20140418 Ver 1_Shoreline Stabilization_20140428

BURCHETT
April 245 2014
Division of Water Quality
1650 Mail Service Centel
Raleigh, NC 27699 -1650
To Whom it May Concern-
On behalf of Tillery Tradition and the Russell Family, we are seeking comments from you'
office
Our Plan on this project is to iemove the existing concrete and wood retaining wall, and then
grade the slop with a track excavator and install boulder type rip rap.
Could you please provide us with you' comment letter to
Cohen Construction Inc.
ATTN Robbie Cohen
P O Box 545
Noiwood, NC 28128
Robbie@ cohenconstructionco com
Sincerely,
Fred B`u c sett

2 0 1 4 0 4 1 8
State of North Carolina
DWR Department of Environment and Natural Resources
Division of Water Resources
Division of W.%trr Resources 15A NCAC 02H .0500 – Water Quality Certification, Shoreline Stabilization
FORM. SSGP 10 -2013
Shoreline Stabilization Application Form
Four copies of the application (including attachments) and the application fee should be sent to:
Division of Water Resources
401 & Buffer Permitting Unit
1650 Mail Service Center 4�
Raleigh, NC 27699 -1650
1. Applicant Information (15A NCAC 02H .0502(a)j
1. Owner Information
Name Thomas F. Burchett
Mailing Address: 2825 Tobernory Lane
Raleigh, NC 27606
r�oa s v adv
Telephone Number: 919- 219 -3891 Fax Number.
E -mail Address: fwd uf- dh -&ttCakim1e - hosnsom f 'Yed LCIVC —hovnI
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
hap / /www saw usace army mil/ Portals /59 /docs /regulatory /reRdocs /Permits /SAMPLE AGENT AUTH
ORILATION FORM —df) must be attached if the Agent has signed this application form.
Name.
Company Affiliation-
Mailing Address:
Telephone Number: Fax Number-
E-mail Address.
Person to receive the Certification Approval:
11. Project Information (15A NCAC 02H 0502(a) & (b)j
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 Mt. Gilead
Subdivision name or site address (include phase /lot number) Fairway Shores
Directions to site - please include road names.and numbers, landmarks, etc • —
Begin on Lilly's Bridge Road turn west on Fairway Shores South. House is 3/
Miles on the left
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc )• Residential Developed
6. Property size (acres):
7. Lake / river/ ocean adjacent to property Lake Tillery
8 Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary), Remove existing concrete and wood retaining wall
Grade slope with a tracked escavator and install boulder type rip rap.
9. Will work be conducted from land? M 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
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-
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):
Agent's signotwe a valid only if an outhorizotion letter from the owner is provided
FORM SSGP 10 -2013
Page 2 of 3
�s.

BK 623 PG 018 DOC #313620
ATTACHMENT
In Pee Dee Township, Montgomery County, North Carolina
Being Lots Nos 31 & 32 of Map 2, Section B, of Fairway Shores Development, as shown on map entitled "Physical
Survey for Frederick Biirchett and wife, Denise Burchett" dated March 4, 2006 prepared by Benp DeBerry, NCPLS
L -4550, and attached to deed recorded in Book 558 Page 372, Montgomery County Registry Also, see map in Plat
Cabinet A, Slide 429, Montgomery County Registry
A.
14�" 1 �z
©URCHETT THOMAS 7 -08
656 Fairway Shores Road MI Gilead, NC 27306

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APPENDIX F
Minor Rip Rap Stabilization
VEGETATE DISTURBED AREA
/",-ABOVE SLOPE -
EXISTING GRADE
CLASS I RIP RAP
2
EROSION CONTROL FABRIC-----*"-
TYPICAL CONDITIONS
12" TO 36' ERODED CUT
• WAVE EXPOSURE
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