20170869 Ver 1_401 Application_20170714

State of North Carolina
DWR Department of Environment and Natural Resources
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
Three copies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resources
401 & Buffer Permitting Unit 2 0 1 7 0 8 6 9
1617 Mail Service Center
Raleigh, NC 27699-1617
D
I. Applicant Information [15A NCAC 02H .0502(a)] EO-WATER
:4,2017
1. Owner Information
DRESOUR ES
Name: Larry O. Jones 401 & BUFFEE-EEMITTING
Mailing Address: 1284 Clark Road
Salisbury, NC 28146
Telephone Number: 704/633-8799 Fax Number:
E-mail Address: [e-mail]
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.armv.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: N/A
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Person to receive the Certification Approval:
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,
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):
300 Fox Hollow Lane, Salisbury NC
Directions to site - please include road names and numbers, landmarks, etc.:
1-85 S to Salisbury exit. L on East Innes Street. L on Stokes Ferry Road L on Providence
Church Rd., R on Brinale Ferry Rd.. L on Clark Rd. L on Fox Hollow Lane
Latitude (in decimal degrees) 35.63321 Longitude (decimaidegrees) 80.29666
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Existing developed residential property
6. Property size (acres): 49 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:
680 So. 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: 4860 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): _Site has an existing
house on the property. Numerous trees of varied size species and condition will be
wn mOvO s Sig ture` 5A NCAC 02H .0502(fj Date
Agent's signature is lid only an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

Full Pond/
Normal Water Level
S
Lake
(At Full Pond/ Normal Water Level)
SEE ATTACHED SITE PLAN AND DETAILS
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.
S. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
FORM: SSGP 10-2013 Page 3 of 3

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VEGETATION AND EROSION
CONTROL FABRIC
EXISTING GRADE
CLASS 2 RIP RAP
EROSION CONTROL FABRIC
LAKE BOTTOM
TYPICAL CONDITIONS
36" TO 72" ERODED CUT
WAVE EXPOSURE
FOR:
LARRY O. JONES
LOCATION: 300 FOX HOLLOW LANE
RESERVOIR: HIGH ROCK LAKE
PROJECT: SHORELINE STABILIZATION PROGRAM
PHASE I SITE EVALUATION
YADKIN, INC. - BADIN, NORTH CAROLINA
DRAWING TITLE: DETAIL
MODERATE RIP RAP STABILIZATION 1 3

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