20230327 Ver 1_Shoreline Stabilization_20230307

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 3/2/2023
submitted on: *
Owner Information:
Name: *
Email:*
Phone Number:
Mailing Address: *
Marshall Duncan Jr
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
33 Morton -Pulliam Road
Address Line 2
City
Roxboro
Postal / Zip Code
27574-8557
Is there an agent working on the project? * Yes
No
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: *
95 Ruddy Duck Shoreline
State / Province / Region
NC
Country
US
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
Upload Map:
site
Latitude: * 36.466432
Longitude: *-79.126656
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.)
s...
pic ...
s...
4. Location of the property (where work is to be conducted)
Nearest Town:* Semora NC
County: * Person
Lake/ river/ ocean adjacent to Hyco Lake
property:
Subdivisions name or site address: *
95 Ruddy Duck Lane, Lot #2
Include phase/lot number
Directions to site: *
Turn off HWY 57 N (semora rd) onto Kelly Brewer Rd., Go approx 1 mile and take Left onto Ruddy Duck Ln, 95 Ruddy Duck Ln
is driveway on left.
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: *
Empty residential lake lot with new boathouse.
Residential, undeveloped, etc.
6. Property Size
2.05 ac
Acres

7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Install rip -rap apron at shoreline to reduce and/or stop erosion caused by large waves from wake boats
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.)
520sf
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.)
910sf
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)
Existing grass at shoreline will remain. No trees will be removed or any grading will be done at existing shoreline.
Sketch:
shoreline drawing.pdf 1.02MB
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
o I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:*
Signature:
Marshall Duncan Jr
Submittal Date: 3/3/2023

Initial Review
Is this accepted into the review process?* J Yes 0 No
Project Number: * 20230327
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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La ke
(fit Full Pond/ Normal'.Vater Lary el-'
C
ESE
0
Side View
Full Pond/ Normal Water Level
Shoreline
2 ft. x 150 ft.
addif.na deariag
"'f ne:essary
Plan View
Lake
�At Full P-d/ N-mal Water Level)
Existing Dock
3 ft x 130 ft
8e'.or+full pcnd/ NWIL
4 ftx 150ft
Above `u,po,.d/ NWL
FORM: SSGP 02-2017 Page 4 of S

11. Signature
Owner/Agent's Signature* [ 5A � �; � U i U 02w Date
*Agent's signature is valid only if an authorization letter from the owner is provided.
12. 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
La ke
(At Fill Pond/ Normal Water Level)
Full Pored/ Normal Water Level ire
Shoreline V C CS? �
q
FORM: SSGP 02-2017 Page 3 of 5