20140492 Ver 1_401 Application_20140514

DUKE POWER LAKE MANAGEMENT, 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
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 FILING FEE, PAYABLE
TO DUKE POWER, TO ABOVE ADDRESS.
I. Applicant Information 1 0 1 4 0 4 9 2
A. Name
B. Mailing Address �� ` 5�� S�,i�l� 111 Z<S l ( 1
C. Telephone (_ __ —4 WZ1
II. Location of Proposed Project PAID
A. Lake
B. Street Address
C
U
E
County `iel
City, Town, Community or Landmar k
Section Lot #
F. Directions to property by road
-- L_ 7 7 d � CX 1 t 3 3), W
1
Subdivision C`
cif aepy_ 4- CK)k pa( iS
G. Latitude and longitude for the project site 5,',5379
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 o
A. Length of wall O
B. Material I A?.g ;Ali# F�C Q. _5
C. Distance from property line /shoreline „� ` `j
IV. Intended Use of Project Area
A. Private X
B. Commercial
V. Applicant Signature
PLEASE NOTE THE FOLLOWING:
/J e__
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: Cyndi
Karoly, PARKVIEW BLDG., 2321 CRABTREE BLVD., RALEIGH, NC 27604, PHONE: 919 - 733 -1786

State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources FORM: SSGP 10 -2013
Shoreline Stabilization Application Form
Four copies of the application (including attachments) and the application fee should be sent to:
Division of Water Resources
401 & Buffer Permitting Unit
1650 Mail Service Center
Raleigh, NC 27699 -1650
I. Applicant Information [15A NCAC 02H .0502(a
1. Owner Information
Name: JL.
Mailing Address:
�Il"e .Kc- -Zz i 1 l
Telephone Number: Sw I - 103-- L4S^�A Fax Number: —
E -mail Address: k "C4 "-p V. ex.:m
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http : / /www.saw.usace. army. mil / Portals /59 /docs /regulatory /regdocs /Permits /SAMPLE AGENT AUTH
ORIZATION FORMWP must be attached if the Agent has signed this application form.
Name: ZriAg e S
Company Affiliation
Mailing Address:
Telephone Number
E -mail Address:
L
Co 3 g F7A'2.r \ 4wy .
M D 1DY'c s vi l (fl, N C ail ('5_
0 -50 I Fax Numb r: -6� - 69
c�c seAyJA -1ls P W� Ord s m . rref
Person to receive the Certification Approval:
ri�ae -s
II. Project Information [15A NCAC 02H .0502(a) & (b)]
1. Attach a vicinity map (i.e. street map) clearly showing the location of the property with
respect to local landmarks such as towns, rivers, and roads.
2. Provide a detailed site plan showing property boundaries and proposed locations of
vegetation clearing, structures (buildings, retaining walls, docks, impervious surfaces,
FORM: SSGP 10 -2013 Page 1 of 4

N
etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
and construction access corridors. You may use the diagram provided at the end of this
application form.
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale
of some sort- a yard stick, shovel handle, etc.)
4. Location of the property (where work is to be conducted) r1 I
County: (-i� Nearest Town:
Subdivision name or site address (include phase /lot number):
DirectiPns to site - please include road names and numbers, landma ks, etc
ex; '�3 VJ on1 kJ tIiA- rA5o^1 Rd. L +oAl fjrl4M1f S
:t:- -7 7 4 Ja
-Dal 0. .
Ci c.it, Ip tey- R + Oni'ia -Po i PIS +'r �. +p lJ
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): V' C-5 i* Jt•,� P p-� me. o Atdtir— coAr5 ArU416,l
6. Property size (acres): (, (Dl l0
7. Lake/ river/ ocean adjacent to property: LLI� �ecUnstk\
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): S4 4A-b7_t 5 h ow-1, rre �+ .�J� IC 'C^1
9. Will work be conducted from land?
From water? 1�1'
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool lake level/ Normal Water Level in square feet or acres:
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres: l E16 X
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 feet landward to be impacted (number of trees, for instance): 6- Ze,) 76r11_�5
0 4/Agent's Signature [15A NCAC O2H .O502(f)] Date
Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10 -2013
Page 2 of 3

Full Pond/
Normal Water Level
Shoreline
I rk ✓G
0
La ke
(At Full Pond/ Normal Water Level)
"/ V6 ca. y4s
JOU)
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ft x 100 ft) *:
1. All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
3. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
4. Location of any proposed structures such as buildings, retaining walls, docks, etc.
5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
FORM: SSGP 10 -2013 Page 3 of 3

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DUKE ENERGY DIRECTIONS BY ROAD
Lake Use Permit Appicants and contractors: Ease of locating the proposed project site can
have a big impact on permit processing time. Please complete this form and return in along with your
completed permit application to:
Duke Energy
C/O Lake Services — EC12Q
P O Box 1006
Charlotte, NC 28201 -1006
1- 800 -443 -5193 and select Option 5
Applicant's Name: J C Faw,
Street Address (at Lake) 130 Brick Kiln Way
Lake Name: Norman
Subdivision Name: The Point Lot—S23
Tax Parcel ID (if known): 4625765126
City: Mooresville County Iredell
State: NC Zip: 28117
Latitude: 35.5378 Longitude: 8 -0.9245
Telephone: [phone]
Directions from major road or highway):
1 -77 N to exit 33 - West on Williamson Rd – Left on Brawley School, to circle – bear right to
Polpis Dr. Left on BrickXiln Way.
Descriptive Structures (s) on Property( i.e. brick garage, white fence, mobile,home, etc.):
1{30 Brick Kiln Way

130 Brick Kiln Way, Mooresville, NC - Google Maps
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