20190642 Ver 1_Shoreline Stabilization_20190513

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SAMPLE AGE J- O FORM
Yr,UrtKJ T LcuHL Lxz)%.Kdri Sufic
LOT NO. 2-9 1 6 PLAN NO. PARCEL ID: 67--2-2-
STREET
:2--
STREET ADDRESS:
Please print:
Property Owner.
Property Owner: thN tLtz4 S'
The undersigned, registered property owners of the above noted property, do hereby authorize
• . � mi
7F— , of _ C : cr 3C- . �� r- CQc — 77= — j �+ L
(Contractor i Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification, and any and..il standard and special conditions attached.
Property
(Owner's
'Address (if different than property above):
R� �"C � �. 1�"• � C��r �f�>. (s ��l�t� \`Jls�1`�t'���P_�_ ,,, �C � t ���
Telephone:
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Date:

State of North Carolina
Department of Environment and Natural Resources
DWR 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
Three copies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: �JDry
Mailing Address: (�/ 11 ffij �-D, &iA C00(,11-
(!f
:flJ( '
Telephone Number: 33% - , ax Number:
E-mail Address: JklfzP� S @ AA 5— L M • -M -i-E-5-f- C,--, M
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: S 44,JIJ
Company'Affiliation: <�OJ car -'r" GAAv-Z-Z�Z�'_---r7A� � ��'J LLG
Mailing Address: 66 .SUN &I G* CV.
Lo J 1 � IIIc Z "� 5
Telephone Number: �/`% &'(- (W� 5 Fax Number: ��Z� -5& 88
E-mail Address: G�=P� Coa"r .4G�" � S ��,/\) Q'_ -QAAA,I L . C10'�1
Person to receive the Certification Approval: S'f-FA-vim
II. 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: J: gg A'SI"i.I^J Nearest Town: 73 j
Subdivision name or site address (include phase/lot number):
l,AV_A_ leb C -f A L_ r
Directions to site - please include road names and numbers, landmarks, etc.:
(� 5`A -IQ
Latitude (in decimal degrees) Longitude (decimal degrees)
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Fr --s Il> ^L L_ 0T_ v'`IFZ
6. Property size (acres): , CUA A'c-•�L `�'5
7. Lake/ river/ ocean adjacent to property:
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
9. Will work be conducted from land? [C From water? ❑
VNI
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool lake level/rmal Water Level in square feet or a©cr
o
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake level/ N rmal Water Leval and 50 feet land -ward in (SV
C2nx1391 -E 235 1/27x ► � � a a�
square feet or acres: ` -qtv coli +lt
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and °�6
50 feet landward to be impacted (number of trees, for instance):
Date
*Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

LAO
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.
5. 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

REFERENCES: Lot 2816 -Revised, Lake Royale Subdivision
Deed Book 2170, Pages 1435 & 1437
Deed Book 2170, Page 1439 - Encroachment Easement
Deed Book 2157, Page 1654 - Restictive Covenants
Plat Record File 1, Slide 102
Tax Record No. 022148
LEGEND: 0. . . . found iron as noted I
O. . . . set iron as shown
C.P. o . . . . calculated point
. •....................• 100 -Year Flood Limits (see note)
- — — — — — - . property line plotted from record
easement line
NOTE: N.C. Grid station unavailable within 2000' at this time.
NOTE: Area of Lot = 0.601 Acre ( Coordinate Method )
NOTE: This survey is subject to all easements, agreements,
rights-of-way and restrictive covenants recorded prior to
the date of this survey.
NOTE: 100 -Year Flood Limits line scaled and plotted entirely
from FEMA DFIRM "Franklin County, NC Map No.
3720283000K, effective 4/16/13
I, w',Iliam T. Dement, Jr., certify that this plat was drawn under my supervision from an
actual field survey made under my supervision (deed description recorded in Book 2170,
Pages 1435 & 1437; that the boundaries not surveyed, ore clearly indicated as drawn from
information found in Plat Record File 1, Slide 102; that the ratio of precision as calculated
is 1/20,000; that this survey is of on existing parcel or parcels of land and does not
create a new street or change an existing street; that this map was prepared in accordance
with G.S. 47-30 as amended. Witness my original signature, lie se number and seal, this
12th day of March, 2019. �
L_'�QO-__. 1—
Professional Land Surveyor L-1456
Curve Radius Length Chord Chord Bear.
Cl 160.00' 44.90' 44.75' S 21.33'35" E
C2 160.00' 44.90' 44.75' S 37'38'00" E
LASE
ROYALE
c6r_ .;
=O`he
0401—N CAROti,,i
�O �pEFSSIp� `9 �y
Q
SEAL —_
L-1456
DEtdF `����`,,•
ufnuM��
Calculated Tie tine From Set Mog Nail
w/Top Flush w/Asphalt Surface In Approx.
Centerline Intersection of Sagamore &
Nakama Drives:
S 04705'55"W 175.63'
Found 1/2' IT I'^
Above . P
1 ourtace At Rao
1 Po.er Polo
\
R,,snr./r,pnd �^I
D
RECORD NORTH surfooe ^ C� e0, 1%
( PRF 1, S. 102) / \
( 281 ) C.P.
Now or Formerly \ 0 ---Cola Point
Jeffrey A. Franklin, et ux e� g� ° At Rase of
( D.B. 1789, P. 259) se ����'/ h• Po— Pole\
too -rear Fmoa mts ��\`I ��
( See Notes )a 0 \)M
6 ��j 2900 7
tJ 60 / 9, rP�pe ./r pInan
Flsh S\
\ \ FS n t/2' o -on 2816 6/01�c�, •/crw a surtaee �7�fy�
\ Pipe ./Top T
Rem+ erauad
Set Mag Nail In \�' ��j��l g ra 0�,� 2817
Top of Retainirg l ��' J�` Now( or Formerly
Wall on Extended �� $ 10 fpr f a BrianJackson, et ux
surxeyed ane l
(D.B.' 2146, P. 857 )
Adlelnare'3 Retaining
A PrEEttaExtents ded N 7 - T
S.ad
ourd,d Easni%) r 1.8u6` O."•• � REar'n a Flus
— LAKE ROYALE
NOTE: High Water Marx \\ 50' Tar River Basin
of Lake Is Property Line
Now or Formerly y \\ Riparian Buffer
Lake Royale P.O.A., Inc.
( D.B. 1803, P. 923 )
Edge of Lake
PLAT OF REVISED BOUNDARY SURVEY FOR
JOSEPH C. HARRIS & WIFE, KATHLEEN H.
(Present Record Owner — Joseph C. Harris, et ux) HARRIS
1273 Sagamore Drive, Cypress Creek Township, Franklin County, North Carolina
Scale: 1"=60' Date: March 12, 2019
60 0 60 120 180
GRAPHIC SCALE —FEET NOTE: owner's name shown for indexing
purposes only and does at constitute
Surveyed & Mapped By title ce tf cation.
WILLIAM T. DEMENT, JR., Professional Land Surveyor, PA
L-1456, C-0649
(0)919-496-6159 (M)919-496-9502
102 West Nash Street Louisburg, N.C. 27549 (File No. 2993-6-2)

REFERENCES: Lot 2816—Revised, Lake Royale Subdivision
Deed Book 2170, Pages 1435 & 1437
Deed Book 2170, Page 1439 — Encroachment Easement
Deed Book 2157, Page 1654 — Restictive Covenants
Plat Record File 1, Slide 102
Tax Record No. 022148
LEGEND: •. . . . found iron as noted
O. . . . set iron as shown
c.P.0. . . . calculated point
. . . 100—Year Flood Limits (see note)
— — — — — — — . property line plotted from record
easement line
NOTE: N.C. Grid station unavailable within 2000' at this time.
NOTE: Area of Lot = 0.601 Acre ( Coordinate Method )
NOTE: This survey is subject to all easements, agreements,
rights—of—way and restrictive covenants recorded prior to
the date of this survey.
NOTE: 100—Yecr Flood Limits line scaled and plotted entirely
from FEMA DFIRM "Franklin County, NC Mop No.
3720283000K, effective 4/16/13
I, William T. Dement, Jr., certify that this plot was drawn under my supervision from an
actual field survey made under my supervision (deed description recorded in Book 2170,
Pages 1435 & 1437; that the boundaries not surveyed are clearly indicated as drawn from
information found in Plat Record File 1, Slide 102; that the'ratio of precision as calculated
is 1/20,000; that this survey is of an existing parcel or parcels of land and does not
create a new street or change an existing street; that this map was prepared in accordance
with C.S..47-30 as amended. Witness my original signature, lic se number and seal, this
12th day of March, 2019.
Professional Land Surveyor L-1456
Curve Radius Length Chord Chord Bear.
C1 160.00' 44.90' 44.75' S 21'33'35° E
C2 160.00' 44.90' 44.75' S 37'38'00" E
RECORD NORTH
( PRF 1, S. 102)
No Scale )
��D�SN CARp(/4�
Q��ssf0,'�'9
SEAL
L-156
pii f! T, DEM`;``
LASE
ROYALE
Calculated Tie Line From Set Mag Nail
w/Top Flush w/Asphalt Surface In App ox.
Centerline Intersection of Sagamore &
Nakoma Drives:
S 04'05'5514 175.63'
Frond:/2' Iron
npK c,°rna
Saudace At Base
I Pa.er Pale
/� / \ • i
Set 5/s' Iran \
Fl:t ./Top
ae
�.
S.A.a>1
da
( 2815 )
Now or Formerly
Jeffrey A. Franklin, et uxeICIN
( D.B. 1789, P. 259) �asgo
O
110 11
Year ood Limits
( See Not -
10 X61
6�
\
\
F 1/2' Iron
Pipe ./Too
Fix,
sero. Groansd
\ sadaae /
/
Set MoNos In
Top off Retaining.
+j
Wall On Extended �`
sur-yed ane
g6•.•
; \
.'•......
Adjoinee. Retaining
\
Wall Proieets 115'
Across Extended
Surveyed U.8.
'
N S 7�9 •'••
2p;'•
(see Recorded Easm't.)
Te 16
/}
4
- LAKE ROYALE
e j ly `� Z
NOTE: High Water Mark
Prop
of Lake Is erty line
`V
Now or Formerly y
Lake Royale P.O.A., Inc.
( D.B. 1803, P. 923 ) ,
Edge of Lake
2816
caiaw.t.d\ .1nt At Base ef
Pa.er Pole
1/2. ese
cr u2 sFlriaa�e Gfy�iy
k�ry6 J<�
(
Now
orBFormerly
BrianJackson, et ux
/ (D.B. 2146, P. 857 )
found 1/2' Iron
' wjc�oane as,°rN ca
X50' Tar River Basin
\ Riparian Buffer
PLAT OF REVISED BOUNDARY SURVEY FOR
JOSEPH Owner
_HARRIS Harris,
WIFE, KATHLEEN H.
( p ) HARRIS
1273 Sagamore Drive, Cypress Creek Township, Franklin County, North Carolina
Scale: 1"=60' Date: March 12, 2019
60 0 60 120 180
GRAPHIC SCALE — FEET NOTE: Owner's name shown for indexing
purposes only and does not constitute
Surveyed & Mapped By title certification.
WILLIAM T. DEMENT, JR., Professional Land Surveyor, PA
L-1456, C-0649
(0)919-496-6159 (M)919-496-9502
102 West Nash Street Louisburg, N.C. 27549 (File No. 2993-5-2)

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