20230706 Ver 1_Shoreline Stabilization_20230520

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 3/13/2023
submitted on: *
Owner Information:
...............................................................
Name: * Harold Skripsky
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:
103 Coyote Cove agent authorization .pdf 289.15KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* 103 Coyote Cove 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
103 Coyote Cove
Address Line 2
City
Louisburg
Postal / Zip Code
27549
Latitude: * 35.960394
State / Province / Region
NC
Country
US
Longitude: *-78.194092
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 *
s...
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.)
Pic
1
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: * 103 Coyote Cove Louisburg NC 27549
Include phase/lot number
Directions to site:*
Turn on to Cheyenne Drive from Sledge road, right on Sagamore Drive, left on coyote Cove.
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,
Residential developed property. Wouldn't seawall is existing and in proper working order.
Residential, undeveloped, etc.
6. Property Size .715
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Excavate 16 ft by 16 ft boat slip 3 ft deep for proposed new 26 ft x 16 ft boat House. Build new vinyl seawall on perimeter of
dredged slip approximately 24 in above normal pool. Existing wooden seawall along entirety of shoreline is in proper working
condition. New wall will tie to existing to prevent erosion.
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 SQ ft / 16 ft by
16 ft dredging for
boat slip and new
vinyl seawall
around proposed
slip.
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.)
50 SQ ft / Four trees need to be
removed within the buffer, no
backfill will be needed, excavation
only for 16'x16' boat slip.
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)
4 trees need to be removed within the buffer. The root systems for these trees would be severely damaged during the dredging
process and would create hazardous conditions in the near future. No other vegetation needs to be removed.
Sketch: 103 Coyote Cove plot.pdf
236.85KB
103 Coyote Cove pie 2 slip & trees.pdf
7.2MB
103 Coyote Cove pie 3.pdf
7.28MB
103 Coyote Cove pie 4.pdf
7.89MB
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:
G V
Submittal Date: 5/17/2023

Initial Review
Is this accepted into the review process?* J Yes O No
Project Number: * 20230706 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