20110202 Ver 1_401 Application_20110311

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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 five (5) copies of this application and supporting
information as well as a non-refundable application fee to the Division of Water Quality of $240.00
for impacts to lake bottom of less than 1 acre and $570.00 for impacts to lake bottom of greater or
equal to 1 acre.
Applications should be sent to:
Division of Water Quality 401 Oversight/Express Review Permitting IN ?go 2
1650 Mail Service Center Raleigh, NC 27699-1650
A P, LU Applicant Information- WAOwne r/Applicant Information $ ererwy
Name: ?Jt V, r I r G V-" c J? Is v 1,
Mailing Address: Z ?c. h e (S{ n /? y`?
Telephone Number: 10 `H`(3 _ `{ 7 q 9 Fax Number:
E-mail Address: ? t ?+_ft"? a m PS c v? 6D e --- V C) I t017 [
v\ v rn e-
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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: -6 a b G re r e v-
Mailing Address: (005 Kxn I e ,4 L-1 ?., e ?J l ter , ??C? Z?'z 17
Telephone Number: 5- Z 7 - (_ Y Fax Number: 7& `l - 5-Z 7 ' 91 Z y
Company Affiliation: ,_V r-4 V'J
,-P6SPS i InG.
E-mail Address:
II. Project Information
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lko ,n - net
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.
1. Location
County: G CIE S+M r Nearest Town: ( VV_ o n I
Subdivision name or site address (include phase/lot number): 32-2-9 Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
vicinity map is included): Fx 7 'L'_ Z "73
S"' ?t ?a it ?-? d u rt -k? o e -o
2. Describe the existing land use or condition of the site at the time of this application:
3. Property size (acres): o ` ?53 A C v?r s
4. Nearest body of water (stream/river/sound/ocean/lake): c- k-e VJ -1 , e.
5. Describe the purpose of the proposed work: ?1 o r e S , z
6. List the type of equipment to be used to construct the project: ? o h,- - f 31 Z txt _ ) <.4-,,,r 9 ,Ss?u -
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres:
&
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:
1 ?z
8.b. Please describe vegetation above the normal pool /lake level and 50 feet landward to be impacted
(numbK)trees for instance): ?/ C- r-x4er C," do --k, ?r,.-
k/Agent's Signatur6 Date I
signature is valid only if an authorization letter from the applicant is provided.)
Please approximately sketch the foliowing information on this plan
(please provide dimensions for each item, such as 10 M x 400 ft):
7) All proposed vegetation 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 its buildings, retaining
walls, docks, etc.
5) The location of any excavation or driedging below the Full Pond
elevation.
6) Location of construction access corridors.
w below fall
1pondi ft KO ft
efiWe fan
136"
Please approximately sketch the following information on this plan
(please provide dimensions for each item, such as 10 ft. x,100 ft):
1) All proposed vegetation 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 sbuctures such as buildings, retaining
wallso docks, etc.
5) The location of any excavation or dredging below the Full Pond
elevation.
0) Location of construction access corridors.
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REGISTER OF DEEDS CERTIFICATE
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WITNE m hand and seal 01o11'IC¢? is y of
ALICE B. BROWN
Register of Deeds
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Latitude and Longitude of a Point
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Latitude: 3S.151792
Longitude: -81.022295
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Degrees Minutes Seconds
Latitude: 35 9 6.4512
Longitude: -81 1 20.2614

DUKE ENERGY LAKE SERVICES 2 0 0 20 2
EC12-Q
P O BOX 1006
CHARLOTTE, NC 28201-1006
704-382-1567 or TOLL FREE 1-800-443-5193
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 ENERGY FILING FEE, PAYABLE TO DUKE ENERGY,
TO ABOVE ADDRESS.
!. Applicant Informs !ion
A. Name ={ n n

B. Mailing Address (Z 3 S C4 r rr e l Sfz f 7 c rl A1r? C k 4 r l• ({t ,1J C Z? Z Z ?,
C. Telephone: 7-6,1 - (-l 3 - `l 1 y 4
iI. Location of Proposed Project
A. Lake _V'?, \1 I i e-
B. Street Addres -3Z--q ¢ o, ,;, 4..c
C. County (' G s-- Fv n
D. City, town, community or landmark V?
E. Section Lot # 9 1- Subdivision
F. Directions to property by road
Sg5 e><1+ .1 7 f-a w Z'7 3
(ec or ?nf-? e? r! ht
G. Latitude and longitu for the project site
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,
www.mal2sonus.com. Directions: Don't register, click "Maps", enter address, draw map, select "Map Clicking
Will...", select "Lat/Long", click map)
III. Description of Project
A. Length of wall H 0
B. Material C l a s s l
C. Distance from property line/,;
IV. Intended Use of Project Area
A. Private
B. Commercial
V. Applicant Signature
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an ti7n r-c
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MAP 2011
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Date ?Ll1-7/11
• 2 COPIES OF THE "DUKE WERGY APPLICATION FOR PERMIT TO STABILIZE THE SHORELINE IN NORTH
CAROLINA", PHOTOGRAPHS OF THE SHORELINE TO BE STABILIZED, AND FIVE (5) 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
919-733-1786
Y TAKEIVIGIVInPackage Information\NC Shoreline Stabilization Application.doc

DUKE ENERGY DIRECTIONS BY ROAD FORM
Lake Use Permit Applicants and Contractors: Ease of locating the
impact on permit processing time. Please complete this forth and return proposed aJ site can have a big
application to: long with your completed permit
DUKE ENERGY
C/O LAKE SERVICES - EC 12 Q
PO BOX 1006
CHARLOTTE, NC 28201-1006
1-800-443-5193 and select Option 5
Applicant's Name: n v, el C?
?L v ,.--yam I7 S G'71
Street Address (at lake): 3 ZZ ???
lake Name: L ?C c ? '
Subdivision Name; `? t '-, f i a ,. ?rl
?t-e-
TAX Parcel ID (if known):
Lotl# /
City P V Yt v r'? County. G4- S 'T D
--------------------
State: N C ?
Zip: 2j?; o 12
-------------
Latitude:
Longitude'':++ 1 W
Telephone: _ / i 6 3 7 7
Directions (from major road or highway):
Sou ?0-1,1 4-- IZd t,z., -?
trhf U (e c F"zov? ?aZ rt t'c ?, ,7
r t?h f-
Descriptive Structure(s) on Property (i.e. brick garage, white fence, mobile home, etc):
V4LCA,1f Lv4 b-et n re r-e ? r