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Home My WebLink About20161141 Ver 1_Shoreline Stabilization_20161118State of North Carolina Department of Environment and Natural Resources D_ R Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization Division of Water Resources FORM: SSGP 10-2013 Shoreline Stabilization Application Form Three copies of the application (including attachments) and the application fee should be sent to: Division of Water Resources 401 & Buffer Permitting Unit 2 0 1 6 1 1 4 1 1617 Mail Service Center p U May Raleigh, NC 27699-1617We NU V 1 8 2016 I. Applicant Information [15A NCAC 02H .0502(a)] 1. Owner Information Name: Ken Pierrehumbert Mailing Address: 2196 Sledge Rd Louisburg, NC 27549 Telephone Number: 252-469-9873 Fax Number: 919-497-0277 E-mail Address: kenph@bellsouth.net 2. Agent/ Contact Person Information A signed and dated copy of the Agent Authorization letter (a form can be downloaded here: http://www saw usace army mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH ORIZATION FORM.pdf) must be attached if the Agent has signed this application form. Name: Company Affiliation: Mailing Address: Telephone Number: E-mail Address: Person to receive the Certification Approval: Fax Number: 11. 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, structures (buildings, retaining walls, docks, impervious surfaces, FORM: SSGP 10-2013 Page 1 of 3 etc.), 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. 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) County: Franklin Nearest Town: Bunn Subdivision name or site address (include phase/lot number): Lake Royale Lot number 2051 Directions to site - please include road names and numbers, landmarks, etc.: From the entrance to Lake Royale turn right on Shawnee Turn right on Sagamore and Left on Chuckwagon Dr follow to 116 Chruckwagon on Right Latitude (in decimal degrees) 35.960722 Longitude (decimal degrees) -78.190120 5. Describe the existing land use or condition of the site at the time of this application (residential, undeveloped, etc.): residential undeveloped lot. 6. Property size (acres): 0.47 7. Lake/ river/ ocean adjacent to property: Tar River/ Lake Royale 8. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or why it is necessary): Build a single boat house with dredging 12' into shore and 14' wide Construct a dock 10x25 with 4' wide stairs attached. Ripwrap alone shore line approx. 80' Seawall around boat house and behind dock approx. 80'. 9. Will work be conducted from land? ❑ From water? ❑ 10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.) below the normal pool lake level/ Normal Water Level in square feet or acres: 432 Sgft 11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining walls, etc.) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in square feet or acres: 830 Sgft 12. 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): 5 trees and a lot of wild bushes No roots to be removed except at dredging boat house area. Owner/Agent's Signature* [15A NCAC 02H .0502(f)1 0 2 f ho Date FORM: SSGP 10-2013 Page 2 of 3 Lake (At Full Pond/ Normal Water Level) ,II 5' 199 F If Pon lo' 3xS i3 Nor. Level . . 3 icy A4o-t_reirn X DMK - ltwZt X X rZ�P� 3�X40`At3wF- 14 CZ.F a JOX 50 AREA Please approximately sketch the following information on this plan (provide dimensions for each item, such as 10 ft x 100 ft)*: 1. All proposed vegetation clearing 2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation 3. Location of rip rap or fill to -be placed below the Full Pond/ Normal Water Level elevation 4. Location of any proposed structures such as buildings, retaining walls, docks, etc. S. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation 6. Location of construction access corridors FORM: SSGP 10-2013 Page 3 of 3 APWIL 7 1t 7- i t { .•a y. tc k AKIO pr fit.rl + r •, - . .- ! } i! t � e rk. - , t r .• � - _ t .lit.✓ �f � - r �r' ' _ � ^r �L'� � . i ! �r�' �a..r , .� �,� r; ilc: �1. , � '� ��✓��,r� t ^'.� � -y�i " ,.> yt .��, ,�' Yi .. : ��+fG"� �' , t.`t^a � 1 ' � s r.� r d•1, '/ � y -r Jai .7� (Z d �� T " e{ - I 1-x � :� R:` Y� `�,.. v „�aRtt� -\�, •l"r' �rCC. l '-� �,. '�. i �: -, moi✓ l t s`1� , ih i •, i, +rw- 14 i -t :.i _ �. .A } r F a. �• •� jj r troti "a 14 ki•i�+, % .. \.;. fi . 1 _ �-.Jl.-... �.•"��f4e- ., ,. }1, �~' /. �`t �* `h r � tat R � - � ` ,_ rr �i � � � /'�"w ,fie. _ .��, � �•�,: �'r" �� *„_ -. 71 44, 'p �� ./ SIE'( i. 'b •i'y'w�:�� L s'. "• �' •- �. •s°'J” � f�� '��`-9"'",r\ F'�Y- � �� ,�: . 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P.-EMrr --tt 337lo - 317-407 11(a L yuLK� pdoba Lor u 2051 q - Abbreviated Application Form For Regional General Permit 80 (Bulkheads and Riprap) For Section 404 Regional General Permits, Section 401 General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules This application cannot be used for wetland or stream impacts. This form is to be used for projects qualifying for the U.S. Army Corps of Engineers' (USACE) Regional General Permits 80 (General Permit No. 197800080) as required by Section 404 of the Clean Water Act and for the North Carolina Division of Water Quality's (DWQ) associated General 401 Water Quality Certification. This form is also to be used for any project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water Quality. This form should not be used if you are requesting an Individual 404 Permit or Individual 401 Water Quality Certification. The USACE is the lead regulatory agency. To review the requirements for the use of General permits, and to determine if general permit 80 applies to your project, please go to the USACE website at %%-ww.sa,.v.usace.army.mil/wetlands/index.html or contact one of the field offices listed on page 4 of this application. The website also lists the responsible project manager for each county in North Carolina and provides additional information regarding the identification and regulation of wetlands and waters of the U.S. The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant which 401 Certification will apply until the 404 Permit type has been determined by the USACE. Applicants are encouraged to visit DWQ's 401/Wetlands Unit website at http://h2o.enr.state.nc.us/ncwetlands to read about current requirements for the 401 Water Quality Certification Program and to determine whether or not Riparian Buffer Rules are applicable. The applicant is also advised to read the full text of the Gcneral Certification (GC) matching the specific 404 Permit requested. Applicants lacking access to the internet should contact DWQ's Central Office in Raleigh at (919) 733-1786. USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms, photos. ffc. o� eifi appTcable USACE Regulatory Field Office. 401 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated as optional. Incomplete applications will be returned. Submit seven collated copies of all USACE Pcrmit materials to the Division of Water Quality, 401/Wetlands Unit, 1650 Mail Service Center, Ralcigh, NC, 27699- 1650. If written approval is required or specifically requested for a 401 Certification, then a non-refundable application fee is required. In brief, if project impacts include less than one acre of cumulative wetland/water impacts and less than 150 feet cumulative impacts to streams, then a fee of $200 is required. If either of these thresholds is exceeded, then a fee of $475 is required. A check made out to the North Carolina Division of Water Quality, with the specific name of the project or applicant identified, should be stapled to the front of the application package. For more information, see the DWQ website at http://`h2o.ehnr.state.nc.us/ncwetlands/fees.htmi. Page 1 of 4 Office Use Only: Form Version Au;ust 2006 USACE Action ID No. DWQ No. (If any particular item is not applicable to this project, please enter "Not Applicable" or "NIA".) I. Applicant Information 1. Owner/Applicant Information Name: Keri Mailing Address: 2i9(o Si-go4F Rz [ou rs 1&3z4 Air. 2.75LL J Telephone Number: %SS- 49-i-oa."13 Fax Number. 409-491-01-71 E-mail Address: 2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter must be attached if the Agent has signatory authority for the owner/applicant-) Name: Company Affiliation: Mailing Address: Telephone Number: Fax Number: E-mail Address: II. Project Information Attach a vicinity map clearly showing the location of the property with respect to local landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property boundarics and development plans in relation to surrounding properties. Both the vicinity map and site plan must include a scale and north arrow. The specific footprints of all buildings, impervious surfaces, or other facilities must be included. If possible, the maps and plans should include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion, so long as the property is clearly defined. For administrative and distribution purposes, the USACE requires information to be submitted on sheets no larger than 11 by 17 -inch format; however, DWQ may accept paperwork of any size. DWQ prefers full-size construction drawings rather than a sequential sheet version of the full-sizc plans. If full-size plans are reduced to a small scale such that the final version is illegible, the applicant will be informed that the project has been placed on hold until decipherable maps are provided. 1. Location County: Fkkiii_,_,n1 Nearest Town: Z", -J.4 Subdivision name (include phase/lot number): Lfty_E (U Y^L_r- 2-U5 i _ Site coordinates: Decimal Degrees (6 digits minimum): ON 35.94PO-1z. - °W -- 78 . i9c7i2(D Directions to site (include road numbers/names, landmarks, etc.): E&M C-- rg owc T_ Page 2 of 4 3. Property size (acres): , H-1 4. Name of nearest named receiving body of water(stream/river/lake): i �e Liza 1 IM 'L'U� 5. Describe the purpose of the proposed work: S,,44WE BOOT NJ•J5,5' YiOXt)6,eJb 12' t U syc Me— fA>T#ZTlGN- AQcuyg, BoAr Aw-4z ANv Qpc4 _ 6. List the type of equipment to be used to construct the project: ' 2Ac w_ gee- S,<, n srzaz_,z 7. Type and amount of impact (including all back fill, excavation, riprap, retaining walls, other fill, etc.) below the normal pool lake level in square feet or acres, and distance from shorelinc: 432 sir: �t2Ec)G,,.�[� �i' x ,y �1et�a / Sc' Sr�,.w� / y0' ;ZleW 8. a. Type and amount of impact (including all clearing, back fill, excavation, riprap, retaining walls, other fill, etc.) above the normal pool lake level and 50 feet land -ward in square feet or acres: 83 o S�rr ko\25 Dec ti _ W S. AI.V6 S0' 4'E'7 MAL, % �Ic` ,_%I'W -AA 14x zc w4, - uooi1< b. Please describe the vegetation above the normal pool lake level and 50 feet land -ward to be impacted (number of trees for instance): S T'ajagwi Ao" A_>: w; -o 13,^;;+&—> • No (?;.,t,rS , a i3e RE&tov,:y E>ccx0 i Ar- Meocneuc, Boar ltc-.ham AAaA /I/ 2 Applicant/Agent',i Signature Date I (Agent's signature is valid only if an authorization letter from the applicant is provided.) Page 3 of 4 US Army Corps Of Engineers Field Offices and County Coverage Asheville Regulatory Field Office Alexander Caldwell Haywood McDowell Swain US Army Corps of Engineers Alleghany Catawba Henderson Mecklenburg Transylvania 151 Patton Avenue Ashe Cherokee Iredell Mitchell Union Room 208 Avery Clay Jackson Polk Watauga Asheville, NC 28801-5006 Buncombe Cleveland Lincoln Rowan Yancey Telephone: (828) 271-7980 Burke Gaston Macon Rutherford Fax: (828) 281-8120 Cabarrus Graham Madison Stanley Raleigh Regulatory Field Office Alamance Franklin Nash Surry TTS Armv Cogs Of Engineers Caswell Forsyth Northampton Vance 3331 mrri-K -rr&& a Chatham Granville Orange Wake se" T Ir )or Davidson Guilford Person Warren Davie Halifax Randolph Wilkes Durham Johnston Rockingham Wilson Edgecombe Lee Stokes Yadkin --ice Beaufort Currituck Jones Pitt US Army Corps Of Engineers Bertie Dare Lenoir Tyrrell Post Office Box 1000 Camden Gates Martin Washington Washington, NC 27889-1000 Carteret* Green Pamlico Wayne Telephone: (252) 975-1616 Chowan Hertford Pasquotank Fax: (252) 975-1399 Craven Hyde Perquimans *Croatan National Forest Only Wilmington Regulatory Field Office Anson Duplin Onslow US Army Corps Of Engineers Bladen Harnett Pender Post Office Box 1890 Brunswick Hoke Richmond Wilmington, NC 28402-1890 Carteret Montgomery Robeson Telephone: (910) 2514511 Columbus Moore Sampson Fax: (910) 2514025 Cumberland New Hanover Scotland Division of Water Quality 401 Wetlands Unit 1650 Mail Service Center Raleigh, NC 27699-1650 Telephone: (919) 733-1786 Fax: (919) 733-6893 North Carolina State Division of Water Quality (Does not need to be submitted) Page 4 of 4