20210796 Ver 1_Pre-Filing Meeting Request_20210413

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DWR Pre-Filing Meeting Request Form
NORTH CAROLINA
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ID#* 20210796 Version* 1
Regional Office* Winston-Salem Regional Office-[phone]
Reviewer List* Sue Homewood
Pre-Filing Meeting Request submitted 4/13/2021
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Contact Name* David Luczynski
Contact Email Address* [e-mail]
Project Name* culvert pipe installation on parcel 13194080 for driveway
Project Owner* David Luczynski
Project County* Ashe
Owner Address: Street Address
512 WEST END AVE
Address Line 2
City State/Rovince/Region
STATESVILLE NC
Fbstal/Zip Code Country
28677 United States
Is this a transportation project?* r Yes r No
Type(s)of approval sought from the DWR:
r- 401 Water Quality Certification- I— 401 Water Quality Certification-
Regular Express
rJ Individual Permit r- Modification
r- 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?
Timothy R. Latham
Please give a brief project description below and include location information.*
Culvert pipe installation in the ditch that channels water from a spring
head across the property for purposes of having a driveway that
leads from one side of the property to the other. Parcel 13194080
Old Fields Township,Ashe County. please see Plat Book 10 page 75
for more details
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 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 4/13/2021