20210485 Ver 1_Pre-Filing Meeting Request_20210302

DWR Pre -Filing Meeting Request Form
ID#*
Regional Office*
Reviewer List*
20210485
Version *
1
Winston-Salem Regional Office - [phone]
Sue Homewood
Pre -Filing Meeting Request submitted 3/2/2021
Contact Name *
Contact Email Address*
Project Name*
Project Owner*
Project County*
Joseph Wilkerson
[e-mail]
Cutter shoreline
Daniel Cutter
Caswell
Owner Address: Street Address
440 Smokehouse Ln
Address Line 2
City State / Rovince / Region
Semora NC
Fbstal / Zip Code Country
27343 US
Is this a transportation project?* r Yes (' No
Type(s) of approval sought from the DWR:
r 401 Water Quality Certification - I— 401 Water Quality Certification -
Regular Express
I— Individual Permit I— Modification
fJ Shoreline Stabilization
Does this project have an existing project ID#?*
r 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. *
Install rip rap to protect the eroding shoreline.
Please give a couple of dates you are available for a meeting.
4/5/2021

4/2/2021
4/6/2021
4/7/2021
Please attach the documentation you would like to have the meeting about.
SSGP 02-2017 Shoreline Form_final.pdf 12.06MB
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 3/2/2021

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
FORM: SSGP 02-2017 Page 1 of 3
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent to:
If sending via US Postal Service If sending via delivery service (UPS, FedEx, etc.)
Karen Higgins
DWR – 401 & Buffer Permitting Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Karen Higgins
DWR – 401 & Buffer Permitting Branch
512 N. Salisbury Street
Raleigh, NC 27604
A.Applicant Information [15A NCAC 02H .0502(a)]
1.Owner Information
Name:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
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: http://www.saw.usace.army.
mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE_AGENT_AUTHORIZATION_FORM.pdf)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
B.Project Information [15A NCAC 02H .0502(a) & (b)]
1.Attach 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.
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.
3.Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale of
some sort- a yard stick, shovel handle, etc.)

Daniel Cutter
PO Box 8SenoraNL 27343
336 534 063 I
dcuHer624 gmail.com
Joe Wilkerson
Maplehurst Outdoor Living
4140 Bill Tuck HarySouthBostonA24592
434 5795625
joe moplehurstoutdoorliving com
FORM: SSGP 02-2017 Page 2 of 4
4.Location of the property (where work is to be conducted)
County: Nearest Town:
Lake/ river/ ocean adjacent to property:
Property size (acres):
Subdivision name or site address (include phase/lot number):
Directions to site - please include road names and numbers, landmarks, etc.:
Latitude (in decimal degrees) Longitude (decimal degrees)
5.Describe the existing land use or condition of the site at the time of this application (residential
, undeveloped, etc.):
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? ◻From water? ◻
8.Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent impacts (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
_____
Temporary impacts in square feet:
_____
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):
11.Signature
Owner/Agent's Signature* [15A NCAC 02H .0502(f)]Date
*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:
Caswell Roxboro Nc
HycoLake
Iac
376 Smokehouse Lane Semora NL
From 57 119 intersection go south on 119 turn left on WhiteDeere RdCatMtolive
left on Smokehouse Chura
36,469928 79.162116
Residence
Rip rap on shoreline to protectfrom furthererosion
Trees are falling into water d hillside is sliding away
Land
1.5
I 500 600 ft 2
I 5 ooo ft 2 to manuerrer equipmentdownhill
riprap will be a 100 long S 6 tall
shoreline 100 in length clear smalltrees 15fromshorelinen8withpath
to bringin material
4AM 3 i 21
FORM: SSGP 02-2017 Page 3 of 4
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
ve l ne
FORM: SSGP 02-2017 Page 4 of 4
Ex
i Geotextile
0
I 3 above waterline
Shoreline
E sprig
Plainview
a cool
neighboring dock f 1.5 belowwaterline X 100
060000000000000000000000000000000000000000000000000000000000000000000000000
3 41 100 above water line
SAMPLE A G E N T AU T H O R I Z A T I O N F O RM

PR O PERTY LE G AL D ESCR I PT I O N :

L O T N O . ______________ PLA N N O . ____________ PARC EL I D : ________________________

S T RE E T A D DRESS : _____________________________________________________________

_____________________________________________________

Pl e ase p ri n t :
Pro p e r ty O w n e r : ________________________________________________________________

Pro p e r ty O w n e r : ________________________________________________________________

T h e u n d e rsig n e d , re g ist e r e d pro p e r t y o w n e rs of t h e a bo v e n o t e d pro p e rt y , do h e r e b y a u t horiz e

__________________________________, o f ________________________________________
(Co n tra ct or / Ag e n t ) (N a m e of consul t in g f ir m )

t o a c t on m y b e h a lf a n d t a k e a ll a ctions n e c e ssa r y for t h e pro c essi n g , issu a n ce a n d a cc e pt a n c e o f
t h is p e r mit or c e r tif i c a t io n a n d a n y a nd a ll st a n d a rd a nd sp e ci a l con di t io ns a t t a ch e d .

Pro p e r t y O w n er’s Addr ess (if di f f e r e n t th a n prop e rty a b ov e ):

_________________________________________________________________

T e l e p h o n e : _____________________________

W e h ere b y c e r tif y t h e a bo v e i n form a t ion su b m i t t e d in t his a p pli c a tio n is t ru e a nd a cc ura t e to t h e
b est of our k n o w l e dg e .

__________________ __________________ _________________ __________________
Au thori z e d Sig n a t u r e Au thori z e d Sig n a t ur e

D a t e : _______________________________ D a t e : _______________________________

0139 oo oo 0040.000
440 Smokehouse hn Senora NC
27343
Daniel Cutter
Joe Wilkerson mapkhwstoutdarhv.bg
P.O Box 8 Senora NC 27343
336 534 0631
Daniel Cutler
3 I 21