20150140 Ver 1_Shoreline Stabilization_20150202

FRED BAIRD BLACKLEY, ASLA
LANDSCAPE ARCHITECT
504 SOUTH DEKALB STREET
SHELBY, NORTH CAROLINA 28150
[phone]
Transmittal
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For: APPROVAL INFORMATION RECORD REQUEST �.J REVIE COMMENT USE
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FAX DENIiUKW DEEMWR OTHER
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Copies
Item
Description
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For: APPROVAL INFORMATION RECORD REQUEST �.J REVIE COMMENT USE
Pawn rle c
Copy To: By: —Pb
RECEIVED
Via: US MAIL (� AIRBORNE PICK UP UPS
FFS 0 2 2015
FAX DENIiUKW DEEMWR OTHER
TORMWAI ER PERMITTING

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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 Apfilicant Information
[J' Owner Information Please provide complete and accurate contact information
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Agent Information Per 15A NCAC 02H 0502 , an agent maybe 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 / /vvww saw usace army mil/ Porldls /50 /docs /regulacory /regdocs /Permits /SAMPLE
AGENT AUTHORIZATION FORM pd f)
II Pr4ect Information
© Vicinity/ 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
Photograph 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
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III Signature
® Per 15A 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
VgA Iplication Fee
The 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
to G 5_143 -2 15 3Q)
➢ $240 00 for impacts to lake (below normal water level) of less than 1 acre
➢ $570 00 for Impacts to lake (below normal water level) of greater or equal to 1 acre
INSTRUCTIONS FOR APPLICATION SSGP307980 08 -13 & SUPPORTING DOCUMENTATION Page 2 of 3

2 0 1 5
Division of 'Water Resources
0 1 4 0 State of North Carolina
Department of Environment and Natural Resources
P — Division of Water Resources
15A NCAC 02H 0500 – Water Quaality- Certif�on, 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
I. Applicant Information [15A NCAC 02H 0502(a)]
1
Owner Information
Name k ,J
Mailing Address
Telephone Number kil — 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
hit //www saw usace army mil Portals 59 cIoclregulator�egoocs, PermrtslSAIVIPLE AGENT AUTH
ORIZATION FOR VI odf) must be attached if the Agent has signed this application form
Name
Company Affiliation
Mailing Address
Telephone Number
E -mail Address
Person to receive the Certification Approval
Fax Number
II. Project Information [15A NCAC 02H _0502Laj & (b)]
%A 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 3

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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 t e property ( here woi k is to be conducted)
County Nearest Town ��
NIMMai
e address (include phase /lot number)
site - please include road named and numbers, landmarks, etc
Latitude (in decimal degrees) E 0 1b 3__ U Longitude (decimal degrees) " 4
5 Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc) 1 "
6 Property size (acres)
7 Lake/ river/ ocean adjacent to property
8 Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary) LAL 0 -a/
9 Will work be conducted from land? [' Rrom water ?, F-1
10 Total amount of disturbance (including all excavation, baackkf ripetaining 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 I a ( 12 & t__
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)
k h 4--X 04 • / V Wlrq V Ad �th�AOnrl i ,,V � W C
Owner /Agent's Signature
Printed Name
[15A 1111CAC 0?_i I 05Q2Jf)I
Agent's signature is valid only if an authorization letter from the owner is provided
Date
FORM SSGP 10 -2013 Page 2 of 3

Full Pond/
Normal Water Level
Shoreline
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Lake
(At Full Pond/ Normai Water Level)
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Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ft x 100 ft)*
All proposed vegetation clearing
2 Location of rip rap or fill to be placed 219y the Full Pond/ Normal Water Level elevation 'SO
Location of rip rap or fill to be placed bed the Full Pond/ Normal Water Level elevation
Location of any proposed structures such as buildings, retaining walls, docks, etc
Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
' 6 Location of construction ccess corridors
FORM SSGP 10 -2013 Page 3 of 3

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BRANCH ALIGNMENT 12/31/14 WHILE M055 LAKE DRAWN DOWN
WATER LINE CFULL POND) LOCATED
BY BANKHEAD SURVEYING 03/11/:0
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WATER LINE CFULL POND) LOCATED
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LEGEND
0 EXISTING IRON
CALCULATED POINT
-- -- WELLS PROPERTY LINE
- - - - OLD WATER LINE
------- - - - --- ROAD RIGHT OF WAY LINE
LINE PLOTTED PER DEED
(UNLESS SHOWN WITH BEARING AND DISTANCE)
704.484.1731
504 50UTht DEKALB STREET
SHELBY, NORTH CAROLINA 28150
BANKHEAD SURVEYING , PA
1203 EAST MARION ST, SUITE 1
SHELBY, N.C. 28150
704- 481 -1040
FIRM LICENSE NUMBER= C -0972
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WELLS PROPERTY
21q FAIRMONT DRIVE
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THI5 DRAWING 15 THE PROPERTY OF FRED B. BLACKLEY. A5LA
AND 15 NOT TO BE REPRODUCED OR COPIED IN WHOLE OR
IN PART WITHOUT PERMI5510N. IT 15 NOT TO BE U5ED ON ANY
RECEIVED OTHER PROJECT AND 15 TO BE RETURNED UPON REQUEST.
FE-B 02 2015
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2x10 PERIMETER BAND
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PLYWOOD 5HE�-'TING. #16 FELT
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OPTIONAL PLYWOOD CEILING
OWNER OPTION, GABLE ROOF WITH OPEN OR CLOSED ENDS
242 OR 240 STRUCTURAL MEMBER
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THIS DRAWING 15 THE PROPERTY OF FRED B. BLACKLEY. ASLA
AND 15 NOT TO BE REPRODUCED OR COPIED IN WHOLE OR
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DRAINAGE AREA FLOWING TO ANY POINT ON SILT FENCE SHALL NOT EXCEED ONE ACRE
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INSTALL AND MAINTAIN 51LT FENCE AND OTHER MEASURES FOR DURATION OF PROZCr
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AX. SEDIMENT STORAGE LEVEL
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TOP ELEVATION - THIS PROJECT - 737.0 CUNDER DOCK)
FULL POND CEL.736.0)
TOE ELEVATION - 733.0
'NOTCH IN' AT TOE TO MO-D STONE IN PLACE
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2x2 LEDGER - ALT.- JOIST MANGER
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DECKING (8 /4x;4 OR 2x6 OR 'TREX')
2x8 JOIST - TO REST ON BEAM C16' OC MAX.) 12' FOR 'TREX*
410 BEAM C2 - 240's WITH BLOCKING)
ATTACH MEMBERS TO POST WITH 3 - 3/8' LAG BOLTS
FULL POND (EL ,73G.0) — --
6x6 POST
ALL WOOD PRl $5URE TREATED SOUTHERN YELLOW PINE OR APPROVED TROPICAL HARDWOOD
ALL FASTENERS HOT DIPPED GALVANIZED
POST TO SUPPORT ROOF ABOVE
DECKING (5 /4xG OR 2x6 OR 'TREX')
2x8 JOIST CIS 00 MAX.) 12' FOR 'TREX'
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CONCRETE FOOTING
WELLS PROPERTY
219 FAIRMONT DRIVE
SHELBY. N G
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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