20201763 Ver 1_Shoreline Stabilization_20210104

Submission Form
Pre -Filing Meeting Information
Before submitting this form please ensure you have submitted the Pre -Filing Meeting Request Form as we will not be able
to accept your application without this important first step. The Pre -Filing Meeting Request Form is used in accordance
with 40 C.F.R. Section 121.4(a) "At least 30 days prior to submitting a certification request, the project proponent shall
request a pre -filing meeting with the certifying agency" and in accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5)
all certification requests shall include documentation that a pre -filing meeting request was submitted to the certifying
authority at least 30 days prior to submitting the certification request. Click here to read more information on when this
form is needed prior to application submission or here to viewthe form.
Attach documentation of Pre -Filing Meeting Request here:
1380775.pdf 2.72MB
Pre -fling Meeting or Request Date 11/17/2020
ID# 20201763 Version
I. Applicant Information [15A NCAC 02H .0502(a)]
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all
mandatory questions are answered.
Primary Contact Email * [e-mail]
Rease provide an err -ail address for payment and requests for pure infornation here.
Owner Information:
Name: * Gregory L Taylor and Cynthia Down -Taylor
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
1352 prevenient dr.
Address Line 2
city
State / Frovince / Region
Wake Forest
NC
Postal / Zip Code
Country
27587
USA

Is there an agent working on the
project? *
Agent/Consultant Information
.................................................................................................................
Name:
Company Affiliation:*
Email:
Phone Number:*
Mailing Address:*
F Yes
r No
Shaun Liggett
Concept contracting and Design LLC
c one eptc ontrac tdes ign@gmaiL c om
[phone]
(XXX)XXX-XXXX
Address
301 E. Nash Street
Address Line 2
City
Louisburg
Fbstal / Zip Code
27549
Asigned and dated copyof the Agent Authorization letter:*
Taylor agent authorization.pdf 998.32KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Taylor Waterfront
State / Province / Region
NC
Country
USA
If your project has a formal name please use this. If your project does not hake a formal name, please identify your project by
the owner name and proposed activity (Jones Property Access Road, Smith Guest House, etc.) List in parentheses any
other names that have been used to identify the project in the past.
1. Provide 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.*
r Upload File
r Lookup address
Property Address Lookup:* Street Address
775 Sagamore Drive
Address Line 2
city
Louisburg
Fbstal / Zip Code
27549
Latitude:* 35.951817
State / Province / Region
NC
Country
US
Longitude:*-78.193206
2. Provide a detailed site plan showing property boundaries and proposed locations of vegetation clearing,
structures (buildings, retaining walls, docks, impervious surfaces, etc.), rip rap, excavation or dredging
below Full Pond/ Normal Water Level elevations, and construction access corridors. You may use the
diagram under section 12.normal pool lake level/normal water level*
775 buffer 3.pdf 829.91KB
Please use the diagram at the link below:

https://edocs.deq.nc.gov/WaterResources/0/edoc/616616/Shoreline%2OLayout.docx
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale of some sort- a
yard stick, shovel handle, etc.)*
775 taylor shoreline pic.pdf 5.47MB
4. Location of the property (where work is to be conducted)
Nearest Town:* bunn
County:* Franklin
Lake/ river/ ocean adjacent to lake royale
property:
Subdivisions name or site address:* lakeroyale
Include phasellot number
Directions to site:*
enter main gate takeright on shawnee dr., then left on ohio drive, right on
sagamore drive, then lot is on left corner of stage line cv
Rease include road names and numbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
wooded uncleared
Fbsidential, undeveloped, etc.
6. Property Size .832 acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
75 feet of shorleine install riprap and 50 feet of new vynil sheet pilings as
bulkhead wall for baot slip. install boat house ad docks
8. How will the work be done?* PF From Land
r From Water
9. Total amount of disturbance below the normal pool lake level/ normal water level:*
(including all clearing, backfill, excavation, rip rap, retaining walls, etc.)
1200
square feet
10. Total amount of disturbance above the normal pool lake level/ normal water level and 50 feet
land -ward: *
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
850
square feet
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet
landward to be impacted:*
(nunber of trees, for instance)
(8) eight large trees to be removed for boat slip access
clean out small vegetation and underbrush and dead organics and seed
straw area or natural vegetation planted when finished
Sketch: 775 buffer l.pdf 1.3MB
775 buffer 2.pdf 1.18MB
Application Fee:

Once the application has been accepted. You will need to send a corresponding fee in with the appropriate DWR#. The
application fee is as follows (pursuant to G.S. 143-215.3D):
0 $240.00 for impacts to lake (below normal water level) of less than 1 acre
0 $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:
o I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the
best of my knowledge and belief
o I, the project proponent, hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time.
o I agree that submission of this Shoreline Stabilization online form is a "transaction" subject to Chapter 66, Article 40 of
the NC General Statutes (the "Uniform Electronic Transactions Act');
o I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act');
0 1 understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
o I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:* Shaun Liggett
Signature:

Initial Review
Is this accepted into the review
process?*
Project Number:* 20201763
Select Reviewer:*
Select Reviewing Office
Has payment been received?*
What amount is owed?*
rYes allo
Version:* 1
Stephanie Goss:eads\szgoss
Raleigh Regional Office - [phone]
r No Payment Needed
r Fee Received
r Need Fee - send electronic notification
r $240.00
f $570.00

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. Z SS � PLAN NO.
STREET ADDRESS:
Please print:
Property Owner:
Property Owner:
PARCEL ID: '2- 3 (P / 3
N 2 7 S+ j
The undersigned, registered property owners of the above noted property, do hereby authorize
j Ar J�J L� -►F t��� of
(Contractor / Agent)
C_Z/U Cg-f "T G.}-5�7«1rC�7.-� .v _f7'> 9-I'T
(Name of consulting firm) L4, C
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and. -all standard and special conditions attached.
Property Owner's Address (if different than property above):
13 5 2 i�V Zy i 1,' en -b
Telephone: 7o 4 `a oa —`- 1 ` V V
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
ems- -(
thorized Signature
Date: 9/1�9- U Z O
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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)
0
� — ,�Kc,:✓ter
,-r�
Full Pond/ Normal Water Level
Shoreline
et/�`-'
2 KX
,Arg,J-15 F
t C oR-PyJ,6 &IM *0 �a
COOEW
%DAIr 14vris a,
I S ) 22 t L mK- LtAA&`'L-
Plan View
Lake
(At Pull Pond/ Normal Water Level) Existing Dock
/ 30h:7fr
O rI •-��lti ���r�� I Q
Fri f� ♦♦ �L
nroreMne
1
Plan QwEAMPLE
FORM: SSGP 02-2017
Page 3 of 4

(DI apO(t
Qa Cam I
P
4-1
(At Full Pond/ Normal Water Level) �twv.
J I W
Q O
Z th
c
Side View
LL-
2 ft. additional clearing
3 ft. below full pond water level 4 ft. above full pond water level •if necessary
10 ft. bank
height
Side VI
Page 4 of 4
FORM: SSGP 02-2017

ID#* 20201763
Version* 1
Regional Office* Raleigh Regional Office - [phone]
Reviewer List* Stephanie Goss
Pre -Filing Meeting Request submitted 11/17/2020
Contact Name* shaun liggett
Contact Email Address* [e-mail]
Project Name* Taylor waterfront buffer zone improvements and shoreline stabilization
Project Owner*
Greg and Cindy Taylor
Project County*
Franklin
Owner Address:
Street Address
1352 prevenient drive
Address Line 2
aty
State / Frovince / Region
wake forest
NC
Fbstal / Zip Code
Country
27587
united states
Is this a transportation project?* C Yes c: No
Type(s) of approval sought from the DWR:
I;W 401 Water Quality Certification - 1— 401 Water Quality Certification -
Regular Express
I— Individual Permit I— Modification
140 Shoreline Stabilization
Does this project have an existing project ID#?*
C Yes (-- No
Do you know the name of the staff member you would like to request a meeting with?
stephanie goss
Please give a brief project description below.*
selective clearing in the 50 ft. buffer zone, dredging and excavation for
boat slip/ seawall, install seawalls, boat house & docks over water,
shoreline stabilization rip rap shoreline areas
Please give a couple of dates you are available for a meeting.

11 /20/2020
11 /23/2020
11 /24/2020
Please attach the documentation you would like to have the meeting about.
ncdeq_shoreline app_1.pdf 7.66MB
ncdeq_shoreline app_2.pdf 2.52MB
ncdeq_shoreline app_3.pdf 2.62MB
ncdeq_shoreline app_4.pdf 7.91 MB
pdr only
By digitally signing below, I certify that I have read and understood that per the Federal Clean Water Act Section
401 Certification Rule the following statements:
• This form completes the requirement of the Pre -Filing Meeting Request in the Clean Water Act Section 401 Certification
Rule.
• I understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request.
• I also understand that DWR is not required to respond or grant the meeting request.
Your project's thirty -day clock started upon receipt of this application. You will receive notification regarding meeting location
and time if a meeting is necessary. You will receive notification when the thirty -day clock has expired, and you can submit an
application.
Signature
a"4v ew
Submittal Date 11/17/2020
Reviewer Meeting Request Decision
Has a meeting been scheduled?* r Yes r No

N°A State of North Carolina
Department of Environment and Natural Resources
w Division of Water Resources
Water Resources 15A NCAC 02H .0500 - Water Quality Certification, Shoreline Stabilization
ENVIRONMENVAL 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 .05Q2(a)]
1. Owner Information
Name: 6>° TA-7La� Ago �•/rFF C`�/�!?7-/iA J�or.J� �7%�Y(�1
Mailing Address: 3 5 Z V E1,.e ^t7- �)Fzl ✓ f--
w A Imo- XEXT N e 2.'� 5 g�
Telephone Number: Fax Number: —
E-mail Address: G/ Y11VJn D/V ?R9667-(° 6 �_ . 0a.^4
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:
http•//www saw usace army mil/Portals/59/dots/regulatory/regdocs/permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf)
Name: `f'Nf�uni Ll�6E7�-
Company Affiliation:
Mailing Address:
Co N CE-PT G0---)TP-1T C_77 .J f, -'�- O E -"4 1J L L 0-
3 a / F. n/ A.SM S_I`7
L-0 (-Je<Sdy2E, /V C- Z 7�54�9
Telephone Number: C7(9 ) 81 ! - ��98 Fax Number:
E-mail Address: Cone LEA-'r-Go^J>7Z_4-,C_T� - ite'J E EjAAA-,(L., C4M
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)
County: r4rJJ�-�-�� Nearest Town: 50NA/
Lake/ river/ ocean adjacent to property:
Property size (acres): - `� S. 04C-4;;r- J
Subdivision name or site address (include phase/lot number): LL�k{� r4 LrL
Lo l 5 5 G
Directions to site - please include road names and numbers, landmarks, etc.:
yA LG -rAt.F- OW bh-r ar-1 S" .u�-IE - L64r7--s..j Crri• i;,- d'•1
SA-t;PA-^A z z ! pn. , AjdEx•r- L4f rET- CVJ GdA¢r &,=Z �7yt �ir� t.f •.7 t­ Pet -
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.): ��r•-I� Lrr` (f/.ip�v� �d
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Ae k --f-AbA2441-.sX- 74
Zf
tje W C �P�e l bh riEa � ftr- .r^` � � E Es "e- Oe �..J
8 oA.-r-- Pd-,) s r..- S+-+i C XZMa � [-�-) S4 ✓E.-J
7. Will work be conducted from land? 10 From water? ❑
8. Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent impacts (including -!I excavation. harkfill, rip raa, retaining walls, etc.] ins tare feet:
� ! {30 r! n m � � - t7R�,q�EaE = S60
Temporary impacts in square feet: 'k-%AA.
50 .5 ,& . fV;AIe__
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:
Elf g-W = 100 FQWT-. rkr St*vJ A` sR. FT. G;0-4,14-34 -- 8 7MxlES,
Temporary impacts (temporary clearing, construction corridor) in square feet: six SR.
Say
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): x t1,W�C,q�
rS PrQf' �.t .��5' • G��+o �
11. Sig e -
��5
/Agent's Si [15A NCAC 02H .0502 f at
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 02-2017 Page 2 of 4

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
Full Pond/ Norma! Water Leve
i i i I• i �
Shoreline
ai3o�s�,P
Plan View
La ke
(At Full Pond/ Normal water Level)
r � 0A^ t.w 2 1'-
k'+
Full Pond/ Normal Water Ley
here Ine
2%., 150 k.
addNbnal deerinp r
d nrceuary
E
Plan View
FORM: SSGP 02-2017
r
2� FC X
A - g.,
' 5k4:--Qr - L -.Q-
Ct�U�
La ke
W Full 71ard1 N-1 WMOI 4-1}
Existing Dock
/Wftx7d
Ri pra p
3f .Lwft
8elourdii pad/ hiyi
ur
ar.aisok
U1 p..V NJR
UQAWk.ff"W19
Page 3 of 4

�pLl ke
4.4
o ,
Qa Cam
P
(At Full Pond/ Normal Water Level) M
E
o °
zIV
Side ViewCL
LL.
3 ft below full pond water level 4 ft. above full pond water level 2 ft. additional clearing
`if necessary
Existing bank
10 ft. bank a
hei I ght cue'
�O
QUO
FORM: SSGP 02-2017 Page 4 of 4