20230692 Ver 1_Shoreline Stabilization_20230516

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 10/19/2022
submitted on: *
Owner Information:
........ ......... ........
Name: * Renee Stewart
Email: *
Phone Number:
Mailing Address: *
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
PO box 19
Address Line 2
City
Bunn
Postal / Zip Code
27508
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: *
Company Affiliation: *
Gregory Poland
Poland's Home Improvement
Email: * [e-mail]
State / Province / Region
North Carolina
Country
United States

Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address: * 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:
1689 Sagamore agent authorization.pdf 319.26KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* 1689 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:* Street Address
1689 Sagamore Drive
Address Line 2
City
Louisburg
Postal / Zip Code
27549
Latitude: * 35.990570
State / Province / Region
NC
Country
US
Longitude: *-78.207848
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:Hedocs.deq.nc.gov/WaterResources/o/edoc/616616/Shoreline%2OLayout.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: * 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 on Cheyenne Drive from Sledge road, left on Shawnee drive, right on eagle drive, left 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:
Camping / multi -use section of Lake Royale. Existing camper with build over. Existing seawall needs to be replaced due to old
age.
Residential, undeveloped, etc.
6. Property Size .196
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Existing seawall needs to be replaced due to old age. Scope of project is to replace the existing wooden wall with a new vinyl wall,
same placement, same height.
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.)
0 SQ ft. No
clearing, backfill,
excavation or riprap
is needed. New
vinyl wall will be
built in the exact
same place as the
old one is removed
from.
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.)
1500 SQ ft. The length of the
shoreline by around 20 ft back
within buffer one to be disturbed
only to operate equipment for
demolition and rebuild of seawall.
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)
No trees need to be removed at this time for this project.
Sketch: 1689 Sagamore plot.pdf 513.41KB
1689 Sagamore pic 2 .pdf 6.09MB
1689 Sagamore pic 3.pdf 5.57MB
1689 Sagamore pic 4.pdf 6.76MB
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):
0 $240.00 for impacts to lake (below normal water level) of less than 1 acre
0 $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');
0 1 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:* Gregory Alan Poland
Signature:
I tom/ //
Submittal Date: 5/15/2023

Initial Review
Is this accepted into the review process?* J Yes O No
Project Number: * 20230692 Version:`
Select Reviewer: *
Select Reviewing Office
Has payment been received?*
What amount is owed?*
Zachary Thomas:[e-mail]
Raleigh Regional Office - [phone]
No Payment Needed
Fee Received
Need Fee - send electronic notification
$240.00
$570.00