20020989 Ver 2_Shoreline Stabilization_20190809

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PA' �State of North Carolina
epartment 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
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name:
Mailing Address
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1851 Waterford Pointe Rd.
Lexington, NC 27292
Telephone Number: 336/413-6101 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.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

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 38 Waterford Pointe, at 1851 Waterford Pointe Drive
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 Wildlife Rec Area Access Rd.,
R on Marvin Hedrick Rd. which turns into Waterford Pointe Rd., site is on the L side of road.
Latitude (in decimal degrees) 35.633 Longitude (decimal degrees)
80.283
5. 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): Approx. 1.07 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:
230 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: 1035 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): No trees
will be removed in order to complete the stabilization proiect.
Owner/Agent's Signature} [15A NCAC 02H .0502(f)l 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 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:
ROBERT JARRETT
LOCATION: LOT 38, WATERFORD POINTE
RESERVOIR: HIGH ROCK 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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