20171247 Ver 1_Shoreline Stabilization_20171003

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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
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 Q D
I. Applicant Information [15A NCAC 02H .0502(a)] 2017
1. Owner Information
Name: Jeff & Jean Cummings DEGl-WATER RPERMInING
Mailing Address: 510 North Wind Drive
Winston-Salem, NC 27127
Telephone Number: 336/775-9058 Fax Number:
E-mail Address:
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: 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

Sep 19 2017 15:58 HP FaxHwyBBIZ Center 3365931034 page 2
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etc.), excavation or.dre�ging below Full Pond/ Nonnal Vrfater
and construction access corridors. Yoe,l ay use the diagram proYidett "thetlN'bl?fHi
. applicR.j j_ rm.
3; ,. Attach a.phadograph of, the sharatirte/-buffer proposed to be #zbitized�=(include a scale
of some sort- a prd -stick; taouel, t'anr)(e,:Qt ;)
4. Location of the property (where work is to be conducted)
Subdivision name or site address (include phase/lot number):
LZ 0. P iiavenlEl Ms
Directions to site - :please Indude road names and n berg ;iailtdrr�ok!4*te.:
NC Huhu 49 to Badu Lake 110 (SR 11Q). kit on Blaine=6r1'
Pinehi t Drive 15H.11ffli orooeWj is at end of rojWgn the
Latitude fn d,wrdes) j.35.7 'Lb�rde f►d►
S.. Describe the exiafg land use or condition of the site at the time"of this,appkit' l n
a
,- .' (�e5iddratfal, un�leii�tbpeti, etc.):: ,tel r '��%.eltis�Elria �aiidig
6. Propeitji sizeacnes (i� � . j �C
T ...
7. Lake/ fiver/ ocean adjacent to property: 641„lw k
8. Descrflseproposed,"rk{inFIude disaasMa aAto hQ+�►hardening sham tlnejwpeen
avoided, or why it is necessary): TA-9abdrzeFaaerg!Ap tg reline xgl—, =et t itfrom
g WNiR w6&be-zwWWedfroth landt..' . Farr; water: Q
s ” � i r fbf.i(�stt riaance it'�:1t lih ``aliiainravattdo �kiaiClit #I `ri ra Vii' walls, etc.
, p l�, ng )
��� i �
ntsrmatpaal lalteYevelIlFbnrr►a11Nlter Leve in squaefeet crrae�s:
294 sa: Ft.
r1: otal'ai�tliunt bf diaturbat °(lhdtMlrig'alt diuttng, back"fill; excavation ':rI rap. retaining
'd. .+3
�hralis, etc:) a.kiove'tF�e nbrmapool fake levelf Norma! Water Level and SQ feet land -yard in
quaet or acres:
:U. lease describe the vege t ebo�re the n©rrrteI pool lake levei/ Normal Waterkmel and
...I,..... .. .. ... .r: . e .-.....W:........... ..:...: .. ..., :. ..
So feet; landward to be imparted -(number of trees, for instance): 6 t91li'tnees-ofyraried'
sm Ain and jcortditlonypll eiih-arde�^�IMm. plebe the 8Ikk 2W$MiW
16 a: n 1. mel �n 1 � nI
FORM: SSGt? 10-2fl13 P{!Ba. Z 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 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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TYPICAL CONDITIONS
12" TO 36" ERODED CUT
WAVE EXPOSURE
FOR: JEFF & JEAN CUMMINGS
LOCATION: LOT 108 PINEHAVEN ESTATES
RESERVOIR: BADIN LAKE
PROJECT: SHORELINE STABILIZATION PROGRAM
PHASE I SITE EVALUATION
YADKIN, INC. - BADIN, NORTH CAROLINA
DRAWING TITLE: DETAIL
MINOR RIP RAP STABILIZATION 1 2

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9/21/2017
Go gle Mai -.)S 756 Plnehaven Dr
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756 Pinehaven Dr - Google Maps
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1756 Plnehaven Drive
2550
Fish Tales
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163 Marina & Grille
Map data ©2017 Google United States 1000 ft
https://www.google.com/maps/place/756+Pinehaven+Dr,+New+London,+NC+28127/@35.4989498,-80.1061208,15z/data=!4m5!3m4! 1 sOx88547fe3e6. . . 1/1