20210060 Ver 1_Pre-Filing Meeting Request_20210108

ID#* 20210060
Version* 1
Regional Office* Raleigh Regional Office - [phone]
Reviewer List* Stephanie Goss
Pre -Filing Meeting Request submitted 1/8/2021
Contact Name * Carter Lewis
Contact Email Address* [e-mail]
Project Name* Rip Rap Installation- Whippoorwill Lane
Project Owner* Carter & Melissa Lewis
Project County* Person
Owner Address: Street Address
204 Whippoorwill Lane
Address Line 2
aty State / Frovince / Region
Semora North Carolina
Rbstal / Zip Code Country
27343 United States
Is this a transportation project?* r Yes r No
Type(s) of approval sought from the DWR:
r- 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#?*
r 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.
Would like the permit to place rip rap on shoreline to prevent further
erosion.
Please give a couple of dates you are available for a meeting.

1 /11 /2021
Please attach the documentation you would like to have the meeting about.
Lewis rip rap.pdf 1.03MB
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 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
GA�L.5
Submittal Date 1/8/2021

a ` ` State of North Carolina
Department of Environment and Natural Resources
- Division of 'Water Resources
15A NCAC 02H .0500 —Water Quality Certification, Shoreline Stabilization
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 Postol Service
Karen Higgins
DWR — 401 & Buffer Permitting Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
A. Applicant Information 115A NCAC 02H .0502 a j
If sending via delivery service (UPS, fedEx, etc.)
Karen Higgins
0WR — 401 & Buffer Permitting Branch
512 N. Salisbury Street
Raleigh, NC 27604
1. Owner Information
Name:1'�t
Mailing Address: ;Z tJ '1
7JD
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r _
Telephone Number: -5L I' 0 3 Fax Number: 3,36 -59q- /,?O(a
E-mail Address: Car ; J aZ; Lf_f CnM
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:
hLtP-://www.saw.usace-armv.mi[/Portals/`59/docs/regulatoryre does Permits SAMPLE AGENT AUTHORIZ
ATION FORM. df)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
B. Project Information 115A NCAC 02H .0502(a) & (b)]
1. Attach a vicinity map (i.e. street map) clearly showing the location of the property with
respect to Focal 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: ��`V Nearest Town: !�,
Lake/ river/ ocean adjacent to property:
Property size (acres): 5 44 �D etc
Subdivision name or site address (include phase/lot number):
Directions to site - please include road names and numbers, landmarks, etc.:
al-Adfyrnn a-i-h IV M C4, r) Id) K_v CEZ S .3 Ly, d,-, 7-a u MY-t-
GLe�fi ��D pt�k. rIL m��-
L64 r1 uj "rl.
--bl Q VI `l - YL0VIt I t Sf pi25 t �eS R
Latitude (in decimal degrees) 3 14CC f Longitude (decimal degrees) '.�
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): ' t �-
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
7. Will work be conducted from land?
i
From water? ❑
8. Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent impacts (includin all excavation, backfiil, rip rap, retaining walls, etc.) in square feet:
Z 1 Q 0 S--
Temporary impacts in square feet:
Z 1 0 d �� k
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:
Temporary impacts temporary clearing, construction corridor) in square feet:
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):
.fiC -e-e S
FORM: SSGP 02-2017 Page 2 of 5

11. Signature
2 �?
Owner/Agent's Signature* [":-;.A NCAC 02H .0502[f)] Datj
*Agent's signature is valid only if an authorization letter from the owner is provided.
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-lPvatinn
Lake
(At Full Pond/ Normal Water Level)
v�i✓'SEC
C,
I
Full Pond/ formal Water Level �
L 0-
Shoreline � 3
Plan View
FORM: 55GP 02-2017 Page 3 of 5