20181580 Ver 1_Shoreline Stabilization_20181115

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'.• State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Water Resources 15A NCAC 02H.0500 —Water Quality Certification, Shorelin&StaI
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ENVIRONMENTAL QUALITY FOR . SGP 02-2.
Shoreline Stabilization Application Form 2 0 1 g 1 5 g 0
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
Raleigh, NC 27699-1617 Raleigh, NC 27604
A. Applicant Information [15A NCAC 02H .0502(a)] \ �S\\
1. Owner Information \ \
Name: John and Pat Drouin
Mailing Address: 2196 Sledge Rd
Louisburg NC 27549
Telephone Number: 919-497-0273 Fax Number: 919-497-0277
E-mail Address: [e-mail]
2. Agent/ Contact Person Information
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:
http Hwww.saw.usace.army mil/Portals/59fdocs/regulatory/regdocsfPermits/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)J
I. 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: fdnklin Nearest Town: Bunn
Lake/ river/ ocean adjacent to property: Tar River/Lake Royale
Property size (acres): .551
Subdivision name or site address (include phase/lot number): Lake Roavle
Directions to site - please include road names and numbers, landmarks, etc.: From the
entrance to Lake Royale turn Right on Shawnee turn Right on Sagamore turn Left on Custer Cv.
Latitude (in decimal degrees) 35.960480 Longitude (decimal degrees) -78.187167
S. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): residential undeveloped lot.
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Build a single boat house dredging 12' into shore and
14'wide Construct a 10 x 12 covered dock area with stairs into the water. Ripwrap along
remainder of shore line approx. 75'. Sea wall around boat slip approx. 35'.
7. Will work be conducted from land? ❑ 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:
345 sgft
Temporary impacts in square feet:
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:
3' wide by 87'long 261 sgft. Rip wrap 14' x 22' boat house 308 sgft ad 10' x 12' covered
area 120 sgft. 7O0sgft.
Temporary impacts (temporary clearing, construction corridor) in square feet:
S00sgft
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): 5 trees a lot of wild bushes at
shore line.
FORM: SSGP 02-2017 Page 2 of 5

(Full Pond
11. Signatur
_ I 9
Owne gent's Signature* [15A NCAC 02H .QW fat
*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
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Shoreline _
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Plan View._
Lake
(At Full Pond/ Normal Water Level)
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FORM: SSGP 02-2017 Page 3 of 5

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FORM: SSGP 02-2017
Page 4 of S
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FORM: SSGP 02-2017
Page 4 of S

3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing
'If necessary
Existing bank
10 ft. bank
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FORM: SSGP 02-2017 Page 5 of 5

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