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Home My WebLink About20140284 Ver 1_Shoreline Stabilization_20140325r— o 20140284 State of North Carolina t , o Department of Environment and Natural Resources Division of Water Resources Division of~Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization FORM: SSGP 10 -2013 I' Shoreline Stabilization Application Form s> Four copies of the application (including attachments) and the application fee should be sent to; 1 Division of Water Resources 401 & Buffer Permitting Unit 1650 Mail Service Center Raleigh, NC 27699 -1650 Applicant Information [15A NCAC 02H .0502(a)] Owner Information Name: k CA_ U) f Iz-� a CC_ Mailing Address: I D 13 L(Y p_ X:� ovcb) e_ LG %A S 1DCkIIQ 9� 13U V 03 O D [OAR 2 5 2014 NR - WA ERR AL.IrY Telephone Number: q1 '� 630 oZk1$ Fax Number: E -mail Address: \-\Mrk IL fOcie_tS I CJ Qos x_A 1-_�L ,n &cr . O ,r 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. army. mil / Portals /59 /docs /regulatory /regdocs /Permits /SAMPLE AGENT AUTH ORIZATION FORM.pdf) must be attached if the Agent has signed this application form. Name: Company Affiliation: Mailing Address: Telephone Number: E -mail Address: Person to receive the Certification Approval: Fax Number: II. 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, structures (buildings, retaining walls, docks, impervious surfaces, FORM: SSGP 10 -2013 Page 1 of 4 .,�. .� Y .� 4 Ae ,Y �r.f�„^ 'L ti 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 propertir (where work is to be conducted) County: Nearest Town: Lky-� R Subdivision name or site address (include phase /lot number): j.,�� nVr,' L ci ,Q n elm o u5 erg I ( of c 0 Directions to site - please include road names and numbers, landmarks, etc.: 41-OM ��u A V', Describe the existing land use or condition of the site at the time of this application (residential, undeveloped, etc.): e5 i"A &,L Property size (acres): 069 NC< C5� 7. Lake/ river/ ocean adjacent to property: L c k e__ 1R or CX 1 e- 8. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or why it is necessary): Ou )m LyOS i 0 b gSLkfr, q o i,JG cr c ' �jdo 'i�dv,5 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: d0 -so +r 11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining walls, etc.) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in square feet or acres: 12. 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): (IN rck-C, S 4 Pi'n -r c- e s a v, e— i n P& A-e- A c , i+ \ KOCA 3 / (9Q /Jq Owner /Agent's Signature' [15A NCAC 02H .0502(f)l Date `Agent's signature is valid only if an authorization letter from the owner is provided. FORM: SSGP 10 -2013 Page 2 of 3 ILS l o� Lake (At Full 0o4ndj,Norrnal beater Level) i Full'Pond/ Normal .4ltl �fe� L�v�l, Shoreline Please approximately sketch the following information on this plan (provide dimensions for each item, such as 10 ft x 100 ft) *: 1. All proposed vegetation clearing 2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation 3. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation 4. Location of any proposed structures such as buildings, retaining walls, docks, etc. 5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation 6. Location of construction access corridors FORM: SSGP 10 -2013 Page 3 of 3 r• DW�� R State of North Carolina Department of Environment and Natural Resources Division of Water Resources Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification instructions for Application FORM SSGP 10 -2013 (Shoreline Stabilization 401 WQC to accompany USACE GP30, GP79, or GP80) Instructions for Shoreline Stabilization Application When to use this form —This application form should be used to apply for a 401 Water Quality Certification to impact: Description U.S. Army Corps of Engineers (USACE) Permit Federal Energy Regulatory Commission (FERC) regulated lake GP30 shore or bottom Tennessee Valley Authority (TVA) regulated lake shore or bottom GP30 Local government regulated lake shore or bottom GP30 USACE Reservoir owned /regulated lake shore or bottom GP79 Private lake shore or bottom GP80 When this form should not be used — This application form cannot be used for wetland or stream impacts. This information does not apply to landowners within the twenty coastal counties that are affected by Division of Coastal Management (LAMA) rules. For more information — If you have been advised that you require a 401 Water Quality Certification, and would like more information about: ➢ The application process: http: / /porta1.ncdenr.org/ web /wq /swplws /401 /certsandpermits ➢ How to download an application form: htto: / /Dortal.ncdenr.org/ web /wo /swp /ws /441 /certsa nd Perm its /apply /forms ➢ Application fees: http: / /Porta1.ncdenr.org/ web /wo/ swp /ws /401 /certsandpermits /aDolv/fees if you are unable to download this information or application, please call (919) 807 -6300 to request an application with instructions. Please note — Not all impacts require written authorization from DWR. This may include the construction of docks or boathouses if there is no dredging or filling involved (other than the pilings). For more information, please visit the following website: http: / /portal.ncdenr.org/ web /wq /swp /ws/ 401 /certsandpermits /fags #always have to applv How to apply — When submitting an application to DWR, please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these instructions will help facilitate a quicker review time and reduce the amount of requested additional information. INSTRUCTIONS FOR APPLICATION SSGP307980 08 -13 & SUPPORTING DOCUMENTATION Page 1 of 3 y Provide four (4) copies of the application and supporting information (maps, drawings, etc.), as well as the appropriate application fee (see below), to the Division of Water Resources, 401 & Buffer Permitting Unit, 1650 Mail Service Center, Raleigh, NC 27699 -1650. I. Applicant Information ❑ Owner Information: Please provide complete and accurate contact information ❑ Agent Information: Per 15A NCAC 02H .0502 , an agent may be given signatory authority for the owner /applicant if a signed and dated copy of an Agent Authorization letter is included with the application. (A sample form may be found at http• / /www saw usace. army. mil / Portals /59 /docs /regulatory /reRdocs /Permits /SAMPLE AGENT AUTHORIZATION FORM.pdf) II. Project Information ❑ Vicinity/ Site Map: Some type of site map so that someone unfamiliar with the area can locate your project. A county map or USGS topographic map indicating the project location is usually sufficient. ❑ Site Plan: A site plan showing the location of the shoreline, location of the impacts to the shoreline and /or lake bottom and the location and any vegetated areas that will be impacted. In most cases the site plans do not have to be professionally prepared. However, if you intend to conduct hydraulic dredging, professionally prepared drawings will likely be required for the spoil structures. See example below. ❑ Photograph of shoreline to be impacted/ disturbed ❑ Description of property and existing features on and near the site ❑ Description of project and impacts/ disturbance proposed III. Signature ❑ Per 15A NCAC 02H .0502 , the application shall be considered a "valid application" only if it bears the signature of a responsible officer of the company, municipal official, partner or owner. This signature certifies that the applicant has title to the property, has been authorized by the owner to apply for certification or is a public entity and has the power of eminent domain. IV. Application Fee ❑ The application must be accompanied by the appropriate application fee (checks made out to the NC Division of Water Resources). The application fee is as follows (pursuant to G.S. 143- 215.3D): ➢ $240.00 for impacts to lake (below normal water level) of less than 1 acre ➢ $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre INSTRUCTIONS FOR APPLICATION SSGP307980 08 -13 & SUPPORTING DOCUMENTATION Page 2 of 3 . =11' I loft Rip Rap 3ftx150ft Above full pond/ NWL Additional clearing Existine I-..— 5 ft iz� 5 TI / Proposed INSTRUCTIONS FOR APPLICATION SSGP307980 08 -13 & SUPPORTING DOCUMENTATION Page 3 of 3 Lake-� (At full Pondt Normal Water Lever = _ .,E ccavated >Area '!�?�`.,,..vs '�K_,- �, tips- Nat t- ��,^vY -•''.. SR `r;y �1� r�''"- - :�1I.1 - ioreline - - • Cleared Area - 8ft x150ft • d Lot A 5 j of R I loft Rip Rap 3ftx150ft Above full pond/ NWL Additional clearing Existine I-..— 5 ft iz� 5 TI / Proposed INSTRUCTIONS FOR APPLICATION SSGP307980 08 -13 & SUPPORTING DOCUMENTATION Page 3 of 3 act -B - ?P,p P 0 5 ED s V-16 J AR DENR UALITY aWr Branch 1 4 0 Vt�R. -6epfmi r! b " tK s ir 17 "1* Jw . . C` m Z `Ji e `ion -T "me S F�),rjT ok3 T, VRi�Yt .. ♦ �.ut,�'� � 45 " �r�.;�K�i �v P ' ,_ _ , f 24i` 4v€d'1 a �I 0) Ly (� i f at 0'�2 -brPA- 5411 L&t k4ic ae�s Belo � w � s i rh, ci-fps / i` / / / / - � ` ' i | � / � ' � ' - � ly C ^ S68 MAP N0. 11 'Z OF e, 0�_— Q IN tv Q3 to v 116. N 2090 2089 ra cm -4 W1 2088 IS 0c, 14 2087 RIVE 9s r ap 2252 .00 z N vlob i 4., 2253 Aq % 0 1% 2254 9255 2257 Ilk, 2258 2259 fj :b 2260 cl wo'�- 20" r- 2261 2065 2360 DRIVE. 2064 2361 2063 2062 2061 2060 2Q59 Q' E 3.01 50 go 60.0 ice -A FRANKLIN COUNTY HEALTH DEPARTMENT PERMIT NUMBER: DATE: 3315I IMPROVEMENTS PERMIT 08.29.91 21044 SIZE= APPLICANT: OWNER: HUDDLESTON MICHAEL 116 LAKE ROYALE LOUISBURG NC 27549 TELEPHONE: 478 -5608 COMMENT: MODULAR HOME LOCATION / DIRECTIONS: LAKE ROYALE LOT 2086 0C FEE: SIGRATit RE OF O N R OR AMTHORIZED AGENT: 50.00 22695 CONFIRMED BY PLANNER: / PLANNER: DATE: THE ABOVE SIGNATURE INDICATES THAT I HAVE READ, UNDERSTAND, AND AGREE WITH ALL PROVISIONS AND INFORMATION AS OUTLINEI ON THE BACK SIDE OF THIS FORM. #BEDRMS 3 DISPOSAL �� OTHER ""' TYPE.SYS _ SZ .TANK SZ .CHAMB r. NITRIFI 5X�?Cb OPER .REO /Up SITE.LOC ✓ REMARKS: D. �� X kdL)v ,-D /�� G2o -sa. JN ' i V � ' (A f op `- Lo /'[[��'� !f! W Q I w DATE .ISSUED 1" 1� EH SPECIALIST, DATE.AP r'4 #. 6 " /& PROPERTY DESCRIPTION APPLICATION FOR -- /b4mprovements O Zoning (NOT A PERMIT) Permit _ Kermit BECK # q / 0 V Proposed Use: O Electrical ---. Permit FORM Z301 O Ot&et�'Y4 " Land use indicated (is) (is not) permitted in the zoning district. If permitted, the following minimum zoning requirements must be met, unless the Health Department requires more land area or other qualifications are indicated in the remarks. Franklin County Zoning Ordinance does not supercede any.restrictive covenants placed on this property. square Front yard 2 /} Corner yard Aggregate Lot area feet depth — ft. depth ft. both sides Side yard O Rear yard l� Lot width feet depth ft. depth ft. Remarks: Permit No. Planning & Community Development by V", Date Required Information for IMPROVEMENTS PERMIT (Health Department) Type of Facility (check one and complete) — > r'singie family dwelling No. of bedrooms No. of bathrooms v • Mobile home No. of bedrooms No. of bathrooms • Multi - family dwelling No. of units No. of bedrooms per unit • Business Wastewater O Domestic O Industrial • Other (Specify) • Existing structure O Renovate O Addition Estimated Daily Waste Flow gal/day Garbage Disposal Unit to be Installed O Yes O No Dishwasher O Yes O No Washer O Yes O No Water Supply Source O Private O Public O Private of[ site Comment Sanitarian Date Permit # I certify that all of the statements made in this application and any attached documents are true, complete and correct to the best of my knowledge and belief and are made in good faith. I understand that false information may be grounds for rejection of this application. Authorized County Representatives are granted right of entry to make evaluation; o i pecti d t� Tfle a lq ormation upon public request. b - / ■ Signature of Owner or Authorized Agent Date ti ` ZONING PERMIT EXPIRES IN SIX MONTHS. c- Attach site plan showing property lines, location of proposed structures (including driveways, patios, decks, etc.) and any existing structure. Owner as on tax re_cornds ) 0 Mailing Address Tele h' one No. App ' 117-1 nt CAae Udcl /rs a Mailing Address We TI hone NP -_ �y�� 72S -,c:o TaIA //O Y !� P UI Trship 's C Jurisdicti�• � ZX Subdi ' ion i Lot No. (�i Section No. Lot Size A Road No.�;�,z�{ Fl Plain O Yes O No Approx. Area to be disturbed Engineering Firm Contact Phone Street address Land use indicated (is) (is not) permitted in the zoning district. If permitted, the following minimum zoning requirements must be met, unless the Health Department requires more land area or other qualifications are indicated in the remarks. Franklin County Zoning Ordinance does not supercede any.restrictive covenants placed on this property. square Front yard 2 /} Corner yard Aggregate Lot area feet depth — ft. depth ft. both sides Side yard O Rear yard l� Lot width feet depth ft. depth ft. Remarks: Permit No. Planning & Community Development by V", Date Required Information for IMPROVEMENTS PERMIT (Health Department) Type of Facility (check one and complete) — > r'singie family dwelling No. of bedrooms No. of bathrooms v • Mobile home No. of bedrooms No. of bathrooms • Multi - family dwelling No. of units No. of bedrooms per unit • Business Wastewater O Domestic O Industrial • Other (Specify) • Existing structure O Renovate O Addition Estimated Daily Waste Flow gal/day Garbage Disposal Unit to be Installed O Yes O No Dishwasher O Yes O No Washer O Yes O No Water Supply Source O Private O Public O Private of[ site Comment Sanitarian Date Permit # I certify that all of the statements made in this application and any attached documents are true, complete and correct to the best of my knowledge and belief and are made in good faith. I understand that false information may be grounds for rejection of this application. Authorized County Representatives are granted right of entry to make evaluation; o i pecti d t� Tfle a lq ormation upon public request. b - / ■ Signature of Owner or Authorized Agent Date ti ` ZONING PERMIT EXPIRES IN SIX MONTHS. c- 2090 M+ r� 3 2089 N -7r - I y ID N Ol u�a t Si J— tag )r4 a i Ql- cfl { �� d 0 Cam' �J ��:.7 r� om- Pc) �1 s s� d x rr. L s A ,."g � I t -ld