20210840 Ver 1_Pre-Filing Meeting Request_20210423

DWR Pre -Filing Meeting Request Form
ID#*
Regional Office*
Reviewer List*
20210840
Version *
1
Winston-Salem Regional Office - [phone]
Sue Homewood
Pre -Filing Meeting Request submitted 4/23/2021
Contact Name *
Contact Email Address*
Project Name*
Project Owner*
Project County*
Owner Address:
Heather LaGamba
[e-mail]
Forsyth Medical Center
Novant Health
Forsyth
Street Address
3600 Country Club Road
Address Line 2
City State / Bovine / Region
Winston-Salem NC
Fbstal / Zip Code Country
27104 USA
Is this a transportation project?* r Yes (' No
Type(s) of approval sought from the DWR:
fJ 401 Water Quality Certification - I— 401 Water Quality Certification -
Regular Express
I— Individual Permit I— Modification
r 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?
Sue Homewood
Please give a brief project description below and include location information. *
The applicant does not request a meeting. The applicant may submit
a request for 401 WQC.
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
eal:*t AO. {�exepref18
Submittal Date 4/23/2021