20221700 Ver 1_Shoreline Stabilization_20221202

Shoreline Stabilization Application Form
NORTH CAROLINA
Environmental Quality
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
DRAFT -NOT FOR USE AT THIS TIME
Submission Form
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*
[e-mail]
Please provide an email address for payment and requests for more information here.
Pre -Filing Meeting Date Request was 10/3/2022
submitted on: *
Owner Information:
Name:* Ryan Trump
Email: * [e-mail]
Phone Number: [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
PO box 567
Address Line 2
City
Bunn
Postal / Zip Code
27508
Is there an agent working on the project? * Yes
No
Agent/Consultant Information
State / Province / Region
North Carolina
Country
United States
Name: * Gregory Poland
Company Affiliation: * Poland's Home Improvement
Email: * [e-mail]

Phone Number:*
Mailing Address:*
[phone]
(xxx)xxx-xxxx
Street Address
PO Box 567
Address Line 2
City State / Province / Region
Bunn North Carolina
Postal / Zip Code Country
27508 United States
A signed and dated copy of the Agent Authorization letter:*
247 Sagamore agent authorization form .pdf 3.25MB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
247 Sagamore Dr Project
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
Property Address Lookup: *
Latitude:*
35.984612
Street Address
247 Sagamore Drive
Address Line 2
City State / Province / Region
Louisburg NC
Postal / Zip Code Country
27596-9576 US
Longitude: *-78.206161
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*
247 Sagamore plot plan.pdf 3.13MB
Please use the diagram at the link below:
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.)
247 Sagamore pic 1.pdf 6.23MB
4. Location of the property (where work is to be conducted)
Nearest Town: * Bunn

County: * Franklin
Lake/ river/ ocean adjacent to Lake Royale
property:
Subdivisions name or site address: *
Lake Royale
Include phase/lot number
Directions to site: *
Turn right on Cheyenne Drive from Sledge road. Turn left on Shawnee
Drive right on eagle Drive and right on Sagamore Drive.
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: *
Developed property, Existing seawall in tact, just adding
boatslip/boathouse and new vinyl seawall around slip
Residential, undeveloped, etc.
6. Property Size 1
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Adding a 12 ft by 24 ft boat House to shoreline. Existing wooden seawall
is intact entire length of shoreline. New vinyl seawall will be added where
slip is excavated for proposed Boathouse.
8. How will the work be done?*
From Land
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.)
50 linear ft of wall -
approx 100 sq',
excavate 12'x14'
slip - approx 168 sq
' „ Total 268 sq'
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.)
268 sq'
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)
None existing, none impacted
Sketch: 247 Sagamore plot plan.pdf 3.13MB
247 Sagamore pic 2.pdf 7.2MB
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
• I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:*
Signature:
Submittal Date:
Gregory Poland
12/1/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number: * 20221700 Version: * 1
Select Reviewer: * Zachary Thomas:eads\ztthomas
Select Reviewing Office: Raleigh Regional Office - [phone]
Has payment been received?* No Payment Needed
Fee Received
Need Fee - send electronic notification
What amount is owed?* $240.00
$570.00

L :Gila(]
ajrn;nu64S p.3YIJ041nv
ainjoul5i Iazjjo4jrvd
'alipalmoual Jno p 1saq
D•Il 07 alernaae pue ami sl uogmildcle t4l ul pall!wgrs ijap ulsulu! aAoge ayl 1 ppmL Agaja'4 0M
Z.
aucs�td1r�1
-7171,7
:(aMCKle AL*doJd uegj lu*aamp ssaJppv s,jaumo +jjado-Ad
'p awUllu suol'+lpum japod% pue piepuals lie pue Am puo uo±looqj!IjF=a as 1uJad sIL41
p a3umidwDe pue a3uummi tuissaAjd ayl .gal rirlst Dail SUDIlae t» it lell pue jleLfoq Aui ua pu of
(WJY Bulllf-ir,"a 1n aureN)tluai5b' lug l
azi-joglne AGUDy op 'Apadoid Palau Dnoge ayl to saamo Aijadoid pajlj%iEia,i 'rau61sjapun ayl
3, k
:,uljd +Seald
C? Ll LDS `l qi � d d 'ON NV'ld
'ON 101
N011di113SRI MD A11:13d0ldd
1 10J N0llVZW0HlFlV 1N39V 3idVV

Vz
Aq
Lew m F
R Y
` -N�w riC �i✓.dZr: F� eo�u��?��C
Olt
zUM
CL
ggULLd
^5>
L)
V
O
d
Kim
k
C6

3
,iw
11F
dPL
vi IV

Vz
Aq
Lew m F
R Y
` -N�w riC �i✓.dZr: F� eo�u��?��C
Olt
zUM
CL
ggULLd
^5>
L)
V
O
d
Kim
k
C6

fjj ��er
q,
14
46;-
41
r ('
4r
;•� it � � 1'�1,9 I�_ - '1 ` 4 - � - � � y }'.�`' �1 <�
:�r Vf rl.r >! 7f yi r I! t• t-'a' �3 _.-
rp'i�y1r� a, i' yr�fy�{twjt�• 1 �` ( ;. d� �� � ��,h k �., r ,�,�� T,:>���.� 6 �.,
o s'
r
a
f 4y
k _
r
w f• -
�r F
,
r