20210152 Ver 1_Pre-Filing Meeting Request_20210122

ID#* 20210152
Version* 1
Regional Office* Raleigh Regional Office - [phone]
Reviewer List* Stephanie Goss
Pre -Filing Meeting Request submitted 1/22/2021
Contact Name *
Contact Email Address*
Project Name*
Project Owner*
Project County*
Owner Address:
John Bullock
[e-mail]
bullock
john bullock
Person
Street Address
4540 semora rd
Address Line 2
aty
roxboro
Rbstal / Zip Code
27574
Is this a transportation project?* r Yes r No
State / Frovince / Region
nc
Country
United States
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?
no
Please give a brief project description below.
add rip rap in the form of rock & fabric to stabilize the shoreline
Please give a couple of dates you are available for a meeting.
2/22/2021

Please attach the documentation you would like to have the meeting about.
Bullock Rip rap diagrams[11877][16701].pdf 1.19MB
bullock rip wrap.pdf 267.01 KB
Bullock riprap form.pdf 3.62MB
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
Submittal Date 1/22/2021

U.S. Army Corps of Engineers (USACE)
Form Approved -
APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT
OMB No. 0710-0003
33 CFR 325. The proponent agency is CECW-CO-R.
Expires: 01-08-2018
The public reporting burden for this collection of information, OMB Control Number 0710-0003, is estimated to average 11 hours per response, including the time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services,
at whs.mc-alex.esd.mbx.dd-dod-information-collections(a-)mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall
be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT
RETURN YOUR APPLICATION TO THE ABOVE EMAIL.
PRIVACY ACT STATEMENT
Authorities: Rivers and Harbors Act, Section 10, 33 USC 403; Clean Water Act, Section 404, 33 USC 1344; Marine Protection, Research, and Sanctuaries Act,
Section 103, 33 USC 1413; Regulatory Programs of the Corps of Engineers; Final Rule 33 CFR 320-332. Principal Purpose: Information provided on this form
will be used in evaluating the application for a permit. Routine Uses: This information may be shared with the Department of Justice and other federal, state, and
local government agencies, and the public and may be made available as part of a public notice as required by Federal law. Submission of requested information
is voluntary, however, if information is not provided the permit application cannot be evaluated nor can a permit be issued. One set of original drawings or good
reproducible copies which show the location and character of the proposed activity must be attached to this application (see sample drawings and/or instructions)
and be submitted to the District Engineer having jurisdiction over the location of the proposed activity. An application that is not completed in full will be returned.
System of Record Notice (SORN). The information received is entered into our permit tracking database and a SORN has been completed (SORN #A1145b)
and may be accessed at the following website: http://dpcld.defense.gov/Privacy/SORNslndex/DOD-wide-SORN-Article-View/Article/570115/al l45b-ce.aspxx
(ITEMS 1 THRU 4 TO BE FILLED BY THE CORPS)
1. APPLICATION NO.
2. FIELD OFFICE CODE
3. DATE RECEIVED
4. DATE APPLICATION COMPLETE
(ITEMS BELOW TO BE FILLED BYAPPLICANT)
5. APPLICANT'S NAME
8. AUTHORIZED AGENT'S NAME AND TITLE (agent is not required)
First - Kirk Middle - Last - West
First - Frank Middle - Last - Stoltmann
Company -
Company - Traditional Southern Construction
E-mail Address-kirkC&,westandwoodall.com
E-mail Address-traditionalsouthern2017@gmaiLCom
6. APPLICANT'S ADDRESS:
9. AGENT'S ADDRESS:
Address- 60 Freckled Point
Address- 800 McGhees Mill Rd
City - Semora State - NC Zip - 27343 Country -USA
City - Roxboro State - NC Zip - 27343 Country -USA
7. APPLICANT'S PHONE NOs. w/AREA CODE
10. AGENTS PHONE NOs. w/AREA CODE
a. Residence b. Business c. Fax
a. Residence b. Business c. Fax
919-524-5138
919-270-4394
STATEMENT OF AUTHORIZATION
11. 1 hereby authorize, to act in my behalf as my agent in the processing of this application and to furnish, upon request,
supplemental information in support of this permit application.
SIGNATURE OF APPLICANT DATE
NAME, LOCATION, AND DESCRIPTION OF PROJECT OR ACTIVITY
12. PROJECT NAME OR TITLE (see instructions)
Whettstone Subdivision
13. NAME OF WATERBODY, IF KNOWN (if applicable)
14. PROJECT STREET ADDRESS (if applicable)
Hyco Lake
Address 65 Freckled Point
15. LOCATION OF PROJECT
City - State- Zip-
Latitude: -N Longitude: -W
16. OTHER LOCATION DESCRIPTIONS, IF KNOWN (see instructions)
State Tax Parcel ID A24 213 Municipality Person County
Section - Township - Cunningham Range -
ENG FORM 4345, MAY 2018 PREVIOUS EDITIONS ARE OBSOLETE. Page 3 of 1

17. DIRECTIONS TO THE SITE
Mcghees Mille Rd to right on Canvasback rd (Whettstone Subdivision), Right on Widgeon rd, Right on Blue Bill, Left on Redhead Pt, Right
on Freckled Pt.
18. Nature of Activity (Description of project, include all features)
Apply rip wrap (stone) to approximately 350 ft of shoreline to reduce erosion. Material used will be heavy landscape fabric laid on shoreline
to eliminate soil washout. The fabric will be covered by medium size stones to breakdown waves, beginning below the water edge and
continuing up the slope of the bank approximately 3 feet.
19. Project Purpose (Describe the reason or purpose of the project, see instructions)
Reduce erosion of shoreline resulting from boat traffic and waves. Application will commence immediately following approval of all required
departments.
USE BLOCKS 20-23 IF DREDGED AND/OR FILL MATERIAL IS TO BE DISCHARGED
20. Reason(s) for Discharge
21. Type(s) of Material Being Discharged and the Amount of Each Type in Cubic Yards:
Type Type Type
Amount in Cubic Yards Amount in Cubic Yards Amount in Cubic Yards
Stone 500 tons
22. Surface Area in Acres of Wetlands or Other Waters Filled (see instructions)
Acres
or
Linear Feet 350 ft applied by backhoe
23. Description of Avoidance, Minimization, and Compensation (see instructions)
This is standard rip wrap used around Hyco lake to reduce erosion of shoreline
ENG FORM 4345, MAY 2018 Page 3 of 2

24. Is Any Portion of the Work Already Complete? Yes ❑ No IF YES, DESCRIBE THE COMPLETED WORK
25. Addresses of Adjoining Property Owners, Lessees, Etc., Whose Property Adjoins the Waterbody (if more than can be entered here, please attach a supplemental list).
a. Address -
City - State - Zip -
b. Address -
City - State - Zip -
c. Address -
City - State - Zip -
d. Address -
City - State - Zip -
e. Address -
City - State - Zip -
26. List of Other Certificates or Approvals/Denials received from other Federal, State, or Local Agencies for Work Described in This Application.
AGENCY TYPE APPROVAL' IDENTIFICATION DATE APPLIED DATE APPROVED DATE DENIED
NUMBER
Would include but is not restricted to zoning, building, and flood plain permits
27. Application is hereby made for permit or permits to authorize the work described in this application. I certify that this information in this application is
compete and accurate. I further certify that I possess the authority to undertake the work described herein or am acting as the duly authorized agent of the
appli nt.
SIGNATURE OF APPLICANT DATE SIGNATURE OF AGENT DATE
The Application must be signed by the person who desires to undertake the proposed activity (applicant) or it may be signed by a duly
authorized agent if the statement in block 11 has been filled out and signed.
18 U.S.C. Section 1001 provides that: Whoever, in any manner within the jurisdiction of any department or agency of the United States
knowingly and willfully falsifies, conceals, or covers up any trick, scheme, or disguises a material fact or makes any false, fictitious or fraudulent
statements or representations or makes or uses any false writing or document knowing same to contain any false, fictitious or fraudulent
statements or entry, shall be fined not more than $10,000 or imprisoned not more than five years or both.
ENG FORM 4345, MAY 2018 Page 3 of 3

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
KV
Water Resources 15A NCAC 02H .0500 -- Water Quality Certification, Shoreline Stabilization
ENVIRONMENTAL QUALITY 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
Full Pond/ Normal Water Level
Shoreline
Plan View
Lake
(At Full Pond/ Normal Water Level)
06 ionc
VIOI�D(5
CINn
0
C�CDOOIC700
�C(0C)C)
Z0"
FORM: SSGP 02-2017 Page 1 of 3

Lake
(At Full Pond/ Normal Water Level)
t
Side View
0 F
z LA
Lake
(At cull Pond/ Noemal Wacer Level)
Existing DOCK
30ftx7f[
3fta150ft
ee,—Ll pondf N WL
Level
Full Pond/ Normal Water LerRije
'Ihore nee—
uftxlsoftan
prap
AL— full pty NM
r�ecessery
E
MPLEE
Plan View
FORM: SSGP 02-2017 Page 2 of 3

Legend 12/8/2020 NOT FOR LEGAL USE
■ Address Utility N
Easements — All Other A
— Conservation
Tax Parcels
Easement mi
0 0.0035 0.007 0.0105 0.014