20171432 Ver 2_Site Plan_20240222

11. Signature
Owner/A
*Agent's s
12. Please app
each ltem�
a. All pr,
b. Local
c. Local
d. Local
e. Local
FORM: SSGP 02-2017
it's Sig ature* [15A NCAC 02H .25q2o Date
aturf � valid only If an authorization letter from the owner is provided.
a v
(Imal ell -sketch the following information on this plan and provide dimensions for
)sed v etation clearing
p rap or fill to be placed below the Full Fond/ Normal Water Level elevation
i of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
I of r,
i of an proposed structures such as buildings, retaining walls, docks, etc,
i of an excavation or dredging below the Full Pond/ Normal Water Level elevation
Lake,
(At rull Pond/ Normal Water Level)
Page 3 of 5

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FORM: SSGP 02,-2017 Page 4 of 5

N1 V 1 1: "1 C? N 00 r' N L ^ V r" L' I 7Y
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 02-2017
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the 9P lication fee should be sent to:
P
If sending via US Postol 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 021±,,0�502 a
1. Owner Informatior
Name: Ben P. Daughtry
Mailing Address: P 0 Bx454
Barnesville, MD 20838
Telephone Numbe 301-502-5512 Fax Number: 301-502-5512 (Call before fax
E-mail Address: [e-mail]
2. Agent/ Contact Person Information
A signed and date c copy of the Agent Authorization letter must be attached if the Agent has
signed this application form. (A form can be downloaded here:
ATION FORM.pdf)
Name:
Company Affiliatio i:
Mailing Address:
Telephone Numbe Fax Number:
E-mail Address:
B. Project Information [ NCAC 02H-.0502La) &_(bl]
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. See Attachment (Atch) 1.A, — A
vicinity map depict ng the Hyco Lake location in relationship to Semora (local post office) and
to Roxboro (Persor County Seat) both in North Carolina aind Danville, VA., nearby larger
town. Attachment 1.13. —A local detail map depicting the location of 676 Clearwater Lane,
Semora, N.C. 27343 at Hyco Lake.
2, Provide a detailed site plan showing property boundaries and proposed locations of
vegetation clearing, buildings, retaining walls, docks, impervious surfaces, rip rap, excavation
FORM: SSGP 02-2017 Page 1 of 3

or dredging below
corridors. You ma
Attachment 2- An
well as the proper,
and dock; project:
3. Attach a
some sort- a yard
line erosion. The
boathouse and cc
where it meets tl°
4. Location of the
County: Person
Lake/ river/ ocean
Property size (acre
Subdivision name
N.C. 2
:uII Pond/ Normal Water Level elevations, and construction access
use the diagram provided at the end of this application form. See
nnotated aerial photo which shows the proposed scope of rip rap work as
, boundaries for Lot # 8. Only shoreline building is the existing boathouse
:ape does not include any of the other subjective topics.
h of the shoreline/ buffer proposed to be stabilized. (Include a scale of
Jck, shovel handle, etc.) See Attachment 3 — Photographs depicting shore
-oposed scope of work starts approximately 365 linear feet east of the
tinues for approximately 350 linear feet on the east side of the lot to
property line for 677 Clearwater Lane, Semora, N. C. 27343; Lot # 9.
(where work is to be conducted)
Nearest Town: Roxboro, NC
idjacent to property: Hyco Lake
): 3.45 Acres
r site address (include phase/lot number): 676 Clearwater Lane, Semora,
Directions to site - )lease include road names and numbers, landmarks, etc.: Fron Roxboro — N
on NC # 57 - 12 mi es; R on NC # 119 N % mile; R on Cunningham Rd — 5 miles; R an Franklin Rd
- 2 miles; continue 0.5 miles on Heritage Harbor, Rd; R on Clearwater Lane — 0.8 miles to, cul-
de-sac; R into the second DW on R to 676 CW Lane.
Latitude (in decima� degree5) 36.5151830 _ Longitude (decimal degree5) -79,0653259
5. Describe the existi g land use or condition of the site at the time of this application
(residential, undeveloped, etc.)- Residential Lot w/a boat dock/boat house, 2 bedroom 2 bath
2 garage house.
6. Describe proposed work (include
i nc'u de discussion as to how hardening of shoreline has been
avoided, or why it i necessary): --- - Install — 350 linear feet of rip rap to stabilize significant
shoreline erosion ( _ 4 ft i nto bank) that has been occurine for many vears. oerhaos antirE
7. Will work be conducted from land? M
From water? El
8. Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent impact (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
_
Temporary impacts in square feet:
FORM. SSGP 02-2017 Page 2 of 5

9. Total amount of i pacts above the normal pool lake level / Normal Water Level and 50 feet
land -ward
Permanent impact (including back fill, excavation, rip rap, retaining walls, etc.) in square feet:
Above normal pod lake level - 1,050 Sq. Ft.; Below normal pool lake level - 700 Sq. Ft. Total
1,750 Sq. Ft.
Temporary impact (temporary clearing, construction corridor) in square feet:
None
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): Normal native grasses and small
scrub trees (primarily hardwoods) with some mature hardwoods — ten feet from shoreline that
continue two to three hundred feet into the lot.
11. Signature
Owner/Agent's Si nABV
re* [I&C 02H M02 01 bate
*Agent'ssignatui �s valid only if an authorization letter from the owner is provided.
12. Please approximat
each item:
a. All proposed
b. Location of ri
c. Location of ri
d. Location of at
ly sketch the following information on this plan and Provide dimensionsfor
?getation clearing
rap or fill to be placed above the Full Pond/ Normal Water Level elevation
rap or fill to be placed below the Full Pond/ Normal Water Level elevation
V proposed structures such as buildings, retaining walls, docks, etc.
FORM: SSGP 02-2017 Page 3 of 5

11. Signature
Owner/Agent'sSig riature*[ ANCACO2H.0502(f)] Date
*Agent's signature 15 valid only if an authorization letter from the owner is provided.
12. Please approximate
each item:
a. All proposed ve
b. Location of rip
c. Location of rip
d. Location of an)
e. Location of any
sketch the following information on this plan and provide dimensions fear
etation clearing
ap or fill to be placed above the Full Pond/ Normal Water Level elevation
ap or fill to be placed below the Full Pond/ Normal Water Level elevation
proposed structures such as buildings, retaining walls, docks, etc.
excavation or dredging below the Full Pond/ Normal Water, Level elevation
Lake
(At Full Pond/ Normal Water Levell,
�Af
FORM: SSGP 02-2017 Page 3 of 5

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FORM: SSCGP 02-2017 Page 4 of 5

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