20210011 Ver 1_Shoreline Stabilization_20210204

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:
DWR Pre -Filing Meeting Request Form
49.83KB
(1).pdf
Pre -fling Meeting or Request Date 12/31/2020
ID# 20210011 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 *
Owner Information:
Name: *
Email:*
Phone Number:*
Mailing Address:*
Martinrobbins 5 8 @gmail. c om
Rease provide an er ail address for payment and requests for more infornation here.
Martin Robbins
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
4945 Seward Road
Address Line 2
City
Pfafftown
Fbstal / Zip Code
27040
State / Rovince / Fbgion
Davidson
Country
USA

Is there an agent working on the f Yes
project?* r No
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Robbins Family
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
1293 Warf Road
Address Line 2
Latitude:* 35.422912
City
State / Province / Region
Lexington
NC
Fbstal / Zip Code
Country
27292
US
Longitude:* 80.150039
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*
IMG 20210202 211224540.jpg 3.66MB
IMG 20210202_202950003.jpg 4.89MB
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.)*
IMG 20210202 213813701.jpg 4.25MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Lexington, NC
County: * Davidson
Lake/ river/ ocean adjacent to Nigh Rock Lake
property:
Subdivisions name or site address:* 1293 Warf Road Lexington, NC 27292
Include phase/lot nunber
Directions to site:*

I- 85 to Lexington, NC to Exit NC Hwy 8 South Go South on NC 8, Left
on Feezor Road, Left on Warf Road, Property will be on the left hand
side of Road - 1293 Warf Road
(1.1 miles East of the intersection of Warf Road and Feezor Road)
Rease include road names and nurrbers, landrrarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
Residential ,cleared and undeveloped
Residential, undeveloped, etc.
6. Property Size 0.29 of an acre
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Existing retaining wall collapse need to repair to avoid future erosion
8. How will the work be done?* I7 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.)
226
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.)
1132
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)
All trees from property have been removed
Sketch:
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 certifythat:
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');
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:* Martin Glen Robbins

Signature:

Initial Review
Is this accepted into the review
process?*
Project Number:* 20210011
Select Reviewer:*
Select Reviewing Office
Has payment been received?*
What amount is owed?*
rYes allo
Version:* 1
Sue Homewood:eads\slhomewood
Winston-Salem Regional Office - [phone]
r No Payment Needed
r Fee Received
r Need Fee - send electronic notification
r $240.00
f $570.00

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Scale Used
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Contact Name*
Contact Email Address*
Project Owner*
Project Name*
Project County*
Owner Address:*
Is this a transportation project?*
Martin Robbins
[e-mail]
Martin Robbins
Robbins Family Shoreline Stabilization
Davidson
Street Address
1293 Warf Road
Address Line 2
aty
Le)angton
Postal / Zip axle
27292
(- Yes c: No
Type(s) of approval sought from the DWR:
F- 401 Water Quality Certification - F- 401 Water Quality Certification -
Regular Express
F- Individual Permit F- Modification
W Shoreline Stabilization
Does this project have an existing project ID#?*
(- Yes c: No
State / Province / Pegion
NC
Country
USA
Do you know the name of the staff member you would like to request a meeting with?
Please give a brief project description below.*
Adding Rip Rap to shoreline for stabilization
Please give a couple of dates you are available for a meeting.
1 /6/2021
1 /8/2021
Please attach the documentation you would like to have the meeting about.
pdf 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 Icannot submit myapplication 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 12/31/2020