20220937 Ver 2_Shoreline Stabilization_20220811

Shoreline Stabilization Application Form
NORTH CAROLINA
Environmental Quality
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
DRAFT -NOT FOR USE AT THIS TIME
Submission Form
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]
Please provide an email address for payment and requests for more information here.
Pre -Filing Meeting Date Request was 4/28/2022
submitted on: *
Owner Information:
............................................................................................................
Name: * Brian and Jaimi Riley
Email: * [e-mail]
Phone Number: [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
751 Lake Royale
Address Line 2
City
Louisburg
Postal / Zip Code
27549-9599
State / Province / Region
NC
Country
US
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: * Shaun Liggett
Company Affiliation: * Concept Contracting and Design LLC
Email: * [e-mail]

Phone Number:*
[phone]
(xxx)xxx-xxxx
Mailing Address:*
Street Address
301 E. Nash St.
Address Line 2
City State / Province / Region
Louisburg North Carolina
Postal / Zip Code Country
27549 United States
A signed and dated copy of the Agent Authorization letter:*
ncdnr agent authorization form.pdf 342.26KB
20220710 ncdnr agent authorization form.pdf 374.3KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: *
Riley Waterfront
If your project has a formal name please use this. If your project does not have 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. *
Upload File
Look up address
Upload Map:
Latitude:*
-78.196559
Longitude:* 35.956138
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*
20220711683 site plan.pdf 1.32MB
683 waterfront plan and section.pdf 557.41 KB
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.)
683 pic 3 shoreline.pdf 4.56MB
683 pic 1 trees to be removed.pdf 4.2MB
4. Location of the property (where work is to be conducted)
Nearest Town: * Bunn
County: * Franklin

Lake/ river/ ocean adjacent to Lake Royale cypress creek
property:
Subdivisions name or site address: *
Lake Royale Subdivision
Include phase/lot number
Directions to site: *
turn into main gate of lake royale on cheyenne drive and take right at stop
sign onto shawnee drive then take left on iriquois drive. property will be
straight ahead on sagamore drive at the end of iriquois drive. 683
sagamore
Please 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 lot undeveloped with large trees underbrush and vegetations
Residential, undeveloped, etc.
6. Property Size
1.45
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
clear and remove existing trees and underbrush approximately 10 large
trees removed to install a boat house and boat slip with dock over water
and stabilize the shoreline with corrugated vinyl sheet piles as a seawall.
install a natural stone walkway path to waterfront and seed straw and
landscape the buffer zone after work is complete.
8. How will the work be done? *
From Land
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.)
350
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.)
1500
square feet
11. 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)
10 large trees removed in area for boat house and seawalls, underbrush
and existing vegetation impacts to construct boathouse docks and seawall
Sketch:
683 waterfront plan and section.pdf 557.41 KB
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):
a $240.00 for impacts to lake (below normal water level) of less than 1 acre
a $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:
a I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the best
of my knowledge and belief

a 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");
a 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");
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
• I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:* Shaun Patrick Liggett
Signature:
Submittal Date: 8/10/2022

Initial Review
Is this accepted into the review process?* • Yes No
Project Number:* 20220937 Version:* 2
Select Reviewer: * Colleen Cohn:eads\cmcohn
Select Reviewing Office: Raleigh Regional Office - [phone]
Has payment been received? * C No Payment Needed
C Fee Received
C Need Fee - send electronic notification
What amount is owed?*
C $240.00
C $570.00

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. ` s S 01 PLAN NO. PARCEL ID:
STREET ADDRESS: 6'3 s46A--N of C>ra4
rsa..) 25-V
Please print: �� �L
Property Owner: t� y
Property Owner: c .k(A(( Ft Le-
The undersigned, registered property owners of the above noted property, do hereby authorize
, of CoA(C ePT C'tA 'T7r0.lz 01E.5/6.J GZ-C
(Contractor/ 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 all standard and special conditions attached.
Property Owner's Address (if different than property above):
Telephone:
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature Authorized Signature
Date: Date:

dotloop signature verification:
SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 4s S T 7 PLAN NO. PARCEL ID: v/ / 6.
STREET ADDRESS: 6'3 s46 -N o C>f2-1
7-0(-2rsa:) A/'-
Please print: �� �L
Property Owner: t� y
Property Owner: cl.-/A(( Fr
The undersigned, registered property owners of the above noted property, do hereby authorize
U , of CoA(C T C'tA cT7r0.lz .nrE.s/6.J Gz,C
(Contractor/ 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 all standard and special conditions attached.
Property Owner's Address (if different than property above):
mailing: 751 Lake Royale, Louisburg, NC 27549
physical: 105 Wynoming Dr., Louisburg, NC 27549
Telephone: Brian Riley 308-529-0116
Jaimi Riley 812-725-4763
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
dotloop verified
// ��«� ��� 07/09/22 11:35 AM CDT
3PDF-6SNP-17G75 CQ OZ,41f/4161e�%'4eef dotloop verified
'''`'O� 07/09/22 5:30 PM CDT
I0UM-6BCC-XENP-2E2A
Authorized Signature Aut luriLeu Jlyrldi.uIC
Date: 07/09/2022 Date: 07/09/2022

REFERENCES: Lots 483 & 484, Lake Royale Subdivision
Deed Book 2298, Page 725 Tr-4.,.' '��
Deed Book 2226, Page 1164 — Restrictive Covenants of '=I ,s
Map Book 12, Page 12 (Map Book 12, Page 45—Amended) 6'; [At " :3
Tax Record No. 019976 ,
`A, 165A
LEGEND: • . found iron as noted
0 . . . set iron as noted rr LAKE
- . 100—year flood limits line (see Note) 16p9 ScIIIIIMir ROYALE
. . . property line plotted from record v. . . easement or buffer line`
ovp
NOTE: Area of Lot = 1.445 Acres ( Coordinate Method )(To Tie Lines; ,,,Mr` ' /�� of
i /moo
NOTE: N.C. Grid station unavailable within 2000' at this time. d'. oP'.
cop Z 11' �`/2
NOTE: This survey is subject to all easements, agreements, 0o0,,P M.f.Qv1,)
rights—of—way and restrictive covenants recorded prior to �t�`;`
the date of this survey. VICINITY MAP /
%I
NOTE: 100—Year Flood Limits line scaled and plotted from Franklin ( No Scale )
County GIS, "Flood Area Layer" ,,toisis111s U,,',
I, William T. Dement, Jr., certify that this plat was drawn under my supervision from an `���� ��N CARQ ,I
actual field survey made under my supervision (deed description recorded in Book 2298, �� 3' (fi SSIO 4e
Page 725; that the boundaries not surveyed are clearly indicated as drawn from information � Qq- i
found in Map Book 12, Pages 12 & 45; that the ratio of precision as calculated is 1/15,000; •
•
that this survey is of an existing parcel or parcels of land and does not create a new -
SEAL
street or change an existing street; that this map was prepared in accordance with G.S. • •
•
47-30 as amended. Witness my original signature, license number and seal, this 4th day • L-1456
of May, 2022. it. ‹$y U q'���
��nn, 7-T 1_ 'ice ` O S
Professional Land Surveyor L-1456 �i,�4 j' DE�`�����``
-if1/111tio
Chd: N 82'53'00"E 18.33'
4,. - L=18.34' R=498.82' R W
1�.t,• 0o • 60' privateR W
jD 1kV N 81'14'15'E rive
16.00' sa, a-ore D
oallcD
—iy ( Asphalt Street )
•
Found Mag Nail w/ 1 a.'15"E 70.53' \ in
N
Top Flush In B1' N 87'22'40"E 1
Intersection \ ( Tie Line ) 135.18 Chd.
N g _ • `� E Sp ement \ Found 1/2" Iron
- 80 88. / Found 5 8" Iron
4----'
�� .1--- ----,
' �111ty / ' Pipel w/Top 1"
Found 5/8" Iron Rebar w/Top 2" Below Ground
Rebar w/Top 5 Below Ground 0.5'
Found 5/8" Ira end Es N of Power Pole I
Rebar w/Top 1 l
Set 5/8" Iron �e1ow Ground
Rebar w/Top
Flush w/Ground d, `�., " ,,,,
O
Chd.: N 419'25"E 117.72' 7
•,
L=127.41' R=93.23' 0 c
'(
•r�-1 a N co
r
;"+ p Now( 482 or Formerly
✓�",-\' p - - Charles E.
ASet 5/8" Iron oeo4 ---- `4 f dp
Rebar wrap 1" i k ��, ���, ,., N a Gragg, et ux
Above Ground 111
of p �v ' p N
\ ion I, ('N ia, ( D.B. 1175, P. 1041 )
ch
n \\ k ``�O\\\\ 67 \ r
C (n W \ \
�t o O \ ..
ry
N all v \ O1 \ \\,,C C Di� > SUl
G_ ri_ 00 1 \ l r ,
Z Found 5/8" Iron 1 l o- '
N Rebar w/Top \ 1'
Cl Flush w/Ground 99, I Found 5 8" Iron
/ 50 Tar River Basin \ N •�� /
O \Found 5/8" Iron �4.3 _�;\•. l° f Rebar wconp 7"
CJ m A Riparian Buffer \ Rebar w/Top 9 fa Below Ground
w
ache \Flush w/Ground O Te �Jne o�
1 \o.5' E of Edge O
100—Year Flood Limits
Drive �?�60c 9� Branch J k.,: ( See Notes )
C-,\off\ I _ 2p \. ° Cn O High—water Mark /
Set Mag Nail w/ N�' • `� N 7 •2.95' `, `� a, of Lake Is ,-... ,[
Top Flush In---.....A`- � m Property Line „//
Intersection ��� N 02'54'20"E1 o Ufl�i.0 'W�=`� m p y
R/W 24.99' Epsemenf �� \ �_ edge of Cake
\ /
Found 5/8" Iron
/ 20' — Lake Royale —
Rebar w/Top 2" Found 5/8" Iron \
Below Ground Rebar w/Top 1" \
( 485 ) Above Ground \1 Now or Formerly
Now or Formerly \ Lake Royale POA, Inc.
Lake Royale POA, Inc. ( D.B. 1803, P. 923 )
o
15, ( D.B. 904, P. 115 ) ea9e
6p r
a \ (ake
tr
PLAT OF BOUNDARY SURVEY FOR
BRIAN LYNN RILEY & WIFE, JAIMI RENAE RILEY
(Property Owner — Brian Lynn Riley, et ux)
683 Sagamore Drive, Cypress Creek Township, Franklin County, NC
Scale: 1 "=60' Date: May 4, 2022
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, P.A.
L-1456, C-0649
(0)919-496-6159 (M)919-496-9502
`102 West Nash Street Louisburg, N.C. 27549 (File No. 3992-2)

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