20100670 Ver 1_401 Application_20100810

20100670
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
1650 Mail Service Center a Z ? c ? ' A
Raleigh, NC 27699-1650
A&I
1. Applicant Information
DEVR • WATER QUALITY
WETLANDS AND STOR31YrA' ERANCN
1. Owner/Applicant Information.`
Name: 7-o wl * Lk v- lp ' 'I'
Mailing Address: y Ct `? ? r Q. U ? r u S c L y o ? JQo 0 c?
? o ,? ? s?: l r? AI C. X 8 1 1 7
Telephone Number: 7 0 4 - 0 7 C,3_0 Fax Number:
E-mail Address: m tLt J r u n r. C
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: A)/,
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
R. 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: L""e Nearest Town:
Subdivision name or site address (include phase/lot number):
JUo - E
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
vicinity map is included): o -f 7 7 } /e t o ti IJ
L e ?' c? n? 1 e y S ?e? J7. 5 e o h
2. Describe the existing land use or condition of the site at the time of this application:
3. Property size (acres): / 3 / r s
4. Nearest body of water (stream/river/sound/ocean/lake): o !tee /V n .?
5. Describe the purpose of the proposed work: K? 5 Y-Q I f P .09 A /'
A J °1 L' -(rb Q' + O 4 ct 7 l' f Yf e_x 7
6. List the type of equipment to be used to construct the project: ?o?<<??i ea fi
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres: ?`, too c '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:
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance):
lWooresv'/le
,ZZ49 c7 ?ro?vley SaL. 1?a ,
/0
/ d
Applicant/Agent's Signatu?ei d Date l
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
PUPRA
J -P+ X j66 -P
Please appro)dnmd*-sketch the fol avdng information onthis-plan
(please provide dimensions for each item, such as 40 M x 400 ft):
-
i) All proposed vegetation dearog (provide dit melons)
A Location of rip rap or fill to be placed above the -Fan Pond=elevation
3) Location of rip tap or fill to be placed low the - Pug -pond elevation
d) The lac Wct of any proposed sductures such as tRAc ing% r takMg
wagss docks; etc.
5) The location of any excavation or dredg'mg below the Full Pond
elevation.
6) Location of construction access corrldors.

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DUKE ENERGY LAKE SERVICES
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.
1. Applicant Information
A. Name 0 w? .,c 99 1 el
B. Mailing Address R`1 1 ? (r a u7 ItV Sc i+ o a 1 Quad moo,-e5 J. I Ie )VC aS/ / 7
C. Telephone: -70 ct 6 60 - 7 6,570
II. Location of Proposed Project
A.
B.
C.
D.
E.
F.
Lake 4_HK1:?_ /?Jovrla.,,
? r a ?J ? e Y ?cl oo / ®Qe a d /? Oo ?C's ? /??
Street Address ?_41i9
County /rg??e I
City, town, community or landmark 1" 6 o re ,5 V? / I C fJ C
Section Lot # 4 _ Subdivision
Directions to property by road
77 E, i 33 /C?? b n a), I I lo Esc n rPd / x.4'1- a H 3,
S
s ;mot-,,'/& 5 duo &, a e ,, /e -C
G. Latitude and longitude for ffie project site /1I 36 ° 30. i} 7 e ' w; o S o s? . 6 7 '
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.mapsonus.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 16 0 -CC C B. Material !L i P RA ?
C. Distance from property line/shoreline
IV. Intended Use of Project Area
A. Private
B. Commercial
. -wt,r?-??? YL? Date / o
V. Applicant Signature 7
PLEASE NOTF. THE FOLLOWING:
• 2 COPIES OF THE "DUKE ENERGY 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 KAROL Y
PARKVIEW BLDG., 2321 CRABTREE BLVD.
RALEIGH, NC 27604 _
919-733-1786 //?\\? eat s
3
O G7
Pt1C .t.b' ? l 7
YALAKEMGMTVackage Information\NC Shoreline Stabilization Application.doc
DUKE ENERGY DIRECTIONS BY ROAD FORM
Lake Use Permit Applicants and Contractors: Ease of locating the proposed project site can have a big
impact on permit processing time. Please complete this form and return it along with your completed permit
application to:
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:
Street Address (at lake): -z tf ej 9_ f a w e y s c o o 6 0 %/'/ e rc s? ;! f e ILIC -Z8/'7
Lake Name: l-a. k-e- AA
Subdivision Name: A-11
Tax Parcel ID (if known): Lot # 6 -?
City: In©arCS all 112
County: H f
State: _ /f v G Zip: _ ?Z I 1
Latitude: 9 70 ? Longitude: 011 O ??0 Q3- 9. -? 6 7 ?
Telephone: 7 D L,c _ 6 7 6 ?O
Directions (from major road or highway):
A)o??ti o 77 ;4 3,3 J-0 ?N (J mod. 17 i m t- 0
h ° u st ? ? o ?? /e
Descriptive Structure(s) on Property (i.e. brick garage, white fence, mobile home, etc):
?r Ac'-C 5 e o.-, /.lre,