20100285 Ver 1_401 Application_20100410

PLEASE Send Approvals to:
LCCS
1156 Perth Road, Troutman, NC 28166
Steve Davis
Sdavisra-), lancasterdock,com704-528-7400
Fax: [phone]
?y DUKE POWER LAKE MANAGEMENT, EC12-Q
P. O. BOX 1006
CHARLOTTE, NC 28201-1006
704-382-1567 OR TOLL FREE 1-800-443-5193
IV
V.
APPLICATION FOR PERMIT TO STABILIZE THE SHORELINE IN NORTH
CAROLINA
Please type or print and fill in all blanks. If information is not applicable, so indicate by placing N/A in
blank. PLEASE SUBMIT APPLICATION AND APPROPRIATE DUKE POWER FILING FEE, PAYABLE
TO DUKE POWER, TO ABOVE ADDRESS.
1. Applicant Information 20 100 28 5
A. Name T/mw fzwAO.Ae
B. Mailing Address P.D. BoX z 19, 1",4,¢Jyv1L-LF , e- 281D3
C. Telephone Toy - SG 7 -15' 33
II. Location of Proposed Project
A. Lake No,e.r?AN ",??„? y
B. Street Address Zd?dB ?E,EP Cmtis Cva-r ??
C. County A'EGKc_,OrwQU2G
D. City, Town, Community or Landmark C., A.vx,.. ys
E. Section Lot #
F. Directions to property by road
Subdivision
77 S ti Ex, f- Z GATAa.BA I B -ry,??
,WA0F4 M*A'0041;0,v
G. Latitude and longitude for the project site 3y: %w i- -de. 898'86 Z
H. Please submit a map showing the coordinates or a detailed map (USGS quad map, city map,
etc.) showing the exact location of the project site. (NOTE: Latitude/longitude coordinates can
be found on internet site, mvw.mapsonus.com. Directions: Don't register, click "Maps", enter
address, draw map, select "Map Clicking Will...", select "Lat/Long", cli r
Description of Project
A. Length of wall Z. 2S ' APR], C. 2ntn
B. Material R/P 94,0 +- N1.arrIAIv ' urro-OLW
Distance from property line/shoreline ?r.'ATER
?o lla w Ex is +1 ^•ti A& f - c ? •v tMcH
Intended Use of Project Area
A. Private X
B. Commercial
Applicant Signature
PLEASE NOTE THE FOLLOWING:
• A COPY OF THE COMPLETE APPLICATION WITH A ROAD MAP SHOWING LOCATION OF THE PROPERTY MUST BE SUBMITTED TO: US
ARMY CORPS OF ENGINEERS, 151 PATTON AVENUE, ROOM 208, ASHEVILLE, NC 28801-5006
• A COPY OF THE "DUKE POWER APPLICATION FOR PERMIT TO STABILIZE THE SHORELINE IN NORTH CAROLINA" AND SEVEN (7)
COPIES OF THE COMPLETED "NC DIVISION OF WATER QUALITY PRE-CONSTRUCTION NOTIFICATION APPLICATION" MUST BE
SUBMITTED WITH THE DIVISION OF WATER QUALITY APPLICATION FEE TO: NC DIVISION OF WATER QUALITY, ATTENTION: Cyndi
Karoly, PARKVIEW BLDG., 2321 CRABTREE BLVD., RALEIGH, NC 27604, PHONE: [phone]
r-4 ? .

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401 WATER QUALITY CERTIFICATION APPLICATION
The following is an abbreviated application form for those applying for a 401 Water Quality Certification to
impact FERC (Federal Energy Regulatory Commission) regulated lake shore or bottom under the U.S.
Army Corps of Engineers Permit GP30. This Application cannot be used for wetland or stream impacts.
Please provide seven (7) copies of this application and supporting information as well as a non-
refundable application fee to the Division of Water Quality of .$200.00 for impacts to lake bottom of less
than 1 acre and $475.00 for impacts to lake bottom of greater or equal to 1 acre.
APPLICATIONS TO BE SENT TO:
DIVISION OF WATER QUALITY WETLANDS UNIT
1650 MAIL SERVICE CENTER
RALEIGH, NC 27699-1650
1. Applicant Information
Owner/Applicant Information
Name 7-'iW ?d !?g?2y.J
Mailing Address ? d Bd,? Z
ihA,¢sNVil.," , is 28!03
Telephone Number 70f - SG 7 - &2-7
Fax Number
E-mail Address

2. Agent Information (A signed and dated copy of the Agent Authorization letter must be attached
if the Agent has signatory authority for the owner/applicant)
Name Mark LANCAs-{-e2
Company Affiliation Lancaster Custom Dock & Shorelines
Mailing Address 1156 Perth Road
Troutman, NC 28166

Telephone Number 704-528-7400
Fax Number 704-5283400
E-mail Address [e-mail]
11. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local landmarks
such as towns, rivers, and roads Also provide a detailed site plan showing property boundaries
and development plans in relation to surrounding properties. You may use the diagram below to
make a hand sketch of your project. Also, see the example below for guidance. Both the vicinity
map and site plan must include a scale and north arrow. The footprints of all buildings, impervious
surfaces, or other facilities must be included.
Location
County fte-KLe/w yk 6 Nearest Town CDR.rrEGl?S
Subdivision name or site address (include phase/lot number):
ed
Lake (Full Pond)
V
Please approximately sketch the following information on this plan (please provide dimensions
for each item, such as 10 ft. x 100 fL):
1) All proposed vpgetation clearing (provide dimensions)
2) Location of rip rap or fill to be placed above the Full Pond elevation
3) Location of rip rap or fill to be placed below the Full Pond elevation
4) The location of any proposed structures such as buildings, retaining walls, docks, etc.
5) The location of any excavation or dredging below the Full Pond elevation.
6) Location of construction access corridors.
Full Pond P fi6
Shoreline Pop

Directions to site - please include road numbers, landmarks, etc. (This is not necessary
if an adequate vicinity map is included): I Z_V 74d 4e, t 28?® cwtnW'6^
2. Describe the existing land use or condition of the site at the time of this application:
3. Property size (acres): z, J"S- 4G,2 6S
4. Nearest body of water (stream/river/sound/ocean/lake): yAR?a?,?.v
5. Describe the purpose of the proposed work:
,D-S744t-1414 RAP RiE P GV'i T/ f /)?7,qtr-/nod 7, ? A&A-4 74 .y'T7e? L
FAOS/i,I
6. List the type of equipment to be used to construct the project:
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below
Z. X L2 f-
8. a. Amount of impact (including all clearing, back fill, excavation, rip rap, retaining walls,
etc.) above the normal pool lake level and 50 feet land-ward in square feet or acres:
/ x 2-2,r
b. Please describe vegetation above the normal pool lake level and 50 feet land-ward to
be impacted (number of trees for instance):
Applicant/Agent's Signature U Date
(Agent's signature is valid only if an authorization letter from the applicant is provided)

r/?-/ o
DUKE POWER D= CTI ONS 13Y ROAD FORM
Lake Vse Permit Applicants and Con'actors: Fam of locating the proposed project site can have a big
finpctct on permit processing time. Please complete this Corm and return it along with your completed
permit application to;
DUKt, POWER
C/0 LAS CE MANAGEMENT- CC 12 Q
PO BOAC 1006
C1IA,.RLOTTE, NC; 282011006
1-800-443-5193 or Option S
Appl;comt's
Stceet Address (at (ctkc): , ZOO ?p.VE ?oy_?

Subdivision Noma:
Prnhetty Section; --?_-_-- Loch- ?1-,.____-.•__
Cr.ty: _ eo-ewe L! 4,?xCounty; >Ec,CG6^•?S deG
Statc: Zip; - -?? ? '3 ?-- -
'f'elr.•plrotae: ___..._ 70? -54.? ??3? --•- ----•--
Type of Permit Requested
"Circlc>":
Private lacility
Cormnercial Facility
Eacavatiou
5tnbilixatloft
Conveyance
MiscOfIfAticOtis Uses
llircctio?l,; (Crorrz rt?.tjor tottrl or high ?a'y): 77.r
f-i EX?fLB
•,B?7?f? L t. t5F!//1G fF ? ?jt/?L?,? / /?/t/D?i2S/rv
Descriptive Stiuclure(s) on Propeibj (i.e. brick garage, wktite fan.ce, mobil homc, etc,):
"Nate: please u;e the back of Us :Corm If desfred to drm us a tnap to the sit'e_
GPAULAKPM(,-MT/tMPP1 /DtRE.CTC)t4.iIAMC Prr-,- n_._. e .,
t
x-? TOTFtE PAGE . ?J
Lancaster's Custom Dock &
Lift Systems, Inc.
1156 Perth Road
Troutman, NC 28166
704-528-7400
704-528-3400 Fax
Tina Edwards
Lot 4 Deep Cove Court
Cornelius, NC 28031
Description
1. Shoreline Management - Rip Rap
A. Shape & slope approximately 225' of shoreline
B. Remove & haul off of shoreline brush & debris
C. Install matting
D. Install rip rap for a compact finish and heavy border
E. Work to be performed by barge or land
CONTRACT
Shoreline Management
4-12-10
Includes Lancaster's Custom Dock & Lift Systems, Inc. permit processing fee
Customer to write a check made payable to Duke Power for $50.00. Customer to write a
check made payable to NCDENR for $240.00. Customer is to provide a copy of the
registered plat for permit.
** Note: Lake levels must be at acceptable levels for work to be done.
***Due to constant changes in state and federal Code regulations, if we are notified by the
county inspector or any agency of any required changes after this contract is signed the
homeowner shall be responsible for any additional costs that may be incurred to comply with
these changes. Every effort is made to stay current with the Code requirements.
Lancaster's Custom Dock & Lift Systems, Inc. hereby proposes to furnish material & labor to
complete in accordance with the above specifications Total payment to be made
as follows: 50% at signing, 50% at completion. 1.5% interest added monthly if balance not paid
upon completion. Material is guaranteed as specified. All work to be completed in a
workmanlike manner according to standard practices. Any alteration or deviation from the
above specifications involving extra cost will be an extra charge not included in this contract.
All agreements are contingent upon strikes, accidents/delays beyond our control. Lancaster's
Custom Dock & Lift Systems, Inc. is fully covered for Workman's Compensation and Liability.
Homeowner is responsible for fire, theft, tornado and other necessary insurance.
The above prices, specifications and conditions are satisfactory and hereby accepted. By signing
below, I authorize you to do the work specified. Payment will be made as outlined. Contract
price is valid for a period of 4-6'days from contract date.
40
Mecklenburg County, NC POLARIS
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