20090752 Ver 1_Shoreline Stabilization_20090706

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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: p 19@[E OwLS
Division of Water Quality 401 Oversight/Express Review Permitting
1650 Mail Service Center JUL Fi 2009
Raleigh, NC 27699-1650
DENR - WATER QUALITY
1. Applicant Information A I r WETLAINIDSANDSTQRMWATERBRANCl1
1. Owner/Applicant Information
Name: Robbie & Amy Cohen
Mailing Address: P O Box 545
Norwood. NC 28128
Telephone Number: 704-438-2460 Fax Number: 704-474-0241
E-mail Address: Robbie(@cohenconstructionco.com
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:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
II. 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.
1. Location
County: Stanly
Nearest Town: Norwood
Subdivision name or site address (include phase/lot number):
Edgewater - Lot #6
Directions to site please include road numbers, landmarks, etc. (This is not necessary if
an adequate vicinity map included): Turn left at the Bank of Stanly in Norwood (Bank on Left) and
Follow Indian Mound Road to Randalls Church Road. Turn Right and then travel aDD. 1 mile and turn left
Into the Edgewater Development. Turn right into the first cul-de-sac and property will be on right.
2. Describe the existing land use or condition of the site at the time of this application:
Residential
I Property size (acres):
74 acres
4. Nearest body of water (stream/river/sound/ocean/lake): Lake Tillerv - Pee Dee River
5. Describe the purpose of the proposed work: Prevent & Control Erosion from Wind and Waves
6. List the type of equipment to be used to construct the project: Robber Track Mini Excavator
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool lake level in square feet or acres:
297.16 ft. of shoreline x 3' below water = 891.48 sa. ft.
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:
297.16 of shoreline x 5' above = 1485.8 sa.ft.
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward
to be impacted (number of trees for instance):
Remove small trees less than 4" P 4 ft. tall and save all of the big trees
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Mail application to: N.C. Department of Cultural Resources
State Historic Preservation Office
4617 Mail Service Center
Raleigh, NC 27699-4617
APPLICATION FOR APPROVAL FORM FOR SOIL DISTURBANCE ON
PROGRESS ENERGY'S PROJECT LAND - LAKE TILLERY
1. Date of Application July 1, 2009
II. Application Information (Please print)
APPLICANT NAME(S)
Robbie & Amy Cohen

PERMANENT MAILING ADDRESS P. O. Box 545
CITY Norwood STATE NC ZIP 28128
TELEPHONE IN TELEPHONE (w) 704-438-2460
FAX NUMBER (optional) E-MAIL ADDRESS (optional) [e-mail]
III. Property Information (please print)
PROPERTY ADDRESS 152 Forest Lake Court
CITY Norwood STATE NC ZIP28128
TELEPHONE(LAKE)704-438-2460 COUNTY Stanly
SUBDIVISION Edgewater LOT #(S) 6 PLAT BOOK AND PAGE # Book 20, Page 235
TOWNSHIP Norwood COUNTY Stanly
DETAILED DIRECTIONS TO PROPERTY
From Norwood (Highway 52) Turn left at the Bank of Stanly (Bank will be on your left) and follow
Indian Mound Road to Randalls Church Road. Turn Right onto Randalls Church Road and then
turn left into the Edgewater Development. Turn right into the first cul-de-sac and property will be
on your right. Lot marker #6

USGS TOPOGRAPHIC QUADRANGLE MAP (check applicable map below)
? Badin, NC ? Morrow Mountain, NC ? Mount Gilead West, NC ® Albemarle, NC
Note: USGS topographic quadrangle maps may be obtained from Natural Resources and Conservation Service
Montgomery County Stanly County
227 N. Main Street 26032-C Newt Road
Troy, NC 27371 Albemarle, NC 28001
1.910.572.2700 1.704.982.6811
IV. Checklist of Enclosures
© APPLICATION FOR APPROVAL FORM FOR SOIL DISTURBANCE ON PROGRESS ENERGY'S PROJECT LAND - LAKE TILLERY
N COPY OF QUADRANGLE MAP CLEARLY INDICATING THE AFFECTED AREA
?¦ COPY OF PROPERTY MAP CLEARLY INDICATING THE FOLLOWING ITEMS:
• Lot leased by lessee
• Progress Energy land between the lot and shoreline
• Water area associated with the lot
• Allocation lines that determine facilities locations and dredging area
• Dimensions of area to be dredged
• Amount of dredged material to be removed
• Description of desired facilities (walkways, piers, boathouses, deck areas [over water only], seawalls)
• Dimensions of desired facilities (walkways, piers, boathouses, deck areas [over water only], seawalls)
• Existing square footage (water area covered) of water dependent structures
• Proposed square footage (water area covered) of new water dependent structures
• Maximum distance facilities will extend horizontally into Lake Tillery and cove widths where appropriate
? PLAN FOR DISPOSAL OF DREDGED MATERIAL- applicant must attach a written description of their plans for disposing of dredged
material. No dredged material may be disposed of within the FERC project boundary, or on property owned or managed by
Progress Energy. N/A
? RESOURCE IMPACTS ASSESSMENT - applicant must attach a brief written description of the potential impacts of the proposed
soil disturbance on surrounding reservoir resources, including impacts to water quality and fish habitat. If there is any
vegetation growing in or around the area of proposed soil disturbance, it should be noted and the areas of vegetation should
be photographed, and included with the application. None Known
? SCHEDULE FOR CONDUCTING THE PROPOSED SOIL DISTURBANCE - applicant must attach a written schedule for completing the
proposed soil disturbance.
Late August, 2009
? AGENCY APPROVALS - applicant must attach copies of written concurrence with the proposed soil disturbance from the following
agencies (refer to instructions - for Application for Approval Form for Soil Disturbance on project land):
• North Carolina Division of Water Quality (.seawalls and dredging)
V. Applicant Signature(s)
I hereby apply for an approval form to perform the above - described soil disturbance at Lake Tillery, I agree to abide by all
applicable requirements of Progress Energy's Shoreline Management Plan, the conditions of the Application for Approval Form
for Soil Disturbance on project land (walkways, piers, boathouses, deck areas [over water only], seawalls and dredging), the
Guidelines for the Use of Leased Properties at Lake Tillery and other Progress Energy procedures and requirements. I also
agree that no work will begin until I receive an Approval Form signed by Progress Energy.
APPLICANT SIGNATURE DATE
APPLICANT SIGNATURE DATE
VI. Requirements
All facilities must be constructed in accordance with the Guidelines for the Use of Leased Properties at Lake Tillery.
All dredging must be done in accordance with the Guidelines for the Use of Leased Properties at Lake Tillery.
All dredging and seawall construction must have prior written approval from the U. S. Army Corps of Engineers, the North
Carolina Division of Water Quality (NCDWQ) and the N.C. Wildlife Resources Commission.
All soil disturbances require prior written approval from the North Carolina Department of Cultural Resources (NCDCR). For
further information regarding this approval, you may contact the NCOCR at the following address:
N.C. Department of Cultural Resources
State Historic Preservation Office
4617 Mail Service Center
Raleigh, NC 27699-4617
Facilities may not be constructed in environmental/natural areas.
Limited facilities may or may not be approved for construction in Impact Minimization Zones.
Dredging may not occur during the months of March through June because of potential impacts to fish spawning.
Dredging is not allowed in Impact Minimization Zones and environmental/natural areas.
Dredging is not permitted in aquatic emergent vegetation beds or other environmentally sensitive habitat unless extenuating
circumstances are involved.
Dredging may remove only silted material, no rock or hard clay.
Dredging must be such that water will drain freely from the dredged area when the reservoir level drops below the level of
the dredged area.
All dredged material must be immediately removed from Progress Energy property.
Individuals performing the dredging are responsible for disposing of dredged material in compliance with the rules and regula-
tions of the North Carolina Department of Environment and Natural Resources (NCDENR). For further information regarding the
disposal of dredged materials, you may contact NCDENR at 1.919.733.1786.
W Progress Energy
Lake Management
c/o Business Services
Progress Energy
P.O. Box 1551, PEB 3A
Raleigh, NC 27602
For PEC Use Only
Date Received
Application Complete
FAF Paid
FAF Expiration
APPLICATION FOR CONSTRUCTING FACILITIES ON
PROGRESS ENERGY'S PROPERTY - LAKE TILLERY
Failure to complete all items will result in a delay of your application being reviewed and approved.
1. Date of Application 07/01/2009 LEASE #
11. Application Information (please print)
LESSEE'S NAME(S)
Robbie & Amy Cohen

BILLING ADDRESS P O Box 545
CITY Norwood STATE NC ZIP 28128
TELEPHONE (h) TELEPHONE (w) 704-438-2460
FAX NUMBER (optional) 704-474-7143 E-MAIL ADDRESS [e-mail]
111. Property Information (please print)
PROPERTY ADDRESS 152 Forest Lake Court
CITY Norwood STATE NC zip 28128
SUBDIVISION Edgewater LOT #(S) 6 PLAT BOOK AND PAGE # M-20 Page 235
TELEPHONE (LAKE) 704-438-2460 COUNTY Stanly
Designation of shoreline area where soil disturbance is to take place as shown on Progress Energy's
Shoreline Management Plan (see Guidelines for the Use of Leased Properties at Lake Tillery, Attachment B, for designation)
? AGRICULTURAL ? COMMERCIAL ? ENVIRONMENTAL NATURAL AREA ? IMPACT MINIMIZATION ZONE 0 RESIDENTIAL
11/. Proposed Activity (please print)
DOCK © NEW ? MODIFICATION
SEAWALL/RIP RAP X NEW ? MODIFICATION
BOATHOUSE X NEW ? MODIFICATION
DECK AREA © NEW ? MODIFICATION
OTHER ? NEW ? MODIFICATION
PLEASE DESCRIBE OTHER

V. Project Information
DATE ACTIVITY IS PROPOSED TO COMMENCE Fall, 2009
LIST ALL APPROVALS OR CERTIFICATIONS REQUIRED BY OTHER FEDERAL, STATE OR LOCAL AGENCIES FOR ANY STRUCTURES,
CONSTRUCTION, DREDGING OR OTHER ACTIVITIES DESCRIBED IN THIS APPLICATION
Issuing Agent Type Approval Identification No. Date of Application Date of Approval

HAS ANY AGENCY DENIED APPROVAL FOR THE ACTIVITY DESCRIBED HEREIN OR FOR ANY ACTIVITY DIRECTLY RELATED TO THE ACTIVITY
DESCRIBED HEREIN? ? YES ® NO
REMARKS OR ADDITIONAL INFORMATION (Attach additional sheet, if necessary)

DETAILED DIRECTIONS TO PROPERTY
From Norwood (Highway 52) Turn left at the Bank of Stanly (Bank will be on your left) and follow
Indian Mound Road to Randalls Church Road. Turn Right onto Randalls Church Road and then
turn left into Edgewater. Turn right into first cul-de-sac and property will be on your right - Lot #6
VI. Specifications
FACILITY IS O PROPOSED ? MODIFICATION TO EXISTING FACILITY
DOCK/BOATHOUSE DIMENSIONS
Length (ft.) See Attached Drawing Width (ft.) Square footage 800
Length (ft.) Width (ft.) Square footage
Length (ft.) Width (ft.) Square footage
ROOF DIMENSIONS
Length (ft.) Width (ft.) Square footage
WALKWAY DIMENSIONS (OVER LAND AND WATER)
AREA OVER LAND Length (ft.) 84 Width (ft.) 5 Square footage 420
AREA OVER WATER Length (ft.) Width (ft.) Square footage 800
NUMBER OF SLIPS 1
SLIP DIMENSIONS (e.g., 8 ft. X 15 ft.)
1. 10x26 2.
3. 4.
TOTAL SOUARE FOOTAGE OF FACILITIES, INCLUDING ROOF OVERHANG, OVER WATER AND ANY AREA INCLUDING
UNCOVERED SLIPS:
DOCK BUILDER OR ENGINEER
Name Cohen Construction Co., Inc.
Address P O Box 545
City Norwood State NC Zip 28128
Telephone [phone]
VII. Checklist of Enclosures
0 APPLICATION FOR CONSTRUCTING FACILITIES
NO DRAWINGS TO SCALE (ON 81/2" X 11" PAPER) SHOWING ALL MEASUREMENTS AND ELEVATIONS
N PLAN FOR EROSION AND SEDIMENTATION CONTROL DURING CONSTRUCTION
?? APPLICABLE LOCAL, STATE AND FEDERAL PERMITS (U.S. ARMY CORPS OF ENGINEERS, NCDWQ AND NCDCR)
Q $100 NONREFUNDABLE FACILITIES APPLICATION FEE ENCLOSED, MADE PAYABLE TO PROGRESS ENERGY
(check or money order only)
N PERMIT LETTER (page 13)
VI11. Please Submit Application, Facilities Application Fee and all items listed in checklist to:
Lake Management
c/o Business Services
Progress Energy
P.O. Box 1551, PEB 3A
Raleigh, NC 27602
IX. Approval Process
• Application reviewed to determine if it is complete.
• If application is not complete or does not contain all the items and information listed in the checklist of enclosures, applicant(s)
will be contacted directly to provide the omitted information.
• If the omitted information is not received within thirty (30) days of information request, the application will be returned to
applicant(s) as incomplete and the application fee forfeited.
• Review of the application.
• A site visit on your property by a PEC representative to review your relevant drawings and discuss PEC requirements.
• If application is approved, Progress Energy will mail a copy of the Permit Letter and PEC Building Permit to the applicant's
address or contact the applicant by phone or in writing of conditions or denial.
• Applicant is to have PEC Building Permit posted within 20 feet of project and it must be viewable from the water. The PEC
permit must remain posted until a PEC representative inspects the project and determines the project is complete and within
the application specifications.
I X. Additional Notes or Comments
For questions concerning the completion of this application, please contact us at 1.877.893.0001 or
lake.management®pgnmail.com.
0 Progress Energy
Lake Management
c/o Business Services
Progress Energy
P.O. Box 1551, PEB 3A
Raleigh, NC 27602
PERMIT LETTER
NAME Robbie & Amy Cohen
ADDRESS P O Box 545
CITY, STATE, ZIP
Norwood, NC 28128
SUBDIVISION Edgewater on Lake Tillery
LOT # 6
Your current lease with Progress Energy (PEC) and the Guidelines for the Use of Leased Properties at Lake Tillery provide that, subject
to certain requirements, you may construct and maintain a pier, wharf and a one-story boathouse at Lake Tillery. PEC does not object
to the installation of a bulkhead or rip rap material for shoreline stabilization provided the required permits are acquired.
NOTE: A pier, wharf and a one-story boathouse must be erected over that portion of Lake Tillery immediately
adjacent to your leased premises and in the location herein approved by PEC. Encroachments that are not
promptly relocated after written notice to do so from PEC subjects your lease to possible termination.
Additionally, you may not construct or install other improvements/structures, i.e., roof overhangs, driveways,
porches, decks over land, garages, buildings, storage buildings, wells or septic tanks on your leased premises.
As required under your lease, you must permit PEC, its officers, agents, employees and other authorized
persons to enter the leased premises at any and all times for the purpose of inspecting the leased premises
and your compliance with the terms and conditions of your lease.
The United States Army Corps of Engineers has issued a regional general permit covering this type of authorized work - a copy of
which is attached for your assistance and information. Please be advised of the requirement in paragraph 2.a. of said Permit (page 5)
regarding the need to apply for and obtain a Water Quality Certification from the North Carolina Division of Water Quality in accor-
dance with Section 401 of the Clean Water Act.
You may use this letter as PEC's permission in your application for a building permit from the appropriate Montgomery County Inspection
Office/Stanly County Planning Department to construct the specific facilities set forth above and in applying for the appropriate certifica-
tion from the state. If you have not completed construction of your facilities within the next three (3) months from the date of this
letter, PEC's permission shall expire, requiring you to submit another application to PEC, along with an additional $100 nonrefundable
application fee. PECs approval hereunder is subject to your compliance with the terms and conditions of your lease and Guidelines for
the Use of Leased Properties at Lake Tillery (as they may be amended from time to time).
Please see the reverse side of this document to describe the improvements you plan to construct.
I/we hereby certify that the above-specified dock complies with Progress Energy's facilities specifications in effect at the time of appli-
cation for a dock permit.
LESSEE'S SIGNATURE
PROGRESS ENERGY REPRESENTATIVE'S SIGNATURE
DATE
DATE
13
Robbie & Amy Cohen
Minor Rip Rap Stabilization
VEGETATE DISTURBED AREA
ABOVE SLOPE
/ EXISTING GRADE
1 CLASS 1 RIP RAP
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