20211024 Ver 1_Shoreline Stabilization_20210623

Shoreline Stabilization Application Form
15ANCAC 02H .0500 — Water QualityCertification, Shoreline Stabilization
FORM SSGP 10-2013
DRAFT -NOT FOR USE AT THIS TINE
Submission Form
Pre -Filing Meeting Information
Before submitting this form please ensure you have submitted the Pre -Filing Meeting Request Form as we will not be able
to accept your application without this important first step. The Pre -Filing Meeting Request Form is used in accordance
with 40 C.F.R. Section 121.4(a) "At least 30 days prior to submitting a certification request, the project proponent shall
request a pre -filing meeting with the certifying agency" and in accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5)
all certification requests shall include documentation that a pre -filing meeting request was submitted to the certifying
authority at least 30 days prior to submitting the certification request. Click here to read more information on when this
form is needed prior to application submission or here to view the form.
Attach documentation of Pre -Filing Meeting Request here:
DWR Pre -Filing Meeting Request Form.pdf 50.14KB
Pre -fling Meeting or Request Date 6/21/2021
ID#
SAW 2021-00692 Version
I. Applicant Information [15A NCAC 02H .0502(a)]
Please note: fields marked with a red asterisk * below are required. You will not be able to submit the form until all
mandatory questions are answered.
Primary Contact Email *
Owner Information:
Name:*
Email:
*
Phone Number:*
Mailing Address:*
[e-mail]
Rease provide an email address for payrrent and requests for pore information here.
Carol Moynihan
coynihan 137@gmail. com
[phone]
(xxx)xxx-xxxx
Street Address
1309 Lake Royale c/o Laura Allen
Address Line 2
CitY
Louisburg
Rbstal / Zip Code
27549
State / Rovince / Region
NC
Country
United States

Is there an agent working on the
project? *
Agent/Consultant Information
.......................................................................................................
Name:*
Company Affiliation: *
Email:*
Phone Number:*
• Yes
✓ No
Clinton Thomas Gupton
House to Home Construction inc
[e-mail]
[phone]
( )m-
Mailing Address:* Street Address
391 huford harris road
Address Line 2
City State / Province / Legion
spring hope NC
Fbstal / Zip Code Country
27882 United States
Asigned and dated copy of the Agent Authorization letter:*
Letter for Clint Gupton.pdf 104.73KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
(Carol Moynihan, Primary Residence)
If your project has a formal name please use this. If your project does not have a formal name, please identify your project by
the owner name and proposed activity (Jones Property Access Road, Smith Guest House, etc.) List in parentheses any
other names that have been used to identify the project in the past.
1. Provide 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.*
✓ Upload File
✓ Look up address
Upload Map: 3858Pre1 W notes.pdf 659.18KB
Latitude:*
35.973638
Longitude:* -78.200125
2. Provide a detailed site plan showing property boundaries and proposed locations of vegetation clearing,
structures (buildings, retaining walls, docks, impervious surfaces, etc.), rip rap, excavation or dredging
below Full Pond/ Normal Water Level elevations, and construction access corridors. You may use the
diagram under section 12.normal pool lake level/normal water level*
3858Pre1 W notes.pdf
Riprap section.pdf
Please use the diagram at the link below:
659.181(B
130.05KB
https://edocs.deq.nc.gov/WaterResources/0/edoc/616616/Shoreline%20Layout.docx
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale of some sort- a
yard stick, shovel handle, etc.)*

2021-6-21-16-55-28.pdf
3858Pre1 W notes.pdf
1.87MB
659.18KB
4. Location of the property (where work is to be conducted)
Nearest Town:* bunn
County:* Franklin
Lake/ river/ ocean adjacent to cypress creek
prope rty:
Subdivisions name or site address:* Lake Royale Lot #2803
Include phase/lot number
Directions to site:*
From Raleigh go east on 64 take exit 442 on SR 1737 .3miles
Keep left to continue toward Tant Road 100ft
Turn left on Tant Road 1.6 miles
Turn right on Old US highway 64 2 miles
Turn left onto Mulberry Road 2.2 miles
Turn right onto Sledge Road 2.5 miles
Turn right onto Cheyenne Dr into Lake Royale
Turn right on Sagamore Dr. Lot on left at 1321.
Rease include road narres and nurrbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
residential undeveloped
Ibsidential, undeveloped, etc.
6. Property Size
.4 acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
We are proposing to build a new residence at 1321 Sagamore Drive
Louisburg NC
8. How will the work be done? *
rJ From Land
r From Water
9. Total amount of disturbance below the normal pool lake level/ normal water level:*
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
200
square feet
10. Total amount of disturbance above the normal pool lake level/ normal water level and 50 feet
land -ward: *
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
5000
square feet
11. 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)
approx. 8 trees
Sketch:
3858Pre1 W notes.pdf 659.18KB
Application Fee:

Once the application has been accepted. You will need to send a corresponding fee in with the appropriate DWR#. The
application fee is as follows (pursuant to G.S. 143-215.3D):
o $240.00 for impacts to lake (below normal water level) of less than 1 acre
o $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:
o I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the
best of my knowledge and belief
o I, the project proponent, hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time.
o I agree that submission of this Shoreline Stabilization online form is a "transaction" subject to Chapter 66, Article 40 of
the NC General Statutes (the "Uniform Electronic Transactions Act");
o I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act");
o I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
o I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:*
Signature:
Clinton Thomas Gupton

Initial Review
Is this accepted into the review C' Yes 0 No
process?*
Project Number:* 20211024
Select Reviewer:*
Select Reviewing Office:
Has payment been received?*
What amount is owed?*
Version: *
Stephanie Goss:eads\szgoss
Raleigh Regional Office - [phone]
1
✓ No Payment Needed
✓ Fee Received
C' Need Fee - send electronic notification
C' $240.00
✓ $570.00

March 31, 2021
Carol A Moynihan
1321 Sagamore Dr.
Lake Royale Louisburg, N.C. 27549
To Whom it may concern,
I, Carol A Moynihan, certify that I am the owner of the building lot located at 1321 Sagamore Dr in Lake
Royale.
I do hereby give Clint Gupton, owner of House To Home Construction And Design, permission to sign off
on any documents as it relates to this property and the obtaining of permits and variances.
Thank you,
Carol A Moynihan
Carol A Moynihan
Digitally signed by Carol A Moynihan
DN: cn=Carol A Moynihan, o, ou, email=[e-mail], c=US
Date: 2021.03.31 07:15:50 -04'00'

PRELIMIN
( 2800 )
( 2801 )
( 2802 )
Now or Formerly
Lake Royale P.O.A., Inc.
( D.B. 1803, P. 923 ) Ae
Oi
Edge of Lake
00�p
r r r V v u`r a.#6,44/.
— LAKE ROYALE — .��.
iaQ
597 Sq. R.
ls Buf[ar
Edge of LakE
Set 5/8
w/Tap
Ground
Calculated Point
In 16" Pine
Tree
Corner of Boat
Shelter is ±15'
West of Projected
Surveyed Line
Boat Shelter
Bo Dock
4-a t Oepw,ria
Lake Retaining Wall
ebar
Above
urface.
50'
Proposed
House
53 sq. r�
Buffer �
Chd.: S 40'01'35"E 151.65'
cordation, Conveyances or
Found 3/8" Iron
Pipe w/Top 2'
Below Ground
Surface
Tie Line From Found Mag Nail
w/Top Flush w/Asphalt Surface
In Apparent Centerline Intersection
of Sagamore & Nakoma Drives:
N 56'39'50"W 882.78'
Found 1/2" Iron
Rebar w/Top 1"
Below Ground
Surface
<,�
c)•�C•0 S' S //
/ 4,,
,.„
(2804 )
Now or Formerly
Delores Anita
Rawlins
( D.B. 2172, P. 1929
Found 1/2" Iron
Rebar w/Top 1"
Below Ground
Surface
100—Year Flood
Limits
( See Notes )
Now or Formerly
Lake Royale
50' Tar River Basin P.O.A., Inc.
Riparian Buffer
( D.B. 1803, P. 923 )
eO J
.94
(44.ossIr,� Found 1/2" B
Reber w/Top 1" %))t
Above Ground
Surface
( 2805 )
This document originally issued and sealed by William
T. Dement, Jr., L-1456 on March 27, 2019.
This media should not be considered a certified
document.
Revised: 2/11/20 — Adjusted 50' Tar River Basin
Riparian Buffer Line
I, William T. Dement, Jr., certify that this plat was drawn under my supervision from an
actual field survey made under my supervision (deed description recorded in Book 1007,
Page 913); that the boundaries not surveyed are clearly indicated as drawn from information
found in Plat Record File 1, Slide 102; that the ratio of precision as calculated is 1/
20,000; that this survey is of an existing parcel or parcels of land and does not create a
new street or change an existing street; that this map was prepared in accordance with G.S.
47-30 as amended. Witness my original signature, license number and seal, this 27th day
of March, 2019.
Professional Land Surveyor L-1456
PLAT OF BOUNDARY SURVEY FOR
JOHN B. ZEPLIN & WIFE, MARCY V. ZEPLIN
(Record Property Owner — John B. Zeplin, et ux)
1321 Sagamore Drive, Cypress Creek Township, Franklin County, North Carolina
Scale: 1 "=60'
60 0
Date: March 27, 2019
60 120 180
GRAPHIC SCALE — FEET
Surveyed & Mapped By
WILLIAM T. DEMENT, JR., Professional Land Surveyor, P.A.
NOTE: Owner's name shown for indexing
purposes only and does not constitute
title certification.
- � 411
- OttP4,Ti - 491442For Recordation, Conveyances or Sales
9-y
102 West Nash Street Louisburg, N.C. 27549 (File No. 3858)

PRELIMIN
( 2800 )
( 2801 )
( 2802 )
Now or Formerly
Lake Royale P.O.A., Inc.
( D.B. 1803, P. 923 ) Ae
Oi
Edge of Lake
00�p
r r r V v u`r a.#6,44/.
— LAKE ROYALE — .��.
iaQ
597 Sq. R.
ls Buf[ar
Edge of LakE
Set 5/8
w/Tap
Ground
Calculated Point
In 16" Pine
Tree
Corner of Boat
Shelter is ±15'
West of Projected
Surveyed Line
Boat Shelter
Bo Dock
4-a t Oepw,ria
Lake Retaining Wall
ebar
Above
urface.
50'
Proposed
House
53 sq. r�
Buffer �
Chd.: S 40'01'35"E 151.65'
cordation, Conveyances or
Found 3/8" Iron
Pipe w/Top 2'
Below Ground
Surface
Tie Line From Found Mag Nail
w/Top Flush w/Asphalt Surface
In Apparent Centerline Intersection
of Sagamore & Nakoma Drives:
N 56'39'50"W 882.78'
Found 1/2" Iron
Rebar w/Top 1"
Below Ground
Surface
<,�
c)•�C•0 S' S //
/ 4,,
,.„
(2804 )
Now or Formerly
Delores Anita
Rawlins
( D.B. 2172, P. 1929
Found 1/2" Iron
Rebar w/Top 1"
Below Ground
Surface
100—Year Flood
Limits
( See Notes )
Now or Formerly
Lake Royale
50' Tar River Basin P.O.A., Inc.
Riparian Buffer
( D.B. 1803, P. 923 )
eO J
.94
(44.ossIr,� Found 1/2" B
Reber w/Top 1" %))t
Above Ground
Surface
( 2805 )
This document originally issued and sealed by William
T. Dement, Jr., L-1456 on March 27, 2019.
This media should not be considered a certified
document.
Revised: 2/11/20 — Adjusted 50' Tar River Basin
Riparian Buffer Line
I, William T. Dement, Jr., certify that this plat was drawn under my supervision from an
actual field survey made under my supervision (deed description recorded in Book 1007,
Page 913); that the boundaries not surveyed are clearly indicated as drawn from information
found in Plat Record File 1, Slide 102; that the ratio of precision as calculated is 1/
20,000; that this survey is of an existing parcel or parcels of land and does not create a
new street or change an existing street; that this map was prepared in accordance with G.S.
47-30 as amended. Witness my original signature, license number and seal, this 27th day
of March, 2019.
Professional Land Surveyor L-1456
PLAT OF BOUNDARY SURVEY FOR
JOHN B. ZEPLIN & WIFE, MARCY V. ZEPLIN
(Record Property Owner — John B. Zeplin, et ux)
1321 Sagamore Drive, Cypress Creek Township, Franklin County, North Carolina
Scale: 1 "=60'
60 0
Date: March 27, 2019
60 120 180
GRAPHIC SCALE — FEET
Surveyed & Mapped By
WILLIAM T. DEMENT, JR., Professional Land Surveyor, P.A.
NOTE: Owner's name shown for indexing
purposes only and does not constitute
title certification.
- � 411
- OttP4,Ti - 491442For Recordation, Conveyances or Sales
9-y
102 West Nash Street Louisburg, N.C. 27549 (File No. 3858)

Qi
Q Q!
-c';)- U
a�
z
c4
cr
\�1

PRELIMIN
( 2800 )
( 2801 )
( 2802 )
Now or Formerly
Lake Royale P.O.A., Inc.
( D.B. 1803, P. 923 ) Ae
Oi
Edge of Lake
00�p
r r r V v u`r a.#6,44/.
— LAKE ROYALE — .��.
iaQ
597 Sq. R.
ls Buf[ar
Edge of LakE
Set 5/8
w/Tap
Ground
Calculated Point
In 16" Pine
Tree
Corner of Boat
Shelter is ±15'
West of Projected
Surveyed Line
Boat Shelter
Bo Dock
4-a t Oepw,ria
Lake Retaining Wall
ebar
Above
urface.
50'
Proposed
House
53 sq. r�
Buffer �
Chd.: S 40'01'35"E 151.65'
cordation, Conveyances or
Found 3/8" Iron
Pipe w/Top 2'
Below Ground
Surface
Tie Line From Found Mag Nail
w/Top Flush w/Asphalt Surface
In Apparent Centerline Intersection
of Sagamore & Nakoma Drives:
N 56'39'50"W 882.78'
Found 1/2" Iron
Rebar w/Top 1"
Below Ground
Surface
<,�
c)•�C•0 S' S //
/ 4,,
,.„
(2804 )
Now or Formerly
Delores Anita
Rawlins
( D.B. 2172, P. 1929
Found 1/2" Iron
Rebar w/Top 1"
Below Ground
Surface
100—Year Flood
Limits
( See Notes )
Now or Formerly
Lake Royale
50' Tar River Basin P.O.A., Inc.
Riparian Buffer
( D.B. 1803, P. 923 )
eO J
.94
(44.ossIr,� Found 1/2" B
Reber w/Top 1" %))t
Above Ground
Surface
( 2805 )
This document originally issued and sealed by William
T. Dement, Jr., L-1456 on March 27, 2019.
This media should not be considered a certified
document.
Revised: 2/11/20 — Adjusted 50' Tar River Basin
Riparian Buffer Line
I, William T. Dement, Jr., certify that this plat was drawn under my supervision from an
actual field survey made under my supervision (deed description recorded in Book 1007,
Page 913); that the boundaries not surveyed are clearly indicated as drawn from information
found in Plat Record File 1, Slide 102; that the ratio of precision as calculated is 1/
20,000; that this survey is of an existing parcel or parcels of land and does not create a
new street or change an existing street; that this map was prepared in accordance with G.S.
47-30 as amended. Witness my original signature, license number and seal, this 27th day
of March, 2019.
Professional Land Surveyor L-1456
PLAT OF BOUNDARY SURVEY FOR
JOHN B. ZEPLIN & WIFE, MARCY V. ZEPLIN
(Record Property Owner — John B. Zeplin, et ux)
1321 Sagamore Drive, Cypress Creek Township, Franklin County, North Carolina
Scale: 1 "=60'
60 0
Date: March 27, 2019
60 120 180
GRAPHIC SCALE — FEET
Surveyed & Mapped By
WILLIAM T. DEMENT, JR., Professional Land Surveyor, P.A.
NOTE: Owner's name shown for indexing
purposes only and does not constitute
title certification.
- � 411
- OttP4,Ti - 491442For Recordation, Conveyances or Sales
9-y
102 West Nash Street Louisburg, N.C. 27549 (File No. 3858)

PRELIMIN
( 2800 )
( 2801 )
( 2802 )
Now or Formerly
Lake Royale P.O.A., Inc.
( D.B. 1803, P. 923 ) Ae
Oi
Edge of Lake
00�p
r r r V v u`r a.#6,44/.
— LAKE ROYALE — .��.
iaQ
597 Sq. R.
ls Buf[ar
Edge of LakE
Set 5/8
w/Tap
Ground
Calculated Point
In 16" Pine
Tree
Corner of Boat
Shelter is ±15'
West of Projected
Surveyed Line
Boat Shelter
Bo Dock
4-a t Oepw,ria
Lake Retaining Wall
ebar
Above
urface.
50'
Proposed
House
53 sq. r�
Buffer �
Chd.: S 40'01'35"E 151.65'
cordation, Conveyances or
Found 3/8" Iron
Pipe w/Top 2'
Below Ground
Surface
Tie Line From Found Mag Nail
w/Top Flush w/Asphalt Surface
In Apparent Centerline Intersection
of Sagamore & Nakoma Drives:
N 56'39'50"W 882.78'
Found 1/2" Iron
Rebar w/Top 1"
Below Ground
Surface
<,�
c)•�C•0 S' S //
/ 4,,
,.„
(2804 )
Now or Formerly
Delores Anita
Rawlins
( D.B. 2172, P. 1929
Found 1/2" Iron
Rebar w/Top 1"
Below Ground
Surface
100—Year Flood
Limits
( See Notes )
Now or Formerly
Lake Royale
50' Tar River Basin P.O.A., Inc.
Riparian Buffer
( D.B. 1803, P. 923 )
eO J
.94
(44.ossIr,� Found 1/2" B
Reber w/Top 1" %))t
Above Ground
Surface
( 2805 )
This document originally issued and sealed by William
T. Dement, Jr., L-1456 on March 27, 2019.
This media should not be considered a certified
document.
Revised: 2/11/20 — Adjusted 50' Tar River Basin
Riparian Buffer Line
I, William T. Dement, Jr., certify that this plat was drawn under my supervision from an
actual field survey made under my supervision (deed description recorded in Book 1007,
Page 913); that the boundaries not surveyed are clearly indicated as drawn from information
found in Plat Record File 1, Slide 102; that the ratio of precision as calculated is 1/
20,000; that this survey is of an existing parcel or parcels of land and does not create a
new street or change an existing street; that this map was prepared in accordance with G.S.
47-30 as amended. Witness my original signature, license number and seal, this 27th day
of March, 2019.
Professional Land Surveyor L-1456
PLAT OF BOUNDARY SURVEY FOR
JOHN B. ZEPLIN & WIFE, MARCY V. ZEPLIN
(Record Property Owner — John B. Zeplin, et ux)
1321 Sagamore Drive, Cypress Creek Township, Franklin County, North Carolina
Scale: 1 "=60'
60 0
Date: March 27, 2019
60 120 180
GRAPHIC SCALE — FEET
Surveyed & Mapped By
WILLIAM T. DEMENT, JR., Professional Land Surveyor, P.A.
NOTE: Owner's name shown for indexing
purposes only and does not constitute
title certification.
- � 411
- OttP4,Ti - 491442For Recordation, Conveyances or Sales
9-y
102 West Nash Street Louisburg, N.C. 27549 (File No. 3858)

DWR Pre -Filing Meeting Request Form
Contact Name*
Contact Email Address*
Project Owner*
Project Name*
Project County*
Clinton Thomas Gupton
[e-mail]
Carol Moynihan
Moynihan Residence
Franklin
Owner Address:* Street Address
424 Shawne Drive
Address Line 2
Mailing Address is 1309 Lake Royale
City State / Rovince / Region
LOUISBURG NC
Fbstal / Zip Code Country
27549 United States
Is this a transportation project?* C Yes f' No
Type(s) of approval sought from the DWR:
I— 401 Water Quality Certification - I— 401 Water Quality Certification -
Regular Express
lW Individual Permit lW Modification
l Shoreline Stabilization
Does this project have an existing project ID#?*
( Yes r No
Please list all existing project ID's associated with this projects.*
SAW 2021-00692
Do you know the name of the staff member you would like to request a meeting with?
Stephanie Goss
Please give a brief project description below and include location information.*
We are proposing to build a new residence at 1321 Sagamore Drive
Louisburg NC.
Part of the deck and covered porch are in the 50' buffer zone of Lake
Royale but not in the first 30 ft from the lake. I will send a map of its
location and the proposed work.
By digitally signing below, I certify that I have read and understood that per the Federal Clean Water Act Section
401 Certification Rule the following statements:
• This form completes the requirement of the Pre -Filing Meeting Request in the Clean Water Act Section 401 Certification
Rule.
• I understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing

meeting request.
• !also understand that DWR is not required to respond or grant the meeting request.
Your project's thirty -day clock started upon receipt of this application. You will receive notification regarding meeting location
and time if a meeting is necessary. You will receive notification when the thirty -day clock has expired, and you can submit an
application.
Signature *
(?dr.ireagr .T ea.‘ewe
Submittal Date 5/17/2021