20150110 Ver 1_Shoreline Stabilization_20150127

FRED BAIRD BLACKLEY, ASLA
LANDSCAPE ARCHITECT
504 SOUTH DEKALB STREET
SHELBY, NORTH CAROLINA 28150
[phone]
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Transmittal
To: Attn:
Project:
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Date:
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For: APPROVAL INFORMATION RECORD REQUEST REVIEW COMMENT USE
Remarks: JAN 2 7 2015
DENR- Q m ,
RMWATEFt PERMITTING
Via: US MAI�_)AIRBORNE__ PICK UP UPS FAX HAND DELIVER OTHER

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Provide three (3) copies of the application and supporting information (maps, drawings, etc ),
as well as the appropriate application fee (see below), to the Division of Water Resources,
401 & Buffer Permitting Unit, 1617 Mail Service Center, Raleigh, NC 27699 -1617.
I Apolicant Information
Owner Information Please provide complete and accurate contact Information
Agent Information Per 15A NCAC 02-1 0502 , an agent may be given signatory
authority for the owner /applicant if a signed and dated copy of an Agent Authorization
letter Is Included with the application (A sample form may be found at
http / /www saw usace army mil/ Portals /59 /docs /regulacorV /regdocs /Permits /SAIVIPLf
AGENT AUTHORIZATION FORM pd f) -
II Prod ct Information
[WVicinity/ Site Map: Some type of site map so that someone unfamiliar with the area can
locate your project A county map or USGS topographic map Indicating the project
location is usually sufficient
Site Plan- A site plan showing the location of the shoreline, location of the impacts to
the shoreline and /or lake bottom and the location and any vegetated areas that will be
impacted In most cases the site plans do not have to be professionally prepared
However, if you intend to conduct hydraulic dredging, professionally prepared drawings
will likely be required for the spoil structures See example below
lyPhotograph of shoreline to be impacted/ disturbed
Description of property (including location information and lat /long coordinates) and
existing features on and near the site
Description of project and impacts/ disturbance proposed
III Sig ature
Per 1SA NCAC 02H 0502 , the application shall be considered a "valid application" only
if it bears the signature of a responsible officer of the company, municipal official,
partner or owner This signature certifies that the applicant has title to the property, has
been authorized by the owner to apply for certification or is a public entity and has the
power of eminent domain
IV
i p-lication Fee
he application must be accompanied by the appropriate application fee (checks made
out to the NC Division of Water Resources) The application fee is as follows (pursuant
�b G S 143 -215 30)
➢ $240 00 for impacts to lake (below normal water level) of less than 1 acre
➢ $570 00 for impacts to lake (below normal wat fj 4I _ ual to 1 acre
INSTRUCTIONS FOR APPLICATION SSGP307980 08 -13 & SUPPORTING DOCUMENTATION Page 2 of 3

State of North Carolina
D,W- R Department of Environment and Natural Resources
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. 1 13 LAe-e POD,yT Dr " ✓e--
rite-r,- V ,IC_ ZB'D ZI
Telephone Number '7 0'/ -`-I&q 19 70 Fax Number
E -mail Address boboLndde66v 0 'e.6,
2 Agent/ Contact Person Information
A11,4
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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 pd f) must be attached if the Agent has signed this application form
Name-
Company Affiliation &/6E
Mailing Address
Telephone Number Fax Number
E -mail Address:
Person to receive the Certification Approval
11. Project Information [15A NCAC 02H 0502(a) 4_U I
1 Attach a vicinity map (i a 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 3

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 C1- CvCLAAID Nearest Town:
k4aoo
Subdivision name or site address (include phase /lot number)-
113 6,4-1467100iev r` 0(Zr ✓C Gf�C r ✓; Ile- A/C Z�C)z)
If
Directions to site - please include road names and numbers, landmarks, etc.
Latitude (in decimal degrees) !V —3 SyJ9- /Z,(, r/ Longitude (decimal degrees) G O I �7j% rD9J
5 Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.). re 5; de- '�� /�`
6 Property size (acres)* . Y/ aue_
7 Lake/ river/ ocean adjacent to property Al os.S L4 4
8 Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): dock ad/a,�� 0.4s r�� ra� eroo4e_ d
S1o,,d, -1e_ . Oe-r re,9 %e.qe f ¢—
9. Will work be conducted from land? [ �a'� ✓°P"" From water?
d ow-1
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:
X3" = 161 S�-- '1 e0D5 r=
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. 7 k �zi - T..5 7 S F L 1 o -0o SF
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) I
Owner /Agent's Signature* [15A NCAC 02H 0502(f)]
/ —iZ i5
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
21 ;,�w1a
Shoreline
La ke
(At Full Pond/ Normal Water Level)
Nall
A5,7-1- _RIM 1$VIV V"S.' 104 �°
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
l2 Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation ?► x
r3 Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation 3 r
✓4 Location of any proposed structures such as buildings, r inin , docks, etc r\IP I
-/5 Location of any excavation or dredging below the Full Pond/ Normal Wat -er Level elevatldn
V/ 6 Location of construction access corridors
FORM SSGP 10 -2013 Page 3 of 3

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FRED B. BLACKLEY. A
LAND5CAPE ARCHITECT
704.484.1731
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SHELBY, NORTH CAROLINA 28150
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GhERRYVILLE, N G JAN 2 7 201;
THIS DRAWING 15 THE PROPERTY OF FRED B. BLACKLEY. ASLA
AND 15 NOT TO BE REPRODUCED OR COPIED IN WHOLE OR
IN PART WITHOUT PERMISSION. IT 15 NOT TO BE USED ON ANY
OTHER PROJECT AND 15 TO BE RETURNED UPON REQUEST.
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FRED B. LAV LEO LA
LAND5CAPE ARCHITECT
704.484.1731
504 50UTH DEKALB STREET
511ELBY. NORTH CAROLINA 28150
HALL PROPERTY
113 LAKE POINT DRIVE
GFtERRYVILLE. N G
TH15 DRAWING 15 THE PROPERTY OF FRED B. BLACKLEY. A5LA
AND 15 NOT TO BE REPRODUCED OR COPIED IN WHOLE OR
IN PART WITHOUT PERMISSION. 1T 15 NOT TO BE USED ON ANY
OTHER PROJECT AND 15 TO BE RETURNED UPON REQUEST.
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01/09/15 HDOCK8.DWG 5HEET 2 OF 3

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DRAINAGE AREA FLOWING TO ANY POINT ON SLT FENCE SrtALL NOT EXCEED ONE ACRE
TO INCREASE STORAGE. CONSTRUCT SEDIMENT PIT OR TRAP ABOVE 51LT FENCE.
51LT FENCE
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ALL POSTS PRESSURE TREATED CGROUND CONTACT) SOUTHERN YELLOW PINE
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FRED B. Bl A t
704.484.1731
504 5OUTH DEKALB STREET
5HELBY, NORTH CAROLINA 28150
DECKING (5/4x6 OR 245 OR 'TREX')
2x8 JOIST - TO REST ON BEAM CIG' OC MAX.) 12' FOR 'TREX'
410 BEAM/GNDER (2 - 2x10's WITH BLOCKING)
ATTACH MEMBERS TO POST WITH 3 - 3/8' LAG BOLTS
PULL POND CEL.73QG.03
6x6 POST
ALL WOOD PRESz'URE TREATED SOUTHERN YELLOW PINE OR APPROVED TROPICAL HARDWOOD'
ALL FASTENERS 10T DIPPED GALVANIZED
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HALL PROPERTY
113 LAKE POINT DRIVE
GIIERRYVILLE, N G
THIS DRAWING 15 THE PROPERTY OF FRED B. BLACKLEY. A5LA
AND 15 NOT TO BE REPRODUCED OR COPIED IN WHOLE OR
IN PART WITHOUT PERMISSION. IT 15 NOT TO BE USED ON ANY
OTHER PROJECT AND 15 TO BE RETURNED UPON REQUEST.
NTS
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01/09/15 HDUDWG 5HEET 3 OF 3
— MAND-PLACED CLASS 'B' tPRAP
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TON' f ESA - ON STEEP. ERODED LOTS NA
THIS APPLICATION - •738.0
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�-----TOE ELEVATION - 733.0 - ON STEEP ERODED LOTS NA
THIS APPLICATION - 734.5
'NOTCH IN' AT TOE TO MQ -D STONE IN PLACE
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2x2 LEDGER - ALT.- JOIST HANGER
FuL POND CeL_736.03 — --
6x6 POST
ALL WOOD PRESSURE TREATED SOUTHERN YELLOW PINE
ALL FASTENERS MOT DIPPED GALVANIZED
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DECKING (5/4x6 OR 2x6 OR 'TREX')
4x10 BEAM (2 - 240's WITH BLOCKING)
ATTACH MEMBERS TO POST WITH 3 - 3/6' LAG BOLTS
2x8 JOIST C36' OC MAX.) 12' FOR 'TREX'
2x2 LEDGER - ALT.- JOIST HANGER
FUl-1 POND CEL736.03 --
6x6 POST
ALL WOOD PRESSURE TREATED SOUTHERN YELLOW PINE
ALL FASTENERS MOT DIPPED GALVANIZED
ALL POSTS PRESSURE TREATED CGROUND CONTACT) SOUTHERN YELLOW PINE
T
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FRED B. Bl A t
704.484.1731
504 5OUTH DEKALB STREET
5HELBY, NORTH CAROLINA 28150
DECKING (5/4x6 OR 245 OR 'TREX')
2x8 JOIST - TO REST ON BEAM CIG' OC MAX.) 12' FOR 'TREX'
410 BEAM/GNDER (2 - 2x10's WITH BLOCKING)
ATTACH MEMBERS TO POST WITH 3 - 3/8' LAG BOLTS
PULL POND CEL.73QG.03
6x6 POST
ALL WOOD PRESz'URE TREATED SOUTHERN YELLOW PINE OR APPROVED TROPICAL HARDWOOD'
ALL FASTENERS 10T DIPPED GALVANIZED
P05T TO SUPPORT ROOF ABOVE
DECKING C5/4x6 OR 2x6 OR 'TREX')
2x8 JOIST C16" X MAX.) 12' FOR 'TREX'
4x10 BEAM/GILDER C2 - 240's WITH BLOCKING)
ATTACH MEMBERS TO P05T WITH 3 - 3/6* LAG BOLTS
FELL POND CE1.724,03
6x6 POST
ALL WOOD PRESSJRE TREATED SOUTHERN YELLOW FINE OR APPROVED TROPICAL HARDWOOD
ALL FASTENERS t*OT DIPPED GALVANIZED
SECT]QN
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CONCRETE FOOTING
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ShORELINE
IMPROVEMENT
DETAILS
HALL PROPERTY
113 LAKE POINT DRIVE
GIIERRYVILLE, N G
THIS DRAWING 15 THE PROPERTY OF FRED B. BLACKLEY. A5LA
AND 15 NOT TO BE REPRODUCED OR COPIED IN WHOLE OR
IN PART WITHOUT PERMISSION. IT 15 NOT TO BE USED ON ANY
OTHER PROJECT AND 15 TO BE RETURNED UPON REQUEST.
NTS
G=\DWG5\HALLR\h0ET.DWG
01/09/15 HDUDWG 5HEET 3 OF 3