20230911 Ver 1_4- SSGP 02-2017 Shoreline Form_final (5)[22]_20230717

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:
Sasser Farms, LLC
4425 Sasser Farms Drive
Gibsonville, NC 27249
Telephone Number: 336-516-5140 Fax Number:
E-mail Address: [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:
htto://www.saw.usace.armv.mil/Portals/59/docs/reeulatorv/reedocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.Pdf)
Name: Lindsey Beck
Company Affiliation: Manager
Mailing Address: 4425 Sasser Farms Drive
Gibsonville, NC 27249
Telephone Number: 336-517-9541 Fax Number:
E-mail Address: [e-mail]
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.
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.
FORM: SSGP 02-2017 Page 1 of 3

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)
PPrcnn
County:
Lake/ river/ ocean adjacent to property:
Property size (acres): 1.4
Nearest Town:
Hyco Lake
Roxboro
Subdivision name or site address (include phase/lot number): The Reserve, Lot 26
Estate Road, Semora NC 27343
Directions to site - please include road names and numbers, landmarks, etc.:
Hwy NC-57, turn on Zion Level Church Rd, Turn left on Pinesborough Estate Rd, Turn left on Estate
Rd, Property is on 1.1 miles down Estate Rd on the right. Lot 26 is marked.
Latitude (in decimal degrees)
36.50789
Longitude (decimal degrees)
79.06538
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): undeveloped/vacant lot
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
In an effortto stabilize the shoreline and minimize erosion we would like to slope 511' feet of shoreline, install filter clothe and place
m waterline
depending on elevation.
7. Will work be conducted from land? ® From water? ❑
8. 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:
2,044
Temporary impacts in square feet:
0
9. 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:
2,044
Temporary impacts (temporary clearing, construction corridor) in square feet:
0
10. 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):
underbrush, dead trees and approximately 10-15 pines trees
FORM: SSGP 02-2017 Page 2 of 5

11. Signature
6/14/2023
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.
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 Full Pond/ Normal Water Level)
Full Pond/ Normal Water Level
Plan
FORM: SSGP 02-2017 Page 3 of 5

7
v
J
La ke a
(At Full Pond/ Normal Water Level) m
v
M
E v
L L
0 0
z n
C
0
Side View
LL.
La ke
(At Full Pond/ Normal Water Level)
Existing Dock
/ 30ftx7ft
Full Pond/ Normal Water Levell r1—T�T—
ww.i ww
E AMP E
Plan View
FORM: SSGP 02-2017 Page 4 of 5

Side
L
1D ft. hank
height
View
3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing
f
Existing bank
i necessary
iOq
Q
AMPLE
FORM: SSGP 02-2017 Page 5 of 5