20120305 Ver 1_401 Application_20120312

DUKE POWER LAKE MANAGEMENT EC12 -Q 2 Q 1 2 Q 3 Q 5
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 POWER FIYNG FEE, PAYABLE
TO DUKE POWER TO ABOVE ADDRESS
I Applicant Information �
A Name �').4m e s 12
B Mailing Address L/ L-lq A e
C Telephoner _ -5-92- 6 6! c) �v 7
II Location of Proposed Project
A
B
C
D
E
F
G
H
Lake NDyL#it 1iw
Street Address L S �, Q,I lid f
County d w
City Town Community or Landmark
Section Lot# � 0 W Subdivision l.(�ESi Bait t
Directions to property by road j� u, I I ►J -f v n r >,.� �,L _ l2 , C G, a c-.
(d T v n �. s d ( /Z
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 Ma s enter
address draw map select Map Clicking N select Lat/Long click map) G
III Description of Project
A Length of wall 444
B Material k w,, i ; /3 l 2011
C Distance from property line /shoreline -40/1 - K - a QU
S @ I'kah
IV Intended Use of Project Area
A Private X
B Commercial
V Applicant Signature
�� i' A
Date
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 Cynd►
Karoly PARKWEW BLDG 2321 CRABTREE BLVD RALEIGH NC 27604 PHONE [phone]

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
I Applicant Information
Owner /Applicant Information
Name James R Garrison
Mailing Address 4174 Lake Shore Rd S
Denver, NC 28037
Telephone Number 704 - 572 -6610
Fax Number
E mad Address
Jim garnson@valworx 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
Terry Hogue
Company Affiliation
Custom Lnadscapes
Mailing Address
P O Box 1504
Denver, NC 28037
Telephone Number
704 - 483 -6006
Fax Number
E mad 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
Location
County Lincoln Nearest Town Denver
Subdivision name or site address (include phase/lot number) Westport

Directions to site — please include road numbers landmarks etc (This is not necessary
if an adequate vicinity map is included) /I t,,, / G /V -t 0 b t ),JU�e �
If
/I>i uh CILIALC 1,9( C`oncr + ha _ -to tha 4 *4/—
lZ�[h y,- L-I Act- 5- 4ct,� GId �iCn/y �S
2 Describe the existing land use or condition of the site at the time of this application
3 Property size (acres) Q 3
4 Nearest body of water (stream /nver /sound /ocean /lake) N D it
5 Describe the purpose of the proposed work l h �J1 G, n c
u/ /LUC /c fW6 6�
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6 List the type of equipment to be used to construct the protect
C V C,019 u� ion
7 Amount of impact (including all excavation backfill rip rap retaining walls etc) below
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
/I Y 910 V
b Please describe vegetation above the normal pool lake level and 50 feet land ward to
be impacted (number of trees for instance) NU ! c t S C", it 4,(=
/I &- `h FvL-- 5Le ^)-I, J-7
Signature Date
(Agents signature is valid only if an authonzabon letter from the applicant is provided)

Lake (Full Pond)
Full Pond `)
Shoreline d
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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 np rap or fill to be placed above the Full Pond elevation
3) Location of np 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
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DUKE ENERGY DIRECTIONS BY ROAD FORM
Lake Use Permit Applicants and Contractors Ease of locating the proposed protect 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 12Q
PO BOX 1006
CHARLOTTE, NC 28201 -1006
1- 800 -443 -5193 and select Option 5
Applicant's Name — James R. Garrison
Street Address (at Lake) 4174 Lake Shore Rd S
Lake Name Norman
Subdivision Name WestPort
Tax Parcel ID (if known) Lot 16 W
City Denver County Lincoln
State NC Zip 28037
Latitude _ 35 5057 Longitude 809767,
Telephone
704572 -6610
Directions (from major road or highway)
Hwy 16 N to Denver — Right on Fairfield Forest Rd — to end take a right on Lakeshore Rd
S — right below Norman Ct on Left
Descriptive Structure (s) on Property (i e. brick garage, white fence, mobile home, etc)
4174 Lake Shore Rd S

4174 Lake Shore Rd S, Denver, NC 28037 - Google Maps
G '81t: Address 4174 Lake Shore Rd S
oDenver, NC 28037
Get Google Maps on your phone
Text the word "GMAPS'to466453
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