20191274 Ver 1_Shoreline Stabilization_20190924

DWR.
0101slon of Water Resources
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline
FORM: 5
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
1. Applicant information (15A NCAC Q2H .0502(a)l
1. Owner Information
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SEP S4 2019
Name: Dana Wells Layne rces
Mailing Address: 2981 Clear Ridge Drive „� �zli. Section
Trinity, NC 27370
Telephone Number: 336-689-4068 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:
htta://www.sew.usace.army.mil/Portaist5 doc5lregulatory/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:
If. Project Information i15A NCAC 02H .0502(a) & (b)i
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: Montgomery Nearest Town: New London
Subdivision name or site address (include phase/lot number): Dixie Shores
Lot 131, 528 Shoreline Road, New -London, NC
Directions to site - please include road names and numbers, landmarks, etc.:
NC HM 49 to.8adin Lake Road (SR 1162), left on Blaine Road right on Charlotte Drive
left on Skyline Drive, left on Shoreline Road. [at is on the right.
.Latitude (in dedma)degrees) 35.28.51 Longitude (dedmaldegrees) 80.04.445
5. Describe the -existing land use or condition of the'site at the time of this application
(residential, undeveloped, etc.): undeveloped lot in existing subdivision
6. Property size (acres): 0.16 acres
7. Lake/ river/ ocean adjacent to property: Badin Lake
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): To stabilize and 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:
108 Sa. Ft.
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
wails, etc.) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres: 486 Sci. 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 project.
Owner/Agent's Signature' USA NCAC 02H .0502(f ll Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM; SSCP 10-2013
Page 2 of 3

Full Pond/
Normal Water Level
E
Lake
(At Full Pond/Normal Water Level)
SEE ATTACHED SITE PLAN AND DETAILS
Please approximately sketch the following information on this pian (provide dimensionsfor 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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EROSION CONTROL FABRIC -------"-
TYPICAL COMMONS
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• WAVE EXPOSURE
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DANA WELLS LAYNE
LOCATION: LOT 131, DIXIE SHORES
RESERVOIR: BADIN LAKE
PROJECT; SHORELINE STABILIZATION PROGRAM
PHASE I SITE EVALUATION
YADKIN, INC. -- BADIN, NORTH CAROLINA
UHAVW G iIILe. DETAIL
MINOR RIP RAP STABILIZATION 2