20170035 Ver 1_Email App to USACE_20170207

Burdette, Jennifer a
From: Randy Dickerson <[e-mail]>
Sent: Tuesday, February 07, 2017 10:59 PM
To: [e-mail]
Cc: Burdette, Jennifer a; Randy Dickerson; Terri Dickerson
Subject: Army Corps Engineer General Permit # 197800080 for William Dickerson 947
Sagamore Drive, Louisburg, NC (Lake Royale)
Attachments: Dickerson 947 Sagamore Dr Permit Request -Franklin County.pdf; Dickerson Boat
House Documents.pdf, Dickerson 947 Sagamore Dr_ Lake Royale_ boat slip cover
drawings.pdf
Dear Mr. Williams,
I have undergone quite a journey trying to clarify the process for obtaining a permit for our boat slip and cover
for Lake Royale in Franklin county. I have attached a copy of the forms that I submitted to NC DWR.
We have been granted a permit by NC DWR #17-0035 for our boat slip and cover. We now need the permit
required from the Army Corps of Engineers, General Permit # 197800080.
Please let me know if I need to provide further information for this permit. Our phone numbers are: 919- 522-
2952 / 919-848-4088. Our mailing address: 4325 Blossom Hill Ct., Raleigh, NC 27613
Thank you,
William (Randy) Dickerson
Terri Dickerson
919- 522-2952 / 919-848-4088

-Lt -0 r l/
12C(
DWR State of North rolina /
Department of Environment and Natural Resources 2_760,�4
Division of Water Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification
Instructions for Application FORM SSGP 10-2013
(Shoreline Stabilization 401 WQC to accompany USACE GP30, GP79, or GP80)
Instructions for Shoreline Stabilization Application
When to use this form —This application form should be used to apply for a 401 Water Quality
Certification to impact:
When this form should not be used — This application form cannot be used for wetland or
stream impacts. This information does not apply to landowners within the twenty coastal
counties that are affected by Division of Coastal Management (CAMA) rules.
For more information — If you have been advised that you require a 401 Water Quality
Certification, and would like more information about:
r The application process: http://portal.ncdenr.org/web/wq/swp/ws/401/certsandpermits
How to download an application form:
http://Porta1.ncdenr.org/web/wq/swp/ws/401/certsandpermits/apply/forms
ry Application fees:
http://Porta1.ncdenr.org/web/wq/swp/ws/401/certsandpermits/apply/fees
If you are unable to download this information or application, please call [phone] to
request an application with instructions.
Please note — Not all impacts require written authorization from DWR. This may include the
construction of docks or boathouses if there is no dredging or filling involved (other than the
pilings). For more information, please visit the following website:
http://Porta1.ncdenr.org/web/wq/swp/ws/401/certsandpermits/fags#always have to apply
How to apply — When submitting an application to DWR, please use the following instructions
as a checklist in order to ensure all required items are submitted. Adherence to these
instructions will help facilitate a quicker review time and reduce the amount of requested
additional information.
�GI j
INSTRUCTIONS FOR APPLICATION SSGP307980 08-13 & SUPPORTING DOCUMENTATION I Ilag6W4 30 Vj 2017
U.S. Army Corps of
Description
Engineers (USACE) Permit
Federal Energy Regulatory Commission (FERC) regulated lake
shore or bottom
GP30
Tennessee Valley Authority (TVA) regulated lake shore or bottom
GP30
Local government regulated lake shore or bottom
GP30
USACE Reservoir owned/regulated lake shore or bottom
GP79
Private lake shore or bottom
GP80
When this form should not be used — This application form cannot be used for wetland or
stream impacts. This information does not apply to landowners within the twenty coastal
counties that are affected by Division of Coastal Management (CAMA) rules.
For more information — If you have been advised that you require a 401 Water Quality
Certification, and would like more information about:
r The application process: http://portal.ncdenr.org/web/wq/swp/ws/401/certsandpermits
How to download an application form:
http://Porta1.ncdenr.org/web/wq/swp/ws/401/certsandpermits/apply/forms
ry Application fees:
http://Porta1.ncdenr.org/web/wq/swp/ws/401/certsandpermits/apply/fees
If you are unable to download this information or application, please call [phone] to
request an application with instructions.
Please note — Not all impacts require written authorization from DWR. This may include the
construction of docks or boathouses if there is no dredging or filling involved (other than the
pilings). For more information, please visit the following website:
http://Porta1.ncdenr.org/web/wq/swp/ws/401/certsandpermits/fags#always have to apply
How to apply — When submitting an application to DWR, please use the following instructions
as a checklist in order to ensure all required items are submitted. Adherence to these
instructions will help facilitate a quicker review time and reduce the amount of requested
additional information.
�GI j
INSTRUCTIONS FOR APPLICATION SSGP307980 08-13 & SUPPORTING DOCUMENTATION I Ilag6W4 30 Vj 2017

1 70035
-- State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
Shoreline Stabilization Application Form
Four copies of the appflication (including attachments) and the application fee should be sent to:
Division of Water Resources
401 &Buffer Permitting Unit
1617 Mail Service Center LLc�'
Raleigh, NC 27699-1617 fix
g , .IAN 0 b 201?
1. Applicant Information [15A NCAC 02H _0502(a)]
1. Owner Information
Name: WILLIAM R. DICKERSON
Mailing Address: 4325 BLOSSOM HILL COURT
RALEIGH, NC 27613
Telephone Number: [phone] [phone] Fax Number:
E-mail Address: terri7104(@gmail.com
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
htto:/lwww.saw_rasa_ce,army.rnil/Portal,;/59/encs/rcuralatony/rr,-f�,Hnc-/Pe,rmit,j5lli 11,1 A("i_fJT ryUTf�
_.._ .
O )7r1TION FORiVLI ) must be attached if the Agent has signed this application form.
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Person to receive the Certification Approval: OWNER
II. Project Information
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 4

ti
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.) EXISTING SEA WALL IN PLACE.
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, 947
SAGAMORE DRIVE, LOT 1704
Directions to site - please include road names and numbers, landmarks, etc.: FROM LAKE
ROYALE SECURITY GATE, STAY RIGHT ON SHAWNEE, TURN RIGHT ON TO SAGAMORE. 947
WILL BE ON YOUR LEFT.
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): RESIDENTIAL
6. Property size (acres): 0.44 ACRES
7. Lake/ river/ ocean adjacent to property: LAKE ROYALE
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): BOAT SLIP AND COVER
9. Will work be conducted from land? 0 From water? 0
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:
PIERS AND FRAMING FOR THE SLIP WILL BE PLACED LAKESIDE (10 FT X 12 FT). BOAT SLIP
WILL PROJECT 10 FT FROM EXISTING SEAWALL INTO LAKE AND WILL BE 12 FT WIDE WITH
4FT DECKING ALONG BOTH SIDES
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: 360 SQUARE FEET (10 FT X 12 FT X 3 FT) EXCAVATED TO FORM HALF
OF BOAT SLIP. 4 FT DECKING AROUND THE SIDES AND BACK.
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): 1 PINE TREE AND
POSSIBLY 2 SMALLER TREES.
Owner/Agent's Signature* [15A NCAC 02H .0502(f)j Date
Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

,piLUuhcP SIY�
Full Pond/
Normal Water Level
1 (� Shoreline
( r
KCa ►0 xl2x��
�-' 2 —ii
IC/ 10
_'11-N -'-V
La ke
(At Full Pond/ Normal Water Level)
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

NAP. '26_99 TF4ti 29:4r HM RUBERT U. WXII.I {6`�M�rS (`RLS.S 1 949 269 5734
NOtE: Bi1NG LOT 1704 OF LAKE ROYALE FORMERLY BoomKE 12. PGp6�.
MAP 8 OF 4.0. SHEET 3 OF I. RECOItDE
L E ROYAi.E 16' BOAT DOCK
EDGE OF WAY R � EXTENDS 9.5' OFYONO
N 144 E 97.62 PROPERTY LINE
Of 170 I
ApppESS: ITo4 SAGAMORE Oft, - 04
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CYPRESS CREEK TOWNSHIP
FRANKLIN COUNTY
/`�` ""'�:.:•�'�, SEAL NORTH CAROLINA
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1, ROBERT G. WILLIAMS, ctfilfy that under my direction and ROBERT G. WILLIAMS
supervision this map was drawn from an actual field surrey; thof RELANG SURVEYOR
the error of closure of the survey ds caloulaied by latitudes and
ZEBULO REGISTERED ULON, NORTH CAROLINA
1 departure$ is 1: 10000 • that this map was prepared In Toleph"41 209-!700.
occor4onco with B.br. 47-30 as amended.
i witness my hand an thhll /201 day Of MARCH, 1919.
DRAWN BY: ROW 11• ELw
L.1417 fiP�.�(/e��n CHECKED BY: RGW
R.L.S. _ -,
Sworn to and subscribed before me thl 23 day of N� CH;19e/.
DATE: - 5-98
My' Cemmissi0n expires: 3'17' 00Y SCALE: "F40'
NOTARY PUD IC FI old Book: 62
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Elm City, NC 27822
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RAILS RECOMMENDED ON
WALKWAYS UNLESS
FUNCTION PROHIBITS.
RAIL POSTS MINIMUM 45<4.
V-011 MAXIMUM
2X'8 JOISTS MAXIMUM
2411 O.C. ANCHOR
JOISTS AGAINST WIND
AND FLOOD UPLIFT
WITH 2X4 BLOCKS /
NAILED TO JOISTS/ �
AND GIRDES.
2" NOMINAL DECKING
OR EQUIVALENT
COMPOSITE DECKING
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BOLTS THROUGH PILES.
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PILES SPACED MAXIMUMiAll'
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OF 12) 2XIOIS, ONE
81-O° ON. CENTER INEACH
CONDITIONS CONSIDERING
F. ZQ
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LONGITUDINAL DIRECTION.
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FIGURE 1: FIXED PIER WALKWAY SECTION
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fRANKLIN COUNTY HEALTH DEPARTMENT
PERMIT N()M8FzR;
DATE:
v
APPLICANT:
OWNER;
TELEPHONE:
COMMENT:
LOCATION / DIRECTIONS -
FEE:
SIGNATURE OF OWNER OR AUTHORIZED AGENT:
CONFIRMED BY PLANNER-
PLANNER:
DATE'!
7v
THE ABOVE SIGNATURE INDICATES THAT I HAVE SWAID, UNDERSTAND, AND AORaE VRTH ALL PROVISIONS AND d4F6RMATI4N AS OUTLINED
ON TH9 BACK SIDE OF THIS FORK
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PIAR-26-90 THU 09:47 AM ROBERT G. WXLLXAMS RLS.S 1 9I9 269 5754 P.04
NOtE: BE114G•LOT 1704 OF LAKE ROYALE FORMERLY LAKE SAGAMORE,
MAP 0 OF 20, SHEET 3 OF S, RECOADED IN PLAT BOOK 12. PG, 54.
EDGE OF WATER LAKE ROYALE, 16' BOAT EXTENDS C 9.5• BEYONO
— —. N 69144101" E 97,62 PROPERTY LINE
ADDRESS: 1704 SAGAMORE DR. IV LOT ITOa j o
BUNN. N.C. Cy
0.44 AC. I A O
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LEGEND
0 EXISTING IRON
40 20 0
LOT 1703
24,4
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' • R=139.44 POLE
• l 19,47 40,00 POWER LINE
S73•J8�3•p —��._ �,_� R/W
- NGT6RNp� s Ct'GRIf- "Eno
Ot-E s3za
AS BUILT
SAGAIAORE OR1YE
--- R/W
40 BO
HOUSE I,OCAT ION FOR
MARIAM CATAPANO
CYPRESS CREEK TOWNSHIP
1.131 i
FRANKLIN COUNTY
;•�i.,''~�;..-'_:,�,;;-�'� ..:..:;_�..- �
SEAL NORTH CAROLINA
1, ROBERT G. WILLIAMS, certify that under my direction and ROBERT G. WILLIAMS
supervision This map was drawn ftem on actual field survey; that REGISTERED LAND SURVEYOR
the error of closure of the survey as c0cUloted by latitudes and ZEBULON, NORTH CAROLINA
departures is is 10000 •that this map was prepared 1a 7etephonel 269-5?00,
accordance with G.S. 47-30 as amended.
Witness my Kana anda thi �25f� /day of MARCH, I999. DRAWN 1BY:ROW b £LW
R.L.S.
L-1417.+�1,Tr �4�s�e�rsY CHECKED BY: RGW
Sworn to and subscribed before me tht 23 day of M cH; Isoe. DATE: 3-23-98
My Corhmissidn expires: 3-17- 002 �a i ... SCALE: I:w4O*
NOTARY PUBLIC Field Book: 62
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71 7 7�5
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SEPTIC 2"
TANK
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10,37
LOT 1705
LOT 1703
24,4
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' • R=139.44 POLE
• l 19,47 40,00 POWER LINE
S73•J8�3•p —��._ �,_� R/W
- NGT6RNp� s Ct'GRIf- "Eno
Ot-E s3za
AS BUILT
SAGAIAORE OR1YE
--- R/W
40 BO
HOUSE I,OCAT ION FOR
MARIAM CATAPANO
CYPRESS CREEK TOWNSHIP
1.131 i
FRANKLIN COUNTY
;•�i.,''~�;..-'_:,�,;;-�'� ..:..:;_�..- �
SEAL NORTH CAROLINA
1, ROBERT G. WILLIAMS, certify that under my direction and ROBERT G. WILLIAMS
supervision This map was drawn ftem on actual field survey; that REGISTERED LAND SURVEYOR
the error of closure of the survey as c0cUloted by latitudes and ZEBULON, NORTH CAROLINA
departures is is 10000 •that this map was prepared 1a 7etephonel 269-5?00,
accordance with G.S. 47-30 as amended.
Witness my Kana anda thi �25f� /day of MARCH, I999. DRAWN 1BY:ROW b £LW
R.L.S.
L-1417.+�1,Tr �4�s�e�rsY CHECKED BY: RGW
Sworn to and subscribed before me tht 23 day of M cH; Isoe. DATE: 3-23-98
My Corhmissidn expires: 3-17- 002 �a i ... SCALE: I:w4O*
NOTARY PUBLIC Field Book: 62
(E e(q �, I
(-�oMe � r a G6• �
71 7 7�5

Franklin County Planning Department
215 E Nash Street
Louisburg, North Carolina 27549
ZONING PERMIT FEE INVOICE 08/15/2016
INVOICE # RN -0056839
DATE PAID:
RECEIVED FROM:
ADDRESS:
HOW PAID:
AMOUNT RECEIVED:
RECEIVED BY:
FEE PAID FOR:
ID #:
08/15/2016
WILLIAM R DICKERSON
4325 BLOSSOM HILL CRT
RALEIGH, NC 27613
Check
$30.00
KR
ZONING PERMIT
120758-ZO16863
CHANGE:
CHECK #: 3299