20211158 Ver 1_Shoreline Stabilization_20210727

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 50.25KB
Pre -fling Meeting or Request Date 6/18/2021
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 email address for payrrent and requests for pure information here.
Owner Information:
Name: * Angelina Corroo
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
178 Needham Lane
Address Line 2
City
State / Frovince / Region
Louisburg
North Carolina
Fbstal / Zip Code
Country
27549
Us

Is there an agent working on the F Yes
project?* r No
Agent/Consultant Information
Name:*
Greg Poland
Company Affiliation:*
Poland's Home Improvement
Email:*
GPolandl982@gmaiLcom
Phone Number:*
[phone]
(xxx)xxx-xxxx
Address:*
Street Address
Po box 19
Address Line 2
Poland's Home Improvement
City
BUNN
Fbstal / Zip Code
27508
Asigned and dated copy of the Agent Authorization letter:*
com. google. android. apps.photos. Image. pdf 3.37MB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: * 112 Chuckwagon Dr.
State / Province / Fbgion
North Carolina
Country
United States
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
112 Chuckwagon Drive
Address Line 2
City State / Province / F3egion
Louisburg NC
Fbstal / Zip Code Country
27549 US
Latitude:* 35.961229
Longitude:*-78.190073
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*
Chuckwagon drive 2.pdf 3.61MB

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.)*
Chuck wagon Drive 3.pdf 5.58MB
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:* 112 Chuckwagon Drive Lot #2053
Include phase/lot nunber
Directions to site:*
Turn in subdivision take first right on Shawnee Drive. Right on Sagamore
Drive. Left on Chuck wagon Drive.
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:*
Undeveloped property
Residential, undeveloped, etc.
6. Property Size .46
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Clearwater front approximately 10 ft back from shoreline and build new 4
ft tall vinyl seawall the length of shoreline to stabilize and gain access to
waterfront. The property is suffering from severe erosion due to being on
the main body of the lake.
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.)
100
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.)
400
square feet
11. 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)
Mini small trees approximately 1 inch in diameter to be removed. Four
large trees to be removed in fear that construction will weaken root
system. Property to be cleared approximately 10 to 15 ft inland 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):
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:* Gregory Alan Poland
Signature:
I

Initial Review
Is this accepted into the review
process?*
Project Number:* 20211158
Select Reviewer:*
Select Reviewing Office
Has payment been received?*
What amount is owed?*
rYes allo
Version:* 1
Scott Vinsomeads\svinson
Raleigh Regional Office - [phone]
r No Payment Needed
r Fee Received
r Need Fee - send electronic notification
r $240.00
f $570.00

XAMPI E AtIIf Nil AUTHORIZATION FORM
;.cif NO (if app►ksWei l 3) g
Plan NO fit applicablei
Street Adrrss W aPOKab+e
;>-oper�_pVnSr
Chvr Pr Name (print I. _ ` l �I� L I ,
Prom" Owner's Address irf different than the above) � � �• fy �-f {`- � t'`-'
owner Signature. G Li
-he above registered property owners of the above property, do hereby authOme
of
%gent Name Agent Company Name (if applicable)
:c, act on my behalf and cake all actions necessary for the application, proceswrtg, issuance and
Kctptance of this permit, certification of authorization including all standard and special conditions
Jttacw.
hereby certify that the above infafmation submitted on this form and application is true and accurate
to the best of my knowledge.
Authorized Agent Name / Company.
Authorired Agent Signature:
Date: L

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Contact Name* Greg Poland
Contact Email Address* [e-mail]
Project Owner* Angelina Corroo
Project Name*
112 Chuck wagon Drive waterfront project
Project County*
Franklin
Owner Address:*
Street Address
112 Chuckwagon Dr.
Address Line 2
aty
State / Province / Region
Louisburg
North Carolina
Postal / Zip axle
Country
27549
Franklin
Is this a transportation project?*
C 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 (: No
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 and include location information.*
We are building appro)amately 80 linear feet of vinyl seawall at 112
chuckwagon drive inside the lake Royale community. This project has
already been approved through Army corps of engineers. The wall
will be appro)amately 42 in tall. The 50-ft buffer will require clearing as
described in the full application.
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.
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 *
S 1111�
�17rz
Submittal Date 6/18/2021

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La ke
(At full Pond/Normal Water Level)
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Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 1O f t x 100 f t) *:
1, All proposed vegetation clearing