20120791 Ver 1_401 Application_20120812

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2 ®12079 1
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 $570.00 for impacts to lake bottom of greater or
equal to 1 acre.
Applications should be sent to:
Division of Water Quality 401 Oversight/Express Review Permitting
1650 Mail Service Center
Raleigh, NC 27699 -1650
I. Applicant Information
1. Owner /Applicant Information
Name:
Mailing Address:
-0-- S 8 t.> *_v' 1 V
Telephone Number: XiP `o299 .3 Fax Number:
E -mail Address: �Js &4 e e- 1 v 140(o a 400 „ h=3
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be attached
if the Agent has signatory authority for the owner /applicant.)
I
Name: 91 bZ iA 'P,—
t I
Company Affiliation: S ` P '-_
Mailing Address:
Telephone Number: `U$— 31 L —536.3 Fax Number:
E -mail Address: r� l T J a (�( V �t h o e G O ^'1
It. Project Information
A?( d 7610
Attach a vicinity map clearly showing the location of the property with respect to loc rks such
as towns, rivers, and roads. Also provide a detailed site plan showing property bound
development plans in relation to surrounding properties. You may use the diagram b 1e�
hand sketch of your project. Also, see the example below for guidance. Both the vici ity nap an si
plan must include a scale and north arrow. The footprints of all buildings, impervio su fa��o ot�ieO'
facilities must be included. 2

5. Describe the purpose of the proposed work: ;o
6. List the type of equipment to be used to construct the project:1 ack
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres: ^ 7,S-O S
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):
Applic nt/A ent's ignature 10 to
(Agent's is valid only if an authorization letter from the applicant is provided.)
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Location
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County: �,Y ed e u Nearest Town: S ��,t S V f i�� ,
Subdivision name or site address (include phase /lot number): 'Old B r t'k, e-
�a T7
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
vicinity map is included):
2. Describe the existing land use or condition of the site at the time of this application:
3. Property size (acres): �( e ,,1
4. Nearest body of water (streariVriver /sound /ocean /lake): D -'i �I,- Lo� 1- qk2 Al "W"
5. Describe the purpose of the proposed work: ��� c� e ; � e !L_'
e Y e-�
6. List the type of equipment to be used to construct the project: SIX R L OR S( <7 15 4&11e_RY_I_
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres: ge o aX-e- QPP ro k ,
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: A L © V l e vp�
IIVt)IJ {�a 0AA% -nY 3T+^ � I�l1`�� = %1_�!i S�
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance): No Tre-es D V ec 0.7 . o � fi(� �
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Applicant /Agent's Signature e
(Agent's signature is valid on uthorizati letter from the applicant is provided.)

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To whom it may concern,
I give authorization to my contractor, Randy Sipe, owner of Sipe Landscape and Design, to fill out all
necessary forms and escavation work on the lake lot as described in our packet of information.
erly
Sipe

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.
I. Applicant Information
A. Name — ,5 Q r
B. Mailing Address hJAW
A Nee v C'�0
C. Telephone:
H. Location of Proposed Project
A. Lake PArt -0 M10 N
B. Street Ad T;,
C. County
D. City, town, community or landmark
E. Section Lot # 7 Subdivision
F. Directions to propr y by road
r..-,. 1 n LL A Aa . T.. - . ^ n e
G. Latitude and longitude 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.mapsonus.com. Directions: Don't register, click "Maps ", enter address, draw map, select "Map Clickin
Will... ", select "Lat/Long ", click map)
III. Description of Project _
A. Length of wall O
B. Material
C. Distance from property line /sh&eli e
IV. Intended Use of Pro ect Area
A. Private
B, Commercial
V. Applicant Signature
1
12►51t. t---
g
Date
• 2 COPIES OF E " UKE ENERGY APPLICAION FOR PERMIT TO STABILIZE THE SHORELINE IN NORTH
CAROLINA"(PkWTOGRAPHS OF THE SHORELINE TO BE STABILIZED, AND FIVE (5) COPIES OF THE
COMPLETE 'NC DIVISION OF WATER QUALITY PRE- CONSTRUCTION NOTIFICATION APPLICATION"
MUST BE SUBMITTED WITH THE DIVISION OF WATER QUALITY APPLIC TION FEE TO:
NCDIYI ON _W TiR UAL Y
ATT TIO : C NDI RO
PARK VI L G., 2 21 C BT E B D. MSC I G l-7
LEI , N 27604
YALAKEMGMIVackage Infonnation \NC Shoreline Stabilization Application.doc
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2582 Buffalo Shoals Rd, Statesville, NC 28677 -2491
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2582 Buffalo Shoals Rd, Statesville, NC 28677 -2491
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Print Report Zoom to Parcel
PIN:
Tax ID:
County: IREDELL
Approximate Acres: 2.89
Deed Reference: 2122/835
OWNERSHIP INFORMATION
Name: BYERLY JOE S
Physical Address:
2582 BUFFALO SHOALS RD
STATESVILLE, NC 28677
Mailing Address:
3316 N ROCKINGHAM RD
rENSBORO, NC 27404
Find Adjoiners
" t: Contact Board of Educati(--n
')ntact Roard of Education
;ten
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Property Data
Iredell County
Property Data
Parcel Number: 4701946993.000
Inquiry Date: 4/24/2012
Disclaimer: While every effort is made to keep information provided over the internet accurate and up- to-date, the County does not
certify the authenticity or accuracy of such information. No warranties, express or implied, are provided for the records and /or mapping
data herein, or for their use or interpretation by the User.
Property Map
2582
e4 �
r �.
ss \\
a r
�ti • �"� 2585
5 ) �Y •
Owner/ Property Info
Tax Account Number: 00DO77476064
Old Parcel Number:
Owner Name: BYERLY 30E S
Mailing Address: 3316 N ROOCINGHAM RD GREENSBORO NC 274047246
Property Location: BUFFALO SHOALS RD
Lot Number: 7
Legal Description: OLD BRIDGE PB48 -134
Municipal Information
Township Code: 15
City Code:
Neighborhood Code: 15046
Value Information - Current Year Tax Card
Building Value: 0
Other Building Features: 0
Land Value: 225000
Tax Assessed Value: 225000
Deferred: D
Land Information - Reoister of Deeds Online Search
Date Recorded Document Type Deed Book Deed Page Plat Book & Page Land Area L.apd Type Zoning
20110603 WD 2122 835 48 -134 2.89 ,,0' AC RA
Tax Information
Exemption Tax Cade 1 Tax Code 2 Tax Code 3 Tax Code 4 Tax Code 5
C FROS
Current Zoning Contact Info.
Iredell County
Harmony
Love Valley
City of Statesville
Town of Troutman
Town of Mooresville
Village of Davidson
Page 1 of 2
http:// web2. mobile311 .com/IredellReport/report.aspx ?PIN= 4701946993.000 4/24/2012