20210509 Ver 1_David Raymond - Lake Royale Info_20210408

ICHAEL T. L LEY
General Contractor- License # 31693
3192 Lewis Road, Elm City, NC 27822
252-469-9689
RECEIVEDINCDEQIDWR
APR 0 8 2021
Water Quality
Permitting Section
Enclosed you will find 4 copies of the shoreline stabilization application form for 120 Custer Cove
Louisburg, NC Please contact me if anything further is needed to get this
completed.
Michael Langley
252-469-9689
[e-mail]

Division of Water Resources
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 - Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
Shoreline Stabilization Application Form
Four 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
1. Owner Information
Name:G .
Mailing Address:
[15A NCAC 021.0502(a)]
-62) co*rwc...iya
RECEIVED/NCDEQ/DWR
APR 0 8 202J
Water Quality
Permitting Section
Telephone Number: (41"t)'f2 - Y995' 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:
http://www.saw.usace.ar my.mil/Pot Pais/S9/docs/r egulatoryiregdocs/Permits/SAMPLE AGENT AUTH
H
ORIZATiON FORM.pci; must a attached if the Agent has signed this application form.
Name: �; (etc 1
LtiA
Company Affiliation:
Mailing Address: �(� �1js
Cs� lam- `IVC--
Telephone Number: S.-ii-tA -titan Fax Number:
E-mail Address: -Z t 0m
Person to receive the Certification Approval: cltet.4.12. t41L-18
11. Project Information 1+5A NCAC 02H .0502(a) at (h)1
1. Attach a vicinity map (Le. street map)clearlyshowingthe location of the property p p rty 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 4

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: �t-t�Lx Nearest Town: (,�iVL!"
Subdivision name or site add ess (inc ude phase/lot number):
LaXe. e ! 12-0 CtAA-e i*- c 1- 4 �.ts,c
Directions to site - please include road names and numbers, landmarks, etc.:
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): 1�� S Ceti %?c . I&..0
6. Property size (acres): C G-s-
7. Lake/ river/ ocean adjacent to property: e..4--a.y'.-Pro 00- - ,
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): b i,L.V C - �Z ► b04.at ;L . _-
i'-
9. Will work be conducted from land? — From water?
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:
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the n rmal pool lake level/ Normal Water Level andL50 feet land -ward in
square feet or acres: " `l�f' . 71QO - -., deck C W,rt� L,ukci.s
12. Please describe the vegetation above the normal pool lake level/ Normal Level and
50 feet landward to be impacted (number of trees, for instance):
fr-w re.i ii
1I_ 2h
Owner/Agent's Si e' 115A. NCAC 02 .0502(f)1 Date
Agent's signatur 's valid nfy if an authorization fetter from the owner is provided.
FORM: SSGP 10-2013
Page 2 of 3

11. Signature
Owner/Agent's Signature' [i5A NCAC 02H .0502(0] 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
Full Pond/ Normal Water Level
Shoreline
Plan View
take
emit metreoi wen tew
Full Pond/ Normal Water level t
ir
.1•fi R. ( ist 1•1•
,�.i.,lj—
•.fnewy r8
EXA
Plan View
Existing Dock
7SC4
/e45ixo al/a
ifi•.
as.+fy'tymltea
Lake
(At Full Pond/ Normal Water Level)
https://files.nc.aovinedeq/Water%20Quality/Su rface%20Wa... Permits/SSGP-02-2017-Shoreline-Farm-final-4-15-20.docx
10119/20, 12:38 PM
Page 3 of 4

Side View
FORM_ SSGP 02-2017
• 3A-.
Lake
(At Full Pond/ Normal Water level)
F
0
-0
c
0
3 ft. below full pond water level
,'guce.ry
No _PP
4 ft. above full pond water level
2 ft. additional clearing
'if necessary
Page 1 of 3
https://files.nc.govincdeq/Water%20Quality/Surface%20Wa...Permits/SSGP-02-2017-Shoreline-Farm-final-4-15-20.doer 10/19/20, 12:38 PM
Page 4 of 4

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. R - o� Of% ! PLAN NO.
PARCEL ID: Oa3183
STREET ADDRESS: 1 10 £1 . (O�/ (�
gtn4
bwv_
Please print:
Property Owner:
Property Owner: ,,,Dk Wes, A Ra. yv, Bv�
David. 'f Raw M,gNi.
The undersigned, registered property owners of the above noted property, do hereby authorize
' tc=tc- 2 �� �x� (1 i� , of
(Contractor ! Agent) 3 () (Name of consulting firr )
to act on my behalf and take all actions necessary for the processing, iss'uance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
461/ A-14-nA4Kn ja. fe, Drr�e,, £a- ?& 02751-e
q
Telephone: qt) 'fig
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature
Date:
/z�s/aozo
c_Pa,INK,71A _Apvcbt=4-1.-
Authorized Signature
Date:

LAKE ROYALE
2840-04-3739 ���� CSC I
00 1219 PG 07>
PC 12 PO 58 �+ I
LOT 2010
-TM MUSTER COVE- /
PAUL k JANET BARA2A52
1002 LANE ROYALE
LOUITRUR0, NC 27849
280.10
/ _ O
/ 2840-04-2791 —
OS 2080 PG 999
PC 12 PO 58
LOT 2009
4U- —120 CUSTER COVE—
'' i '- Z3659.9 54 FT A7.11:7-44::24.Hr s'D � � �
r, / 0.55 AC Ii6,411
� X�'/y ✓'Aill K(/IPF• y/�1aea+a'3a•e/348.09' -•- ___, ,,,� - �. � / m00%
/ .---Oi55.00, y 0 )/ /
/ 2840-04-2054 REFERENCE IRON HCO t"g f f
/ DO 1060 PO 907 SET 0 Y FRW PP Q.',Ei ( 1
/ PC
LOT 2008 77 r /j
-122 CUSTER COVE- /
655/
LAKE ROYALE
LOUISBURG, NC 27840 r
ii
IPF r
I
1/
611
IPF
e J
117 O 30' 80' 90'
I„ s30• _.....
IPF
to GRAVE. (,RIVE 7;;;;-
MO-,
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IPF 1
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1
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wa •IUKPie rnuim
Noll UOMRA1IRMUM
0RL OJONHr*O Waft
N.00 NOT 10WPM!
Ut7NYP0t0
IK scrancsMVO
VICINITY
N. L
MAP/DEED REFERENCES:
OD 2080 PC 999
00 1906 PO 003
P8 12 PO 88
SURVEY CERTIFICATE
1 OV. COOKE, AS A PROFESSIONAL LAID SURVEYOR IN THE
STATE OF NORTH CAROLINA, 00 HEREBY CERTIFY THAT 111111 PLAT
WAS DRAW/ UNDER MY SUPERVISION FROM AN ACTUAL SURVEY MADE
UNDER MY SUPERVISION AND COMPLETED ON 2-22-2020, USWO
SHE REVERENCES SNONH HEREON; MAT THE 000NDN0ES NOT
SURVEYED ARE CLEARLY INDICATED AS DRAWN FRED IN0ORMA110N
FOUND IN THE AVM ICES SHOWN HEREON; THAT THE RATIO OF
PRECISION AS CALCULAI•EO IS 1 , 10,000 a ;{ THAT
1M6 MAP WAS PREPARED IN ACCORDANCE YARN NORM CAROLINA
GENERAL STATUTES 47-30, AS AMENDED. WINLESS /Y ORIMSAL
SIONATUREfak8Eu -D0 / y fi-bFH, .•y A.O., 2020.
NOTES:
I. AREAS COMPUTED BY COORDINATE NEM00.
2 RAMS OF BEARINGS; PLAT 800K 12 PACE 88 OF FRARKUS
COUNTY REGISTER OF DEEDS.
3. THIS SURVEY WAS PREPARED WITIIOUT THE BFNERT OF A
TIRE REPORT AND MAY BE SUBJECT TO ANY MATTERS MAT A
FULL 11711 SEARCH W0UL0 DISCLOSE.
4. ALL DISTANCES ARE HORIZONTAL GROUND DISTANCES.
5. METAL STAKES FOUND OR SET AT ALL CORNERS UNLESS
N01E0 OTHERWISE
6. THIS PA9CE6 IS LOCATED 74 ZONE X PER FIR/ PANEL
63720284000J, EFFECTIVE DATE 4-10-2013.
7. MIS NAP IS OF F1IARKIIN COUNTY PARCEL NUMBERED (PIN)
2040-04-2791.
8. MIS PROPERTY UES WITHIN 111E TAR-PAMUCO RIVER BASIN.
NUTRIENT SENSITIVE WATERS WITHIN THIS BASIN ARE 9LIOJEOT
TO P401EC11VE BUFFERS,
9, LOT 2009 OF T11E •LAKE SAOAMORE MAP 8 OF 20 SHEET 7
10 THIS PROPERTY 19 SUBJECT TO RESTRICTIVE 80VENANT9 OF
ME LAKE ROYALE PGA.
11• THE ACREAGE WAS MEASURED 10 WATERS EDGE AT THE
TIME OF SURVEY. THIS ACRBAOE MAY CHANGE OVER 114E DUE
TO ALLUVIUM OR EROSION AFFECTS.
TYPE OOP pPLLEAT pFE spy �AA� L�TY g L
ICER T�OACryOp�NE l7R�AlORE�,LgOpF�A F'OLApOy/1HpTO�y AS QIECki g OP7
A OR0�1}C�pq�SIN AprTpREOOCFNUILATEE'S Fy1.7R1MLS �LI�A�A7 A4h'gR{MT�
II a [iRW'4AMCE M elitgg0LIarg PARCpt1�6�8 `ARE TEDp ASS ID`
C 1AD�NL4�D � 1 QNEAIE A0AgNIEEW 31REEt O0p7NOEP*4310
I� 0. OR OiYRONaF O flM IR OMEN IVY
Q E. THAT INFIN1O5NR�I92 10IM3 SR aSvc
NAS0 CairiEORIMr(O7 A •
0UY T7: COVE, PROFESSIONAL LAND SVRLEYOY Na L-090
Tine: BOUNDARY SURVEY
DAVID RAYMOND
120 CUSTER COVE
CYPRESS CREEK TOWNSHIP
FRANKLIN COUNTY
GC MAPPING,
711 LAKE ROYA
LOUISBURG, NC 2
GUY V. COOKE, PL8
FIRM # P-1311
919.901.5641
80ALQ;, 30
DATE: i 2-23-20