20201944 Ver 1_Shoreline Stabilization_20210225

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:
20201211 Pre File meeting pg 2.PDF 6.03MB
20201211 Pre File meeting.PDF 6.94M13
Pre -fling Meeting or Request Date 12/11/2020
ID# 20201944 Version 1
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 er ail address for payment and requests for more infornation here.
Owner Information:
Name:' Dr. Jeffrey J. Milroy and Wife Stefanie Milroy
Email:* jmilroy@uncg. edu
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
4106 Redwine Dr.
Address Line 2
City
State / Rovince / Fbgion
Greensboro
NC
Fbstal / Zip Code
Country
27410
United States

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 East Nash Street
Address Line 2
City
Louisburg
Postal / Zip Code
27549-2463
Asigned and dated copyof the Agent Authorization letter:*
20210218_Agent Authorization form.PDF 5.75MB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Milroy Waterfront
State / Province / Region
NC
Country
US
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
1529 Sagamore Drive
Address Line 2
city
Louisburg
Postal / Zip Code
27549
Latitude:* 35.984388
State / Province / Region
NC
Country
US
Longitude:*-78.201752
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*

2021 1529 Sagamore Plan View.PDF 7.08MB
2021 1529 Sagamore Side View.PDF 2.28MB
2021 1529 Sagamore Site Plan.PDF 2.47MB
Please use the diagram at the link below:
https://edocs.deq.nc.gov/WaterResources/0/edoc/616616/Shoreline%20Layout.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.)*
pic Lpdf
4.91MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Louisburg
County:* Franklin
Lake/ river/ ocean adjacent to Lake Royale
property:
Subdivisions name or site address:* Lake Royale lot #C1203
hclude phasellot nunber
Directions to site:*
enter main gate of lake royale subdivision on Cheyenne dr. take left at
stop sign onto Shawnee dr. take right at stop sign onto Eagle Dr. take left
at stop sign onto Sagamore Dr. take right at next stop sign to continue
across the north bridge of lake royale and follow to 1529 Sagamore dr.
on right side
Rease include road nacres and nunbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
existing gravel driveway and partially cleared lot. buffer zone has many
mature trees and vegetations and has not been cleared. there is an existing
lean to structure on land.
Residential, undeveloped, etc.
6. Property Size .471
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
stabilization of shorline erosion by means of placing rip rap on filter fabric
along the entire shoreline 18-24" above normal pool and 24" below normal
pool to stop further erosions. Install a 10'-0" x 30'-0" over water adjacent
to shoreline.
8. How will the work be done?* I7 From Land
F From Water
9. Total amount of disturbance below the normal pool lake level/ normal water level:*
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
670 sf rip rap
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.)
670 sf rip rap and
300sf equipment
path
square feet
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet
landward to be impacted:*
(nunter of trees, for instance)
approx. 30 mature trees with briars underbrush and some small
vegetation
Sketch: 2021 1529 Sagamore Site P1an.PDF 2.47M13
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:* 20201944
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. 1203C PLAN NO. PARCEL ID:
STREET ADDRESS: 1529 Sagamore Drive
�0U t5KLC_ 's4i
Please print:
Property Owner: Dr. Jeffrey J. Milroy
Property Owner: Stefanie L. Milroy
022 (`1 o
The undersigned, registered property owners of the above noted property, do hereby authorize
Shaun Liggett
(Contractor / Agent)
of Gorl L�+'T C�f.1 rt�-n� 1� Pin p� s ���1 uC
(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 all standard and special conditions attached.
Property Owner's Address (if different than property above):
/D !o 11Z£O 4.Jinl r DR . 4 12,,f5- ,YS,6411-6 W ,�- Z�4 /o
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
��4 4�� �)
S � �4,e-4.A- F
Aut ri g to Authonz ignature
Date: 9-14-2020 Date: 9-14-2020

Page 1 of 1
1, William T. Dement, Jr., certify that this plat was drawn under my supervision from on actual field survey made under
my supervision (deed description recorded in Book 785, Page 470 & Book 1803, Page 923); that the boundaries not surveyed
are clearly indicated as drawn from information found in Map Book 12, Page 67; that the ratio of precision as calculated
is 1/10,000; that this map was prepared in accordance with G.S. 47-30 as amended. Witness my original signature,
license number and seal, this 18th day of August, 2017.
Professional Land Surveyor LProfessional Land Surveyor L-1456
1, William T. Dement, Jr., certify that this plat is of a survey of a recombination of existing parcels, a court —
ordered survey or some other exception to the definition of subdivision.
Professional Land Surveyor L-1456
2�$g\.\ CARO� � ,FpFFSS/O,y
Q "Y
SEAL
L-1456
(�yOSUR° Q:
Found 1/2" Iront
Pipew/Topt
suo" c"croead
RECORD NORTH 50' Tor River Basin
( M.B. 12, P. s7 Riparian Buffer (c-116s j
Now or Formerly
Robert Yaw, et ux
( D.B. 1852, P. 226 )
0 5
Edge of Lake ---\• \ A\•\\��Q D1$
Found 1.5" Iran Pipes
w/TaP Flush w/
Ground Surface
Under Chain —link I ��
Fence
—LAKE ROYALE
�3
° td
Now or Formerly 1ry / t, Cx
Lake Royale P.O.A., Inc. \' N9h to\°Oros/
( D.B. 1803, P. 923) �' hti .�0�09
( c-t2o4 )
NOTE: Mean High Water Mark C.P. �' C.P. Now or Formerly
of Lake Is Property Line Constance P. Reeves
\.5 ( See D.B. 821, P. 164 )
C.P.
C.P. 1-3 N 38.40'55"E 115.64'
—LAKE ROYALE — r ( Old Property Line )
N
Pipe
C.P. .,r'J Fug pt 13"oAli—
�• croand sunaae
0,111— aver Fisher
C.P. "�...� ...�—...
Edge of Lake
—LAKE ROYALE Now or Formerly
Lake Royale P.O.A., Inc.
( D.B. 1803, P. 923 )
This plat is approved for recording pursuant to Section 27�L of the Franklin Coun7;y�Sa division Regulations.
8.294 % �:
Date County H) nner
Approval expires if not recorded on or before 22 2q• i.? and must be submitted for reapproval.
1, aTfa $ Review Officer of Franklin County, ertif that the map oL/co
which this
certificate is offixe eets all statutory requirements for racordi g.
8•�9•i7
Date Re a, fflcer
Q� Tie Line From Found Mag Nail
In Apparent Centerline Intersection
of Sagamore Drive & Lightfoot
Drive:
S 2755'50"E 159.93'
Rebar
Use
\ 2 Set 5/e" Iran
\ F Rebar w/Tap
Flush w/Ground
1PSurface �9
/ e r \
�s•G o,�s o� �q�a/
er
r �
r Found 1/2"
j r ironw/rp.
1
srG—ra \F.oN
s
/ 100—Yeor Flood Limits
( See Notes )
IIIIIIIIIIIIIIIIIIIIIIIIIII(Iliill(Illilll llllllllllllllllllllllllllllllllllllll
Doc ID: 005496310001 Type: CRP
Recorded: 08/29/2017 at 02:22:10 PM
Fee Amt: $21.00 Page 1 of 1
Franklin county North Carolina
Bra di S. Davis Register of Deeds
­2017 P0232
Course
Bearing
Distance
L1
N 53.11'05" W
32.73'
L2
N 01.49'10" W
27.46'
L3
N 76.38'55" E
33.19'
L4
N 63'22'05" E
38.82'
L5
N 57.01'25" E
35.52'
L6
N 58.12'00" E
19.55'
arr —
'` a
REFERENCES: Lot C-1203, Lake Royale Subdivision (Dianne P. Braswell)
See Deed Book 785, Page 470
Deed Book 2056, Page 755 - Restrictive Covenants
Map Book 12, Page 67
Tax Record No. 022190
Parcel A - Lake Royale Property Owner's Association, Inc.
Deed Book 1803, Page 923
Tax Record No. 033285
LEGEND: • . . . . found iron as noted
0 . . . . set iron as noted
c.P. o . . . . calculated point at mean high water mark
— — — — — — —. property line plotted from record
--------------- 100-Year Flood Limits
easement line
—•••—•••— —. edge of lake
NOTE: Area of Lot C-1203 = 0.392 Acre
Area of Lake Royale P.O.A., Inc. to be recombined = 0.079 Acre
Total Recombined Area = 0.471 Acre ( Coordinate Method )
NOTE: N.C. Grid station unavailable within 2000' at this time.
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 scaled and plotted from FEMA DFIRM "Franklin
County, NC", Map No. 3720283100K, effective 04/16/13
PLAT OF SURVEY SHOWING RECOMBINATION OF PROPERTY FOR
JEFF MILROY & WIFE, STEFANIE MILROY
(Property Owner — Dianne P. Braswell & Lake Royale P.O.A., Inc.)
1529 Sagamore Drive, Cypress Creek Township, Franklin County, North Carolina
Scale: 1 "=60' Date: August 18, 2017
60 0 60 120 180
GRAPHIC SCALE - FEET
Surveyed & Mopped By
WILLIAM T. DEMENT, JR., Professional Land Surveyor, P.A.
L-1456, C-0649
(0)919-496-6159 (M)919-496-9502
102 West Nash Street Louisburg, N.C. 27549
NOTE: Owner's name shown for Indexing
purposes only and does not constitute
title certification.
(File No. 3782-2)
Recorded In Plat Book 2017, Page
Book: 2017 Page: 232 Page 1 of 1

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
ENIVIRONMEN r AL OVAL II Y FORM: SSGP 02-2017
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
X 335- F( La ke
lel�� (At Ful n Normal Water Level)
26
Full Pond/ Normal Water Lev I
Shoreline
Plan View
FORM: SSGP 02-2017 Page 1 of 3

Side View
U-
Lake
W FmU Pmdl NOE 1-?.Ter L-10 Existing dock
30 ft a 7 ft
�ftx 150 ft
W.M ponds NV&
Full Pond/ Normal Water Le — ,,,,, —
. ' ire m;' .. b ft a ISO R
1 Riprap r� F. I W,di NAL
1 f.. a 150It.
additional ckui�
N n ,..ry
E AMPLE
Plan View
FORM: SSGP 02-2017

Y1
a C-�0
C
Gi
O
C
L
1
(D a
1
�C
J'lVAl.[[�}�)
•A
ImQ "4-111 I1�
D
W
CCU) �("D
CT
(D 7 O f
a
CO
O
�.
M
1<0 rF
O+
I
0
fU
CL
Q
CD
U1
cn
I
N
N
Art
n
v
ro

AW
I. � c\
�� i
T
�N��
"'z,MR+•cam - -

Y1
a C-�0
C
Gi
O
C
L
1
(D a
1
�C
•A
J'lVAl.[[�}�)
D
W
CCU) �("D
CT
(D 7 O f
a
CO
O
�.
M
1<0 rF
O+
I
0
fU
CL
Q
CD
U1
cn
I
N
N
Art
n
v
ro

1 /5/2021
Please attach the documentation you would like to have the meeting about.
pdr or y
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
Submittal Date 12/11/2020

ID# * 20201944
Version * 1
Regional Office *
Raleigh Regional Office - [phone]
Reviewer List*
Stephanie Goss
Pre -Filing Meeting Request submitted 12/11/2020
Contact Name *
Shaun Liggett
Contact Email Address*
[e-mail]
Project Name *
Milroy Project
Project Owner*
Dr. Jeffrey J. Milroy and wife Stefanie Milroy
Project County*
Franklin
Owner Address:
Street Address
4106 Redwine Drive
Address Line 2
City State I Province / %gion
greensboro NC
Postal; Zip Gode (buntry
27410 us
Is this a transportation project?* r Yes C No
Type(s) of approval sought from the DWR:
W 401 Water Quality Certification - F 401 Water Quality Certification -
Regular Express
r- Individual Permit r- Modification
W Shoreline Stabilization
Does this project have an existing project ID#?*
(- Yes r 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.*
place rip rap and stabilize shoreline
install dock over water approximately 10'x15'
dig boat slip and rip rap
Please give a couple of dates you are available for a meeting.