19970921 Ver 2_Shoreline Stabilization_20200827

Water Resources
ENVIRONMENTAL QUALITY
State f NYrthloardZiia VC
Department of Environment and Natural Resources
Division of Water Resources Pwot
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 02-2017
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent to:
If sending via US Postal Service If sending via delivery service (UPS, FedEx, etc.)
Karen Higgins Karen Higgins
DWR — 401 & Buffer Permitting Branch DWR — 401 & Buffer Permitting Branch
1617 Mail Service Center 512 N. Salisbury Street i ,
Raleigh, NC 27699-1617 Raleigh, NC 27604 RECEIVE®
A. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: James T. Weaver. Jr.
Mailing Address: 811 Fox Lair Trail
Semora, NC 27343
Telephone Number: 919-222-2800 Fax Number:
E-mail Address: [e-mail]
2. Agent/ Contact Person Information
AUG 2 7 2020
NCDEQ/DWR/NPDES
A signed and dated copy of the Agent Authorization letter must be attached if the Agent has
signed this application form. (A form can be downloaded here:
httD://www.saw.usace.armv.mil/Portals/59/docs/reRulatorv/rep-docs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf)
Name:
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Fax Number:
B. 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, buildings, retaining walls, docks, impervious surfaces, 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.
FORM: SSGP 02-2017 Page 1 of 3

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: Person Nearest Town: Roxboro, NC
Lake/ river/ ocean adjacent to property: Hyco Lake
Property size (acres): X acre
Subdivision name or site address (include phase/lot number):
811 Fox Lair Trail Semora NC 27343
Directions to site - please include road names and numbers, landmarks, etc.: from Roxboro
NC take Hwy 57 west. Cross three bridges at Hyrn Lake. After the third brid a take first road
to right, Zion Level Church Road Go one mile take first right Fox Lair Trail About a mile
down Fox Lair Deer Run will fork to the left. Continue ri ht stmi ht on Fox Lair. 811 is
second house (grav and green) on left after fork Number is on mailbox
Latitude (in decimal degrees) 36.481330 Longitude (decimal degrees)-79.113730
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): residential
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Install 53' of rip ran on north shoreline lnsta1124' of rip rap
between boat house and attached deck. Grade and install a 13 ft. wide section of riD rap 40'
UP the bank to connect to a dry creek bed which will handle rain runoff Reasons soil is
collapsing under my deck Rain runoff is washing my Yard into the lake
7. Will work be conducted from land? X
❑ From water? ❑
8. Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent impacts (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
245 sq. ft.
Temporary impacts in square feet:
0
9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet
land -ward
Permanent impacts (including back fill, excavation, rip rap, retaining walls, etc.) in square feet:
1090 sq. ft.
Temporary impacts (temporary clearing, construction corridor) in square feet:
0
FORM: SSGP 02-2017
Page 2 of 5

10. 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): Only weeds and grass will be
removed.
11. Signat e p `
1 D ��L —'-G1C)
Ow r/ ent's Signature' [15kUNC 02H .0502(f)] Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
12. Please approximately sketch the following information on this plan and provide dimensions for
each item:
a. All proposed vegetation clearing
b. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
c. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
d. Location of any proposed structures such as buildings, retaining walls, docks, etc.
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
Lake
f At FuH PaW Norm der Level)
E,�iS��n1 BOA4 Norse
ao;t• f ar4.
11 Pond/ Normal Water
Shoreline
Plan View
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FORM: SSGP 02-2017 Page 3 of 5

Side View
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FORM: SSGP 02-2017 Page 4 of 5

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Property of
JOSEPH J. JACKAN
a BETTY J. JACKAN
VICINITY MAP Cunningham Twp„ Person Co., N. Carolina
I November 1906, Noll - Hamlett A Assoc.
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%R/w I 1, NEAL C. IIAMLer/ __- Certify
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