20180532 Ver 1_Shoreline Stabilization_20180413

201 80532
State of North Carolina
DWJI
11111V Department of Environment and Natural Resources
(L Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
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
RFC'ElVED
APR 131018
I. Applicant Information L > NCAC 02H .0502(a)1 DE
1. Owner Information STORMWq JSR PQUA')N
Name: Sheri Herbert TTING
Mailing Address: 5 Roberson Ave.
Pine Bush NY 12566
Telephone Number: 845-234-2140 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.army.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
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: Davidson Nearest Town: Lexington
Subdivision name or site address (include phase/lot number):
Lot 13 Yachtsman's Point
Directions to site - please include road names and numbers, landmarks, etc.:
1-85 to Lexington exit for NC Hwy 8, go south on NC Hwy 8, R on Wildlife Recreation
Area Access Road. R on Scout Road, Lot 13 is on right near end of road.
Latitude (in decimal degrees) 35.6362 Longitude (decimal degrees) 80.2635
S. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Single-family residential community
6. Property size (acres): 1.43 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 an eroding 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:
320 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: 1540 So. 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): Many trees of varied
species, size and condition will be removed in order to complete the stabilization proiect.
Owner/Agent's Signature` [15A NCAC 02H .0502101 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
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.
5. 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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Parcel Number: 06039A0000013
Pin Id :
6628-01-48-5895
Deed Book:
HERBERT LEE A
Deed Date:
HERBERT SHERI L
Owner:
5 ROBERSON AVE
Exempt Code:
PINE BUSH NY 27292
Property Address:
1182 SCOUT RD
Township:
06
Building Value:
10
11
Land Units:
1.43 AC
Deed Book:
2202 Pg:,
Deed Date:
11/20/201
Account Number:
9221027
Exempt Code:
$0 Other Building Value:

VEGETATION AND EROSION
CONTROL FABRIC
3
CLASS 2 RIP RAP
EROSION CONTROL FABRIC
TYPICAL CONDITIONS
• 36" TO 72" ERODED CUT
• WAVE EXPOSURE
EXISTING GRADE
\.�\. LAKE gpn�M - -
FOR:
SHERI HERBERT
LOCATION: LOT 13, YACHTSMAN POINT
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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