20240707 Ver 1_401 Application_20240515

3
ROY COOPER
covernor
MICHAEL S. REGAN
Secretory
S. DANIEL SMITH
Director
NORTH CAROLINA State of North Carolina
Environmental Quality Department of Environment Quality
Division of Water Resources
15A NCAC 02H .o5oo — Water Quality Certification, ShoreliFORM: SSta 09 anon
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the a lication fee should be sent to:
UPS F dEx etc )
if sending via US Postal Service
Paul Wojoski
DWR —401 & Buffer Permitting Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
if sending via delivery service I e
Paul Wojoski
DWR — 401 & Buffer Permitting Branch
512 N. Salisbury Street
Raleigh, NC 27604
NOTE: Before submitting this form, please ensure you have submitted the Pre -Filing Meeting Request
Form as we will not be able to accept your application without this important first step. The Pre -Filing
Meeting Request Form is used in accordance with 40 C.F.R. Section 121.4(a) which states "At least 30
days prior to submitting a certification request, the project proponent shall request a pre -filing
meeting with the certifying agency." In accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5), all
certification requests must include documentation that a pre -filing meeting request was submitted to
the certifying authority at least 30 days prior to submitting the certification request. Click here to read
more information on when this form is needed prior to application submission or here to view the
form.
Attach documentati of Pre-Filing.Nieeting Request to this application.
Date of Pre -filing Meeting
DWR ID #
: !�_ f (required)
A. Applicant Information 115A NCAC 02H .0502 al]
Owner Information
(if applicable)
Name: James R. Fisher
Mailing Address: 4951 Charnel Road
Winston-Salem NC 27127
Telephone Number: 336 768-8094 Fax Number:
E-mail Address:
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 1 1617 Mail Service Center Raleigh, North Carolina 27699-1617
919.707.9000
oeva�^^^m e�wonmonr� o.u�v�

2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter must be attached if the Agent has
signed this application form. (A form can be downloaded here:
http://www.saw.usace.ar�.m (Portals T3 docs re ulato re docs Permits SAMPLE AGENT AUTHORIZ
ATION FORM.odf)
Name:
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Fax Number:
B. 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, buildings, retaining walls, docks, impervious surfaces, 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: Davidson Nearest Town: Lexington
Lake/ river/ ocean adjacent to property: Hi h Rock Lake
Property size (acres): 0.75 acres
Subdivision name or site address (include phase/lot number):
188 Riverview Blvd. Lexington
Directions to site - please include road names and numbers, landmarks, etc.:
1-85 to Lexington exit for NC Hwy $ o south on NC Hwy 8 R on Linwood-
Southmont Rd. L on Red Barn Rd. R on Riverview Blvd.
ro erty is on the L near the end of road.
Latitude (in decimal degrees) 35.42.5568 Longitude (decimal degrees) 80.19.0323
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Single amilresidential community
FORM: SSGP 09-2020 Page 2 of 6

6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): To stabilize an eroding shoreline and protect it _
from further erosion.
7. Will work be conducted from land? ® From water? ❑
8. Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent impacts (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
550 Sq. Ft.
Temporary impacts in square feet:
9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet
land -ward
Permanent impacts (including back fill, excavation, rip rap, retaining walls, etc.) in square feet:
1380 S . Ft. _
Temporary impacts (temporary clearing, construction corridor) in square feet:
1375 Sa. Ft.
10. 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): 6 to 10 trees
will be removed in order to complete the stabilization project.
11. Signature
By signing below, I, as the project proponent, certify to the following:
The project proponent hereby certifies that all information contained herein is true,
accurate, and complete to the best of my knowledge and belief
• The project proponent hereby requests that the certifying authority review and take action
on this CWA 401 certification request within the applicable reasonable period of time
4Qwn Agent's Signature` 15A NCAC 02H .0502 f) Date
ent's signature is valid only if an authorization letter from the owner is provided.
12. Please approximately sketch the following information on this plan and provide dimensions for
each item:
a. All proposed vegetation clearing
b. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
c. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
FORM: SSGP 09-2020 Page 3 of 6

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Director
NORTH CAROLINA
Environmental Quality
State of North Carolina
Department of Environment Quality
Division of Water Resources
15A NCAC 021­1 .o5oo — Water Quality Certification, FORMn SStabiliz09 2020 anon
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent to:
UPS FedEx etc )
If sending via US Postal Service
Paul Wojoski
DWR-401 & Buffer Permitting Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
if sending via delivery service I ,
Paul Wojoski
DWR-401 & Buffer Permitting Branch
512 N. Salisbury Street
Raleigh, NC 27604
NOTE: Before submitting this form, please ensure you have submitted the Pre -Filing Meeting Request
Form as we will not be able to accept your application without this important first step. The Pre -Filing
Meeting Request Form is used in accordance with 40 C.F.R. Section 121.4(a) which states "At least 30
days prior to submitting a certification request, the project proponent shall request a pre-filing)(5), all
meeting with the certifying agency." in accordance with 40 C.F.R. Section 121.5(b)(7), and (c
certification requests must include documentation that a pre -filing meeting request was submitted to
the certifying authority at least 30 days prior to submitting the certification request. Click here to read
more information on when this form is needed prior to application submission or here to view the
form.
Attach documentatio f Pre-Filin eeting Request to this application.
Date of Pre -filing Meeting R est: f __._J
(required)
DWR ID #_ Verson (if applicable)
A. Applicant Information [15A NCAC 02H .0502 a ]
Owner Information
Name: James R. Fisher
Mailing Address: 4951 Charnel Road
Winston-Salem NC 27127
Telephone Number: 3361768-8094 _ Fax Number:
E-mail Address:
North Carolina Department of Environmental Quality i Division of Water Resources
512 North Salisbury Street 1 1617 Mail Service Center Raleigh, North Carolina 27699-1617
919.707.9000
prypNMN W Emimnm.nW UuaM�

2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter must be attached if the Agent has
signed this application form. (A form can be downloaded here:
httt)://www.saw.usace.army.mil/Portals 59 dots re ulator re dots Permits SAMPLE AGENT AUTHORIZ
ATION FORM. df)
Name: N/A
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Fax Number:
B. 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, buildings, retaining walls, docks, impervious surfaces, 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: Davidson Nearest Town: Lexin ton
Lake/ river/ ocean adjacent to property: Hi h Rock Lake
Property size (acres): 0.75 acres
Subdivision name or site address (include phase/lot number):
188 Riverview Blvd. Lexin ton
Directions to site - please include road names and numbers, landmarks, etc..
1-85 to Lexington exit for NC Hwy 8 o south on NC Hwy 8 R on Linwood-
Southmont Rd.. L on Red Barn Rd. R on Riverview Blvd.
ro erti is on the L near the end of road.
Latitude (in decimal degrees) 35.42.5568 Longitude (decimal degrees) 80.19.0323
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Single-family residential communitv
FORM: SSGP 09-2020 Page 2 of 6

6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): To stabilize an eroding shoreline and protect it
from further erosion.
7. Will work be conducted from land? ® From water? ❑
8. Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent impacts (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
550 Sa. Ft.
Temporary impacts in square feet:
None
9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet
land -ward
Permanent impacts (including back fill, excavation, rip rap, retaining walls, etc.) in square feet:
1380 S . Ft.
Temporary impacts (temporary clearing, construction corridor) in square feet:
10. 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): 6 to 10 trees
will be removed in order to complete the stabilization Proiect,
11. Signature
By signing below, I, as the project proponent, certify to the following:
The project proponent hereby certifies that all information contained herein is true,
accurate, and complete to the best of my knowledge and belief
The project proponent hereby requests that the certifying authority review and take action
on this CWA 401 certification request within the applicable reasonable period of time
Own Agent's Signature* [15A NCAC 02H .0502 f) Date
ent's signature is valid only if an authorization letter from the owner is provided.
12. Please approximately sketch the following information on this plan and provide dimensions for
each item:
a. All proposed vegetation clearing
b. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
c. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
FORM: SSGP 09-2020 Page 3 of 6

d. Location of any proposed structures such as buildings, retaining walls, docks, etc.
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level
elevation
FUI1 0 A 1 rinrm=i %A/atPr I PVP_I
Plan
Lake
(At Full Pond/ Normal Water Level)
Lake
(At FuO frond/ Normal Water level) Existing Hoek
J 30fta7ft
3 ft x 150 k
- &lwfuli pond/NM
Full Pond/ Normal Water Level ® — r .r
ft
whore ne : rr " ` ^-=IR—I f 3 Above full pond/ NW,'--- P P
Y=4Y 11-t_-�
additional deanng
}
if nK,,sary
i
EkAMIJ-.-.IE
Plan View
FORM: SSGP 09-2020 Page 4 of 6

a�
N
Lake;
(fit Full Panel/ Normal Water Level) M
a�
-
Z tA
c
Side View
LL-
FORM: SSGP 09-2020 Page 5 of 6

10 ft. bank
height
Side Vi
3 ft. below full pond water level 4 ft. above ft. additional clearing
e full pond water level 9f necessary
Existing bank
•
�r •
t., r
Y
FORM: SSGP 09-2020 Page 6 of 6

NCDEQ 401 WATER QUALITY CERTIFICATION
SHORELINE IMPACT AREA CALCULATIONS
APPLICANT: James R. Fisher
Lots 10 & 11, Riverview Acres
STABILIZATION IMPACT AREA CALCULATIONS
The attached shoreline site plan shows 275 LF of proposed shoreline stabilization measures.
Detail 3 indicates a proposed shoreline slope that is graded at 2:1 and reflects the estimated
normal pool level and the estimated height of the subject shoreline above the normal pool
level.
Calculation 1— Impact Area Below Normal Pool Level
(Item 8 on NCDEQ Form SSGP 09-2020)
Area of Impact = Shoreline Length x Depth* x Slope
_ (275') x (1') x (2)
= 550 sq. ft.
*For this calculation, an average water depth of 1 ft. has been assumed. This will
produce a conservative overestimate of the stabilization impact area.
Calculation 2 — Impact Area Above the Normal Pool Level
(Item 9 on NCDEQ Form SSGP 09-2020)
Permanent Impact From Shoreline Stabilization Measures
Height of Bank Above Normal Pool Varies Across the Shoreline
Estimate 135 LF of Shoreline = 2 ft. Above Normal Pool
Estimate 140 LF of Shoreline = 3 ft. Above Normal Pool

Area of Impact = Length x Height x Slope
= ( 13 5' x 2' x 2) + ( 14 0' x 3' x 2 )
= 540 + 840
= 1,380 sq. ft.
Impact From Construction Above Shoreline Stabilization
Assume 5 ft. Wide Zone
Area of Impact = 275' x 5 ft.
= 1,375 sq. ft.
Total Area of Impact Above Normal Pool Level = 2,755 sq. ft.

r
N
TgelF
LAKE
'5,ciQm
0
SITE MAP - JAMES FISHER
SCALE 1'= 50'

VEGETATION AND EROSION
CONTROL FABRIC
EXISTING GRADE
I
� I
I
CLASS 2 RIP RAP I
1 � G� 1
2 o I
EROSION CONTROL FABRIC
TYPICAL CONDITIONS
36" TO 72" ERODED CUT
WAVE EXPOSURE
FOR: JAMES FISHER
LOCATION: LOTS 10 & 11, RIVERVIEW ACRES
HIOGH ROCK LAKE
RESERVOIR:
PROJECT:
LAKE BOTTOM
SHORELINE STABILIZATION PROGRAM
PHASE I SITE EVALUATION
YADKIN, INC. — BADIN, NORTH CAROLINA
DRAWING TITLE:
N MODERATE RIP RAP STABILIZATION
3

I
1
AW
of• �..~ �► f 1. ,.r -� _ +

L7 bing maps
188 Riverview Blvd, Lexington, NC 27292
Location: 35.715467,-80.31739
` 4
RICH
ROCK
ESTATES
r
r
rr
I
f
JFRSEY
9
188 Riverview Blvd,
Lexington, NC 27292
RavErawoat7
MOUNTAIN
VIEW
ESTATES
FOXCROFF
2000 ft 500 m
0 2024 TomTom