20210157 Ver 1_Shoreline Stabilization_20210223

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.pdf 51.02KB
Pre -fling Meeting or Request Date 2/26/2021
ID# 20210157 Version
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]
Rease provide an email address for payrrent and requests for pure information here.
Owner Information:
Name: * John F Griffin
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
125 Cobbs Creek Rd
Address Line 2
city
State / Frovince / Region
Leasburg
NC
Fbstal / Zip Code
Country
27291
United States

Is there an agent working on the f Yes
project?* r No
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Hyco Rip Rap
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
125 Cobbs Creek Rd
Address Line 2
City
Leasburg
Fbstal / Zip Code
27291
Latitude:* 36.463889
State / Province / f;bgion
NC
Country
United States
Longitude:*-79.125559
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 20210122 OOOI.pdf 271.5KB
IMG 20210222_0001.pdf 175.36KB
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.)*
20210122 081818.jpg 1.82MB
20210122_081837. jpg 2.19MB
20210122 081843.jpg 2.72MB
20210122_081853. jpg 2.73MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Leasburg
County:* Person
Lake/ river/ ocean adjacent to Hyco Lake
property:
Subdivisions name or site address:* 125 Cobbs Creek Rd, Leasburg NC 27291
Include phasellot nunber
Directions to site:*

From
Roxboro
North Carolina -
Take Reams Ave to N Madison Blvd
1 min (0.2 mi)
Follow NC-57 N/Semora Rd and Concord Church Rd to Ralph Winstead
Rd in Semora
14 min (9.6 mi)
Continue on Ralph Winstead Rd. Drive to Cobbs Creek Rd in Leasburg
Rease include road narres and nunbers, landrrarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
Residential property
R sidential, undeveloped, etc.
6. Property Size 1.1
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Shoreline bank is undercut by several feet with trees and shrubs undercut
and leaning over water and dock. Proposed removal of undercut trees and
shrubsibushes and install of rip rap, per code, to prevent further shoreline
erosion and falling of trees and shrubs into Hyco lake or onto existing
dock.
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, back fill, excavation, rip rap, retaining walls, etc.)
2ft x 250 ft
square feet
10. Total amount of disturbance above the normal pool lake level/ normal water level and 50 feet
land -ward:*
(including all clearing, backfill, excavation, rip rap, retaining walls, etc.)
2ft x 250ft
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)
Aprox 5-7 trees that are undercut by water and multiple shrubs/brush that
are undercut by water. Clearing will not impact anything past 6 foot from
shoreline.
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 certify that:

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');
0 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:* John F Griffin
Signature:
"Ww

Initial Review
Is this accepted into the review
process?*
Project Number:* 20210157
Select Reviewer:*
Select Reviewing Office
Has payment been received?*
What amount is owed?*
rYes allo
Version:* 1
Stephanie Goss:eads\szgoss
Raleigh 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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Contact Name* John F Griffin
Contact Email Address*
[e-mail]
Project Owner*
John Griffin
Project Name*
Hyco Rip Rap
Project County*
Person
Owner Address:*
Street Address
125 Cobbs Creek Rd
Address Line 2
aty
Leasburg
Postal/ Zip axle
27291
Is this a transportation project?*
(- 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#?*
c: Yes r' No
Please list all existing project ID's associated with this projects.*
20210157
State / Province / Region
NC
Country
United States
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.*
Removal of multiple trees and shrubs/brush from shoreline that are
undercut and threatening to fall on existing dock or in lake.
Placement of rip rap and all required steps involved to meet code for
shoreline stabilization with rip rap.
Please give a couple of dates you are available for a meeting.
2/26/2021
3/5/2021

Please attach the documentation you would like to have the meeting about.
IMG_20210122_0001.pdf 271.5KB
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.
1 understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request.
1 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 2/21/2021