20211456 Ver 1_Pre-Filing Meeting Information_20211004

Contact Name*
Contact Email Address*
Project Owner*
Project Name*
Project County*
Owner Address:*
Is this a transportation project?*
Robert Turnbull
[e-mail]
Champion Industries, Inc.
Champion Industries Road realignment
Forsyth
Street Address
3765 Champion Boulevard
Address Line 2
aty
State / Province / Pegion
Winston-Salem
NC
Postal / Zip axle
Country
27105
USA
C Yes c: No
Type(s) of approval sought from the DWR:
W 401 Water Quality Certification - F- 401 Water Quality Certification -
Regular Express
F- Individual Permit F- Modification
F- 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?
Please give a brief project description below and include location information.*
Champion Industries is proposing to realign and repave an access
road on their property. The realignment is necessary due to
undercutting of the road by Leak Fork. The road will be moved away
from Leak Fork. Bank stabilization is proposed on appro)amately 75
feet along Leak Fork.
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.
1 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 7/23/2021