20140615 Ver 1_Shoreline Stabilization_20140616

20140615
® State of North Carolina
Department of Environment and Natural Resources
D Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources 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 LL_- 1650 Mail Service Center Raleigh, NC 27699 -1650 N 1 6 2014
I. Applicant Information [15A NCAC 02H 0502(a)] A 13rsnch
1. Owner Information
Name.
Mailing
Telephone Number. 6177 -63`+ax Number: TI '-' S 7Cd — oo1fJ3
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.army mil/ Portals /59 /docs /regulatory /regdocs /Permits /SAMPLE AGENT AUTH
ORIZATION FORM pd f) must be attached if the Agent has signed this application form.
Name: T n ins` Ap-�rrS
Company Affiliation: _iSvw
Mailing Address.
S t•�a L f
Telephone Number O S Fax Number: -L a y �?$ - �$
E -mail Address: ✓VtiCA -Py. V-\ -%T'A20 ca V'-'
Person to receive the Certification Approval:
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

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) n
County. [= a'k= Nearest Town. I�� v�v� ✓'
Subdivision name or site address (include phase /lot number):
,+ D30�
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 ): v. I a -Q-v �Q_l aJ Q'G
6. Property size (acres)- I CL-r-
7. Lake/ river/ ocean adjacent to property: L_., �/— -0—
8 Describe proposed work (include discussion as to how hardening of
avoided, or why lit is necessary)-
� J'--' r—Q— l � V`-e -.
9 Will work be conducted from land? From watery ❑
oreline has been
P --a ��
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:
»�� boo' X �.� '_�]' -�-a`: 6 sl;P la �xo�-
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 /ac
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):
-_ice - /
Date
{Agent's signature is valid only if an authorization letter from the owner ►s provided
7 ..f

i
La ke
(At Full Pond/ Normal Water Level)
Fl1.11 n_-J /
Normz
SI
S ezuw aA
-2;> c-> c�. "Xa
fL�j,,,-4, Sl ;
a-
3 o c-. '
f
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

SURVEY FCW
EDWARD & JUDITH MELLCY
CHARLES R. & JULIE L. RICHTER
LOT R-- -2104, LAKE ROYALE
1225 SAGAMORE DRIVE
88 0415
PIN# 2830— —
D.B. 1699, PAGE 834
ADOPTED FROM P.R.F. t, SLIDE 103 P R F 1 SLIDE 103
. . . ,
CYPRESS CREEK TOWNSHIP
FRANKLIN COUNTY. N J CAROLINA
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AR 23, 2009
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/ 47,853 sq. ft.
/ 1.099 AC.
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DRIVEWAY IS 18 7' 251.4'
NORTHEAST OF , +
PROPERTY UNE
EIP
SAGAMORE DRIVE,
60' PU13LIC R /w,; ;'.
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ao
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6'd £OZO -OL9 6 66
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PROPOSED
HOUSE
LOCATION
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PROPOSED
DRIVEWAY
/ LOCATION
21 a5
VICINITY MAP
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LAKE ROYALE
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LEGEND:
EIP —
EXISTING IRON PIPE
EPK — EXISTING PK NAIL
NIP —
NEW IRON PIPE SET
R/W — RIGHT OF WAY
CAN
— CABLE TV BOX
ES —
ELECTRIC BOX
TEL —
TELEPHONE PEDESTAL
PP —
POWER POLE
OHL — OVERHEAD LINE
LP —
LIGHT POLE
WM —
WATER METER
WV —
WATER VALVE
CO —
SEWER CLEAN —OUT
LINE TABLE
LINE L
LENM B
BEARING
L -1 7
70.0 0' S
S 24'48'35" W
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