 3 of 3

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TYPICAL CONDITIONS
36" TO 72" ERODED CUT
WAVE EXPOSURE
FOR: SALISBURY ELKS LODGE #699
LOCAnON: 390 LODGE TRAIL, TAX PARCEL 612 005
RESERVOIR: HIGH ROCK LAKE
PROJECT- SHORELINE STABILIZATION PROGRAM
PHASE I SITE EVALUATION
YADKIN, INC. — BADIN, NORTH CAROLINA
DRAWING nTLE:
DETAIL
MODERATE RIP RAP STABILIZATION 3
VEGETATION AND EROSION
CONTROL FABRIC
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EXISTING GRADE
3
lo
I
CLASS 2 RIP RAP
I
Ai
2
EROSION CONTROL
FABRIC---'—
LAKE
BOTTOM
TYPICAL CONDITIONS
36" TO 72" ERODED CUT
WAVE EXPOSURE
FOR: SALISBURY ELKS LODGE #699
LOCAnON: 390 LODGE TRAIL, TAX PARCEL 612 005
RESERVOIR: HIGH ROCK LAKE
PROJECT- SHORELINE STABILIZATION PROGRAM
PHASE I SITE EVALUATION
YADKIN, INC. — BADIN, NORTH CAROLINA
DRAWING nTLE:
DETAIL
MODERATE RIP RAP STABILIZATION 3

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