20211088 Ver 1_Shoreline Stabilization_20210714

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:
Tom Pre Meeting.pdf 527.35KB
Pre -fling Meeting or Request Date 6/3/2021
ID# 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 err -ail address for payrrent and requests for pure infornation here.
Owner Information:
Name: * Tom Jennings
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
8504 Newberry Grove Dr
Address Line 2
City
State / Frovince / Region
Louisburg
NC
Fbstal / Zip Code
Country
27549
Us

Is there an agent working on the
project? *
Agent/Consultant Information
.................................................................................................................
Name:
Company Affiliation:*
Email:
Phone Number:*
Mailing Address:*
F Yes
r No
Philip W Poland
Phirs Quality Construction
philsqualityconstruction@gmaiL com
[phone]
(XXX)XXX-XXXX
Address
1 Lake Royale
Address Line 2
City
Louisburg
Fbstal / Zip Code
27549
Asigned and dated copyof the Agent Authorization letter:*
Tom authorization. pdf 414.54KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Tom Jennings Seawall
State / Province / Region
NC
Country
US
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
1073 Sagamore Drive
Address Line 2
city
Louisburg
Fbstal / Zip Code
27549
Latitude:* 35.962090
State / Province / Pegion
NC
Country
US
Longitude:*-78.187102
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*
Tom Plot Plan.pdf 324.31KB
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.)*
Tom Photos.pdf
1.15MB
4. Location of the property (where work is to be conducted)
Nearest Town:*
Bunn
County:*
Franklin
Lake/ river/ ocean adjacent to
Lake Royale
property:
Subdivisions name or site address:*
Lake Royale Lot#2026
hclude phasellot number
Directions to site:*
Cheyenne Dr turn right onto Shawnee Dr, continue
Straight thru 3-way stop sign, at next 3-way stop sign
Turn right onto Sagamore Drive, approximately 2 miles
1073 Sagamore Drive will be on your left side.
Rease include road narres and numbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
Residential developed
Residential, undeveloped, etc.
6. Pro pertySize .4319
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Stop erosion and make land more usable
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 w alls, etc.)
Seawall252 sq.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, back fill, excavation, rip rap, retaining walls, etc.)
Seawall 252 sgft.,
excavator 300sq.ft.,
trees 220 sgft
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)
15 tree's 220 sq.ft. 50ft. Inward
Sketch: Tom Sketch.pdf 1.84MB
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):
0 $240.00 for impacts to lake (below normal water level) of less than 1 acre
0 $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:* Philip W Poland
Signature:

Initial Review
Is this accepted into the review
process?*
Project Number:* 20211088
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

sM � •IEir .�
DWR Pre -Filing Meeting Request Form
Contact Name* Philip Poland
Contact Email Address* [e-mail]
Project Owner*
Torn Jennings
Project Name *
Jennings
Project County *
Franklin
Owner Address:'
s;ret Hddres..
1073 Sagamore Drive
Address Line 2
city State / Navince ! Region
Louisburg NC
Postal / Zip code -•
27549 United States
is this a transportation project?*
Yes No
Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Individual Permit
Shoreline Stabilization
Does this project have an existing project ID#?
Yes No
401 Water Quality Certification - Express
Modification
Do you knout the name of the staff member you would like to request a meeting with?
No
Please give a brief project description below and include location information.
This is in Lake Royale in Louisburg NC_ We are
Installing 84ft of vinyl seawall.
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.

understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request-
] 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 6/3/2021

ICA

i
n
�
r
E

r
x
5

Version 12I22/201,S
FuH,Pond/
Norm, at Water Le'vel
Plan view
crass tent or, view
Please approximately sketch the following information an his plan (provide dimensianslor each
ie , such as loftx 00ft)4.
1. All proposed vegetation clearing
7-. Location of rip rap or f ll to be placers above the Full Pond, Normal Water Level elevatbon
3- Location of rip rap or rill to be placed below the Full Pond-/ Normal Water Leve€elevator;
4. Location of anv proposed structures such as buildings, retaining walls, docks, etc.
5, Location o� aiiy excavation or dredging below the Fall Pond/ Normal Water Level elevation
Location of construction access corridors

EXAMpLE AGE AMoRlZI'l ON FORM
Promo 4 1
Parcei w:.
lot No. Of applic") —0 Z. to - � plan tim qif aMdlcablel
Prp�ty0 sAddre s (if the alwee ; i C3�} r i~ vd� i?3� ?.ail � ��A Pex
3 e a%c�elf a�"Oahcv6W*PeL'tY- ""Ammh fau#�r�e
tMme AgeaCotnpartq Hmm (ifappllmWP)
W eacm my belt Band tale all aedans Bee tleforthe awn, � � aW
� oftM Vomit� or author ► inchtdirg all surd and spacial Condit =
l hewr* that the abwe bftrmadon subrr6tted an t1fs iarrn WW a-PPUmb(m is true ants accurate
to the uf mrknowledge-
Aut wOmd Agent lam! CDmPanV-
AutwrIwdrrt5re:
Date:
�� .+ dos+rCLJ'00