20140879 Ver 1_401 Application_20140814

DUKE POWER LAKE MANAGEMENT, EC12 -Q
P. O. BOX 1006 2 0 1 4 0 8 7 9
CHARLOTTE, NC 282 06
704 - 382 -1567 OR L fRF4 -4.43 -5193
APPLICATION FOR PERMIT TO t ABILIZE -THE SHORELINE IN NORTH
CAROLINA
Please type or print and fill in all blanks. If information is not applicable, so i ira il><lllK
blank. PLEASE SUBMIT APPLICATION AND APPROPRIATE DUKE POWER
TO DUKE POWER, TO ABOVE ADDRESS.
Applicant Information
A. Name
B. Mailing Address
C. Telephone
II. Location of Proposed Project
A. Lake
B. Street Address
C. County
AU CI 1 4 2014
r
S 0
201 I S L A OF-7nVt=ST -F)k I r a c 0
E.
F
21.2 �sLAKD F Is T_ �R
City, Town, Community or Landmark C V '
Section r Lot # 5 Subdivision L
Directions to property by road T -17 —I W- Ca," Ate, f�
G. Latitude and longitude for the project site ?Y
�,
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 �-
B. Material y q IF, G vl P �� il
C. Distance from property line /shoreline �� 1' �N X `S� 11C� Shies I j ^, r✓
IV. Intended Use of Project Area
A. Private X
B. Commercial
V. Applicant Signature Date T/
PLEASE NOTE THE FOLLOWING:
C 2 go31
• 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
Division of WaterAesources
Division of Water Resources 15A,NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
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:
Mailing
Telephone Number: 7Qq-- E25-5_022 Fax Number:
E -mail Address: ( WAN ITSun (Q HC I M-81 L_ . C-cM
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 /reizdocs /Permits /SAMPLE AGENT AUTH
ORIZATION FORM.pdf), must be attached if the Agent has signed this application form.
Name:
Company Affiliation: CZ C
'Mailing Address: FGT M HWQ
MoartsyMt . v �A06-
Telephone Number: �11G�� �(� 0 - 511 ) Fax Number: C1CL� - c
E -mail Address: CbCZ-5CC\AfGI,� 1,6 � IN (ndSTf('t')tM, .
Person to receive the Certification Approval: C G
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

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'en&of this
application form.
I 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)
County: , Nearest Town: , U4
Subdivision name or site address (includ&phase /lot number)': j5
5.
Directions to,site -, please include road names and numbers, landmarks, etc.: T_ — _7 T
UcbLr we Lne exisung iano use or conaition of the site at the time of this application
(residential, undeveloped, etc.): -
6. Property size (acres): 0.2811
7. Lake/ river/ ocean adjacent to property:
8. .Describe proposed work (include discussion as to how hardening of shoreline,has been
7
avoided, or why it'is necessarv):
Will work be conducted from land? 9 From water,? ❑
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: .2 - -, � -f- F±
12. Please describe the vegetation above the normal pool lake level/ Normal Water level and
50 feet landward tote impacted (number of trees, for instance): NO
of
Owner /Agent's Signature* [15A NCAC 02H .0502(f)1
< �11 20/ 5 �Z
Date
-Agent's,,signature is valid only if, an authorization letter from the owner is provided
FORM: SSGP40 -2013 Page 2 of 3

:lake-yam �r�. -,x .. ti,.�,'� ,a'''" _ ) , +� ,k- •-xr _ _ %,', - � 'rte _" - - - _
Pond %111orinal :Wafer Level)
- <
� _ ��-' `k,t �:.'; sip _ ��; s•` ('e .�i, .`_.. F_ ` 'ti _ _- - �:
.. "J-. :iti_ _ .'� -; +L' .r�J _ i —�i� � _ - s F, ; g � _ F.e�• ii t t^ • p..
• "
}_ {
��; _ `�� - _ �r�"•` �s'�,` -t_ '�s,^ -.Fib _ _ - ;z.rx "� `
Futir.'.('"_ - _� ''�,�yu ]�. ;,P.'. ''`x� `..f r /r4T'i i[YS,, _ q,c� r• -> `
•Norma111water'Le
Shoreline
foX Ki
Please approximately sketch'the following information on this,plan (provide dimensions for each
item,, such as 10 ftx 100 ft) *:
1. All proposed vegetation clearing q1IA,
2. Location of rip rap or fill to be placed above the Full Pond / Normal Water Level elevation Cq/A,
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.
S. Location of any excavation or dredging,below the Full Pond/ Normal Water Level elevation,
6. Cocation.of construction, access corridors
i
`i FORM: SSGP 10-2013
5
Page 3 of 3
'l

DON ALLEN & ASSOCIATES, P. A.
"Since 1971"
Commercial 4 Residential ° Mortgage Surveys 4 Multi— Fomily
Construction Staking = Subdivision Design = Topographical
(704) 664 -7029 (704) 664 -8041 Fox
I, certify that this map was drawn under my supervision from an actual
s. -vey —ode order my supervision recorded in deed boo:c_7319 _, page— 829 - -, and /or
plat book - - -? —_ —, page— 339 - - -, that the ratio of oree:s`iosl is 1':10J,000, that this map
was prepared in accordance with the General Statutes of North Cara-,^a Chapter 89C.
my hand and seal on the —_ 24 —_, day of -- APRIL __ -- _
B
WILL AM W `��° SPL_4 - - --
0
y %e LAKE NORMAN4epg�P,. =
L't`T s<� CLR' *E:, :JS
,pa4CyG �G �` 73 EXIT 28 CONC °E E'
O RCy ENCROACHES 0.73'
SON R�_ ^ 2 CC NC.RETE
-
VICINITY ,MAP NO SCALE of f r
761'
COtdFOUR 7F• — � i
LINE I
DIRECTION
DISTANCE
L1
N, 02'42'54" E
7.17'
L2
'S 87'06'15 " -- E
`64.97
L3
.S 01'12'36" W
8.60'
L4
S 87 *22'25 E
6.29'
L5
N 04'14'42" E
8.58'
L6
S 87'25 21 0 E
4.18'
L7
S 72'47'36 E
34.25
L8
N 68'43 23_ E
47.41'
� L►_NF�
�2f1��`'
�n
Sgr
ENCROACHES 0.50•
A/C
j5 174'
O
IL 24 B'
°
� • •
w
O
M I of
° CONCRETE
Ln
e,
N DOG _,
oI
DRI
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128'
I LOT in GARAGE
LO o o 768 06'
I�at
•
4
n
°
DRIVE
�f
'
ENCROACHES 0.50•
A/C
= 765.46'
m
128'
N
4
14 r
LOT 55
c� w ,�
^
, sroRY�eR�c1c &FRAME
°�
�'
LOT 57
T. RICHARD
F o'
OMP. ROOF
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N
KATHRYN W.
MORRIS
W N`
o
= 779 48' h
_`
BEATY
48541851
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(n o1
BASE = 770 58'
N
a
0
°
2907 159
Z pro a
m
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:'
m
n
r
1^ PORCM 8 5' 15.3'
LOT 56
N
0.28 AC.
,
�• TOTAL
N
-
R/W�Q
(CHORD BEARING) S 89'21'40" W
N 89'18'18" W 64.90'
16.95'
R = 507.31'
L = 16.95
60.00'
I
ISLAND FOREST'
DRIVE
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DUKE ENERGY DIRECTIONS BY ROAD
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 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:_Mitsuo Iwasaki
Street Address (at Lake) – 20801 Island Forest Dr.
Lake Name: Norman
Subdivision Name: Island Forest Lot 56
Tax Parcel ID (if known): 00111415
City:—Cornelius County Mecklenburg
State: NC Zip: 28036
Latitude: 35.4946 Longitude: 80.9118
Telephone: 704 - 895 -5022
Directions from major, road or highway):
177 North to Exit 28 west on Catawba Ave - Right on Bethel Church Rd then right, on
Pinehurst Dr right�on Island Forest
Descriptive Structures (s) on Property (i.e. brick garage, white fence, mobile home, etc.):
20801 Island Forest Dr

20801 Island Forest Dr - Google Maps
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