20230302 Ver 1_Shoreline Stabilization_20230228

Shoreline Stabilization Application Form
NORTH CAROLINA
Environmental Qualify
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 2/24/2023
submitted on: *
Owner Information:
Name: *
Email:*
Phone Number:
Mailing Address: *
Scott Barrett
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
5 Banstead Place
Address Line 2
City
Chapel Hill
Postal / Zip Code
27517
Is there an agent working on the project? * Yes
No
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: *
Riprap for 245 Pinesborough Estates Rd Semora NC 27343
State / Province / Region
North Carolina
Country
USA
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: * 36.502480
Street Address
245 Pinesborough Estates Road
Address Line 2
City State / Province / Region
Semora NC
Postal / Zip Code Country
275343 US
Longitude: *-79.086295
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:
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.)
4. Location of the property (where work is to be conducted)
Nearest Town: * Scmora
County: * Person
Lake/ river/ ocean adjacent to Hyco Lake
property:
Subdivisions name or site address: *
245 Pinesborough Estates Rd Semora, NC 27343
Include phase/lot number
Directions to site: *
Directions to site - please include road names and numbers, landmarks, etc.: Take Zion Level Rd to Pinesborough Estates Rd.
Look for gravel driveway just past Hrady Hollow Rd on left. Double navy farm gates in front of drive. 245 Pinesborough Estates
Rd is on the left, through another single navy farm gate. Please contact owner prior to visiting lot for access through gates.
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: *
Undeveloped land
Residential, undeveloped, etc.
6. Property Size
1.12
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Adding riprap to shoreline to stabilize, prevent erosion, and protect shoreline

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.)
300
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.)
1400
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)
2 small persimmon trees (trunk diameter < 5"), intermittent watergrass as seen in photos
Sketch:
SSGP 02-2017 Shoreline Form final245
17.72MB
Pinesborough Estates Rd Barrett 022423.pdf
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
d I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:* Scott Barrett
Signature:
set ffe4t-terr
Submittal Date: 2/24/2023

Initial Review
Is this accepted into the review process?* J Yes 0 No
Project Number: * 20230302
Select Reviewer: *
Select Reviewing Office:
Has payment been received? *
Version:* 1
Zachary Thomas:[e-mail]
Raleigh Regional Office - [phone]
No Payment Needed
Fee Received
Need Fee - send electronic notification
What amount is owed?* $240.00
$570.00

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a State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Water Resources 15A NCAC 02H .0500 —Water Quality Certification, Shoreline Stabilization
ENVIRONMENTAL QUALITY FORM: SSGP 02-2017
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent to:
If sending via US Postal Service If sending via delivery service (UPS, FedEx, etc.)
Karen Higgins Karen Higgins
DWR-401 & Buffer Permitting Branch DWR-401 & Buffer Permitting Branch
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC 27699-1617 Raleigh, NC 27604
A. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name:
Mailing Address
Telephone Number:
E-mail Address:
Scott Barrett
5 Banstead Place
Chapel Hill, NC 27517
919-888-8010 Fax Number: n/a
[e-mail]
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter must be attached if the Agent has
signed this application form. (A form can be downloaded here:
http://www.saw.usace.army.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
B. 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.
FORM: SSGP 02-2017 Page 1 of 3

245 Pinesborough Estates Rd
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2. Provide a detailed site plan showing property boundaries and proposed locations of
vegetation clearing, buildings, retaining walls, docks, impervious surfaces, 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.)
FORM: SSGP 02-2017 Page 2 of 8

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5. Location of the property (where work is to be conducted)
County: Person County Nearest Town: Roxboro
Lake/ river/ ocean adjacent to property: Hyco Lake
Property size (acres): one
Subdivision name or site address (include phase/lot number): 245 Pinesborough Estates Rd,
Semora, NC 27343
Directions to site - please include road names and numbers, landmarks, etc.: Take Zion Level
Rd to Pinesborough Estates Rd. Look for gravel driveway just past Hrady Hollow Rd on left.
Double navy farm gates in front of drive. 245 Pinesborough Estates Rd is on the left, through
another single navy farm gate. Please contact owner prior to visiting lot for access through
gates.
Latitude (in decimal degrees) 36.50267132381937
Longitude (decimal degrees)-79.0863171732722
6. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): undeveloped, to be residential
FORM: SSGP 02-2017 Page 5 of 8

7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Adding riprap to shoreline to stabilize, prevent erosion, and
protect shoreline
8. Will work be conducted from land? ® From water? ❑
9. Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent impacts (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
300 sq ft (100' linear feet of riprap x 1' depth x 1' width below— lake is very shallow at lot)
Temporary impacts in square feet:
0'
10. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet
land -ward
Permanent impacts (including back fill, excavation, rip rap, retaining walls, etc.) in square feet:
900 sq ft (100 linear feet of riprap x 3' width)
Temporary impacts (temporary clearing, construction corridor) in square feet:
500 sq ft (10' wide x 50' long construction access)
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): 2 small persimmon trees (trunk
diameter < 5"), intermittent watergrass as seen in photos
12. Signature
02 24 23
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.
13. Please approximately sketch the following information on this plan and provide dimensions for
each item:
a. All proposed vegetation clearing
b. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
c. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
d. Location of any proposed structures such as buildings, retaining walls, docks, etc.
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
f.
FORM: SSGP 02-2017 Page 6 of 8

FORM: SSGP 02-2017
Page 7 of 8

1' water depth
r
Side View
1'
FORM: SSGP 02-2017 Page 8 of 8