20200467 Ver 1_Shoreline Stabilization_20200331

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
N__r
s
Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
ENVIRONMENTAL QUALITY 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
Karen Higgins
DWR - 401 & Buffer Permitting Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
A. Applicant Information [15A NCAC 02H .0502(a)]
Owner Information
Name: I e-re50. SG. p10
If sending via delivery service (UPS, FedEx, etc.)
Karen Higgins
DWR - 401 & Buffer Permitting Branch
512 N. Salisbury Street RECEIVED
Raleigh, NC 27604
MAR 31 2010
Mailing Address: ) 3 O L.a lze. )QO yo-( e
Telephone Number: q I�i'-1SJ —I �(o Fax Number:
E-mail Address: tx�Sgsc-ip t e*ii 9nncu I • GCy✓1
2. Agent/ Contact Person Information
KDEOUNRINPDES
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://www.saw.usace.army.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf)
Name:
Company Affiliation:
Mailing Address:
T
Telephone Number: aS-Q- ?957-aR !o l Fax Number:
E-mail Address: L-eeCA-X'p(o(P P i C 10LA-4 . Caul
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: P1-0-A IG I 1 Y 1 Nearest Town: U-M rl
Lake/ river/ ocean adjacent to property: L-ake_ Foyo-le
Property size (acres): • 39 (.0 0-Gres
Subdivision name or site address (include phase/lot number): Z 9'Z01
Directions to site - lease include road na
,It l nr\ � EA(,,5}' Chu"ROa
Latitude (in decimal degrees)
nd numbers, landmarks etc.: } bt1 q? �0
on sl edge and Z) on Cheyenne bri ve.
Longitude (decimal degrees)
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): LA.nctWe_IoPeoI
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): IY15tVLLI IL), Y I (o dock,
7. Will work be conducted from land? [f From water? ❑
8. Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent im acts (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
0 biG- 'w-i- R�Rn-p ► D Sa �-�
Temporary impacts in square feet:
D
9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet
land -ward
Permanent impacts (including ba k fill, excavation, rip
r,'� D Gub<<- I c40 C,q
retaining walls, etc.) in square feet:
Temporary impacts (temporary clearing, construction corridor) in square feet:
O
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): Sir'ce5 , 9005q;lF+
orlF C(A4&rb0_nc .,
11. Signa re
3 a-t -0
Owner/Agent's Signature' [15A NCAC 02H .0502(f)) D to
`Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 02-2017 Page 2 of 4

M
N

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
La ke
(At Full Pond/ Normal Water Level)
la'�t6�
Full Pond/ Normal Water Level «�o�oorxsa 2►,� _ _
Shoreline�3
Z' x yam'
Plan View
Lake
(At Full Pond/ Normal Water Level) Existing Dock
/30hx 7h
rrrrrrrrrrr
E AMP E
Plan View
FORM: SSGP 02-2017 Page 3 of 4

SURVEY FOR b
Sim
THERESA SCIPIONI ,
o_ LOT 2829, LAKE ROYALE
w 1251 SAGAIVIORE DRIVE
N PIN-H 2830-89-2305
. D.B. 1524PAGE 137
. ................
P.R.F. 1, SLIDE 102A VICINITY MAP
CYPRESS CREEK TOWNSHIP LEGEND:
FRANKLIN COUNTY, NORTH CAROLINA EIP -EXISTING IRON PIPE
EIS — EXISTING IRON BAR
APRIL 10, 2019 BEIP — BENT IRON PIPE
I—' BEIB — BENT IRON BAR
0 40 20 0 40 80 CM - CONCRETE MONUMENT
EPK - EXISTING PK NAIL
SPK - SET PK NAIL
SCALE 1 n=40� NIP - NEW IRON PIPE SET
R/W - RIGHT OF WAY
CAN - CABLE TV BOX
EB - ELECTRIC BOX
TEL - TELEPHONE PEDESTAL
PP - POWER POLE
OHL - OVERHEAD LINE
LP - LIGHT POLE
WM - WATER METER
WV - WATER VALVE
CO - SEWER CLEAN -OUT
I
TIE TOIN AN EPK
CT
O THE SA INTERSECTION EPK
- OF SAGAIIORE DPJVE
& NAna+Is COVE �
o
c c .+4
U ^
Oj
�--� APPROYMATE LOCATION N
zq C , OF PLAIN
YEAR FI MA FLOOD N
Z v'n PLAIN PER FlMA flRAI CO
s EE co PANEL# 37202830DOK
gs,� DATED APRIL 16, 2013 /
r20',J
_ — _ RIPRRAP
O____ MEANIG- _ _��230.00'Ei02829 e�/�ryLit17,250 S`1•``•LP GAS TANK N0.396 AC. IS 5.5' NORMOFPROPERTY LINEUj
SATEWTE OLSTiIS 5.5' NORM FENCE IS 8.3'ZOF PROPERTY LINE NORTH OF G 0
c'y PROPERTY LINE O -m cc
LD
Ed230.00' _ Fj N Q CL
1 N 8T20'S4' W a
1
I
11 2830
1 r.
I DECLARE THAT THIS SURVEY COMPLIES WITH THE NORTH �,,++"'"+�+""`�a,�
cre `�,g % CAROLINA STANDARDS OF PRACTICE FOR SURVEYING, �.�' �� CARo
�..J��J1� IS t0) FOR CLASS A SURVEYS AND THAT THE
CALC10�00+ULATEDaRA_nO OF FURTHERMORE.SION BEFORE ADJUSTMENTS
PRO PROPERTY CORNERS SHOWN :�p�O1.gSS
CAWTHORNE, MOSS ARE PRIM CONTROL MONUMENTATION FOR THE RE- _ =Q�
& PANCIERA, P.C. ESTA9 T OF PROPERTY CORNERS IN THE ABSENCE SEAL
OF MO MENTS AND OTHER SUBDIVISION PROPERTY = 3 L-3035
Professional Land Surveyors s
CO ERS. 15 SURVEY IS NOT TO BE RECORDED WITH- %t✓ �+
C-1525 OU THE L ITTEIV AUTHORIZATION OF THE SURVEYOR: ' ` 'f .t,�
333 S. White Street ':'�S1�S m (V��=
Post Office Box 1253
Woke Forest, N.C. 27588 ''•.,y �. Pi�.•'�
[phone]

1251 Sagamore Drive j
Deck to be positioned
in-between cones.
10'Dx16"W
Side View
Deck to be positioned
in-between cones.
10'Dx16"W
XTree Removal
Area to be modified
with Rip Rap — 40' along
waterfront. 2' Below
NWL & 2' above NWL