20221274 Ver 1_Shoreline Stabilization Application Form_20220930

Shoreline Stabilization Application Form
15A NCAC 02H .0500 – Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
DRAFT-NOT FOR USE AT THIS TIME
I. Applicant Information
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 *
Pre-Filing Meeting Date Request was
submitted on:
Owner Information:
Is there an agent working on the project?*
I. Applicant Information [15A NCAC 02H .0502(a)]
[e-mail]
Please provide an email address for payment and requests for more information here.
7/11/2022
Name:*
Email:*
Phone Number:*
Mailing Address:*
Michele Swart
[e-mail]
[phone]
(xxx)xxx-xxxx
City
Raleigh
State / Province / Region
NC
Postal / Zip Code
27615-1508
Country
US
Street Address
113 Artillery Lane
Address Line 2
Yes
No
II. Project Information
Project Name:*
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.*
Property Address Lookup:*
Latitude:*Longitude:*
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 *
Please use the diagram at the link below:
hps://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.)*
4. Location of the property (where work is to be conducted)
Nearest Town:*
County:*
Lake/ river/ ocean adjacent to
property:*
Subdivisions name or site address:*
Project Information [15A NCAC 02H .0502(a) & (b)]
Michele Swart 209 Sagamore Drive - Franklin County bulkhead
dock boathouse
Upload File
Look up address
City
Louisburg
State / Province / Region
NC
Postal / Zip Code
27549-9517
Country
US
Street Address
209 Sagamore Dr
Address Line 2
35.987175 -78.208941
Riparian Buffer Map 9-2022.pdf 12.22MB
pdf only
Riparian Buffer Map Measuring Stick 9-
2022.pdf 4MB
pdf only
Louisburg
Franklin
Lake Sagamore - Lake Royale Subdivision
209 Sagamore Dr Louisburg NC Lot 1344
Include phase/lot number
Directions to site:*
5. Describe the existing land use or condition of the site at the time of this application:*
6. Property Size
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
8. How will the work be done?*
9. Total amount of disturbance below the normal pool lake level/ normal water level:*
10. Total amount of disturbance above the normal pool lake level/ normal water level and 50 feet land-
ward:*
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet landward to
be impacted:*
Sketch:
Take a slight right turn onto Mort
Harris Rd
3.5 mi
Continue onto Sledge Rd
4.4 mi
Turn left onto Cheyenne Dr
900 ft
Turn left onto Shawnee Dr
1.5 mi
Turn right onto Oklahoma Dr
900 ft
Take a slight left turn onto Stallion Dr
350 ft
Turn left onto Sagamore Dr
700 ft
The destination is on your right
Please include road names and numbers, landmarks etc.
Lot cleared to 50' buffer zone; undeveloped at this point.
Residential, undeveloped, etc.
0.494
Acres
Rip Rap with matting underneath along 65' shoreline, which is the
total length of the property line; 6” above the ordinary high water
mark of the lake and 1.5’ below waterline to the bottom of the lake
on a 45 degree angle for a total of 2’ rip rap buffer along shoreline
and 2' out into the lake. Also placing riprap 2’ back from the full
pond/normal water level onto the shoreline with matting
underneath.
From Land
From Water
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
97.5
square feet
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
250 sq ft
square feet
(number of trees, for instance)
3 trees with a diamter of 4' or less; brush like vines and dead tree
limbs will be impacted. See PDFs attached to Questions 2 and 3 for
site map and current vegetation pictures.
pdf only
Sign and Submit
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):
$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
By digitally signing below, I certify that:
I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the best
of my knowledge and belief
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.
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”);
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”);
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:*
Signature:*
Michele Swart