20081726 Ver 1_401 Application_20081108

PAID
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 grea er or
equal to 1 acre.
08-1726
Applications should be sent to:
`",
Division of Water Quality 401 Oversight/Express Review Permitting
1650 Mail Service Center
Raleigh, NC 27699-1650
1. Applicant Information VA
d?jl(?yJSANDSl??
1. Owner/Applicant Information
Name: J s c n J Q EPA ?(?S ,JY1t?X' 1
Mailing Address:
Telephone Number. gag t(7 0 51116 Fax Number:
E-mail Address:
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:
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
H. Project Information
Fax Number:
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.

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I
pT
Please approximately sketch the fogowing information on this plan
(please provide dimensions for each Item, such as 10 ft. x 100 ft)=
1) AN proposed vegetation clearing (provide dimensions).
.2) Location of rip, rap orfill to be placed above the ? Pond-elevation
3) Locution of rip rap or fill to be placed below the Full Pond elevation
4) The location of any proposed shuctures such as buildings, retaining
walls, docks, etc.
6) The location of any excavation or dredging below the Full Pond
elevation.
6) Location of construction access corridors.

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Parcel Summary Printed Map Scale 1 inch = 130ft
Parcel ID: 461902680907 Parcel Address: 1395 ROUNDSTONE RD, SHERRILLS
Owner: Address: City
Owner2: Address2: State/Zip: ,
Building(s) Value: Land Value: i ffotal Value:
DISCLAIMER: This map/report product was prepared from the Catawba County, NC Geospatial Information Services. Catawba
County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on
this report. Catawba County promotes and recommends the independent verification of any data contained on this map/report
product by the user. The County of Catawba, its employees, agents, and personnel, disclaim, and shall not be held liable for any
and all damages, loss or liability, whether direct, indirect or consequential which arises or may arise from this map/report product
or the use thereof by any person or entity.
http://www.gis.catawba.ne.uslwebsitelParcellprintMapandReport.asp?pinc=461902680907... 11/3/2008
e
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 J A/vqF_S f lb tl Q ,i'')L
V _(o7
B. Mailing Address L'1 i2, pAS? 10 , r{`Al S A )C . 09 3
a?Z? u7?s?7?
C. Telephone:
II. Location of Proposed Project
A. Lake t JO('(Y%C J\,
B. streetA IZounc-?.s?y?r lZ.c?, ?1rnrr? 115 Furd?.1?, ag?`Z3
C. County?J? .
D. City, town, community or landmark SV%er ^ 11? ? r
E. Section Lot # 128 Subdivision rrz&zu;V law& T,in Jxr (3x'p
F. Directions to property by road 11 R -fib ?wc6!g an LeX+ Jl nAA6 ISO . 'Tuv
(f dii?y 4a !- n lbUrdS rRe. f?
G. Latitude and lon for the project -gb 5N " -£057' Sr.S?
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 "LaVL.ong", click map)
III. Description of Project ,
A. Length of wall 101
B. Material ?taC,
C. Distance from property tin orelin
IV. Intended Use of Project Area
A. Private
B. Commercial
V. Applicant
;?,;?ilAy?' AT1D ?
Date //-3-40&
• 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 KAROLY y`
PARKVIEW BLDG., 2321 CRABTREEBLVD.
RALEIGH, NC 27604
919-733-1786
Y-M AKEMGMTWacimp Information\NC Shoreline Stabilization Application.doc
DUKE ENERGY DIRECTIONS BY ROAD FORM
Lake Use Permit Applicants and Contractors: Ease of locating the proposed proiect site can have a bt!:
impact on permit proces-sum time. Please complete this form and return it along with your completed permit
application to-1
DUKE ENERGY
CIO LAKE SERVICES - EC 12 Q
PO BOX 1006
CHARLOTTE, NC 28201-1006
1-800-443-5193 or Option 5
Applicants Name: E-?' _
Street Address (at lake):
Lake Name:
}//K++?orm
Subdivision
Property Section:
Lot # Ps
City: - t??S jrGL County: t f?.6
State: Zip:
Telephone: L1-79751-47f?
Directions (from major road or highway
fig Q it> C4?? -N.0 - ?W' 3 (??W" VqP y 15D,
?? Ot?? Sh>??rr•?Ls Fisrr?.. ?cl t?,?- ?,tt°? M?t?,S ?,?c4kbo,r?,
Tz? er??-o 7La,3 rds-ZaY,?
Descriptive Structure(s) on Property (i.e. brick garage, white fence mobile home, etc):
*2 5kbry +P.*-) V\L>vst? L4 W4?i`?2 +t'?m (!)'?3 V.?ec-k
*Note: Please use the back of this form if desired to draw us a map to the site.
WaVLAKEMGMTJPackage hlfonnation/Dinxtions by Road Form.doc
August 15. 2006
S DON ALLEN & ASSOCIATES, P. A.
Complete Surveying
D
Commercial * Residential * Multi-Family
Construction Staking * Subdivision Design * Topographical
[phone] [phone] Fax
I, certify that this map was drown under my supervision from an actual
survey made under my supervision recorded in deed book --__-__, page -----_, and/or
plot book--16 ___, page-- 2 _-_, that the ratio of precision is 1':10,000, that this map
was prepared in accordance with the General Statutes of North Carolina Chapter 89C.
my hand and seal on the __t5day of --MARCH
WILLIAM N
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14 REBAR
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STEPHEN A. CRUTCHFIELD
2262/833
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SEAL
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760' CONTOUR LINE PER 1•L ?? _/ / /
ACTUAL FIELD SURVEY.
115
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761' CONTOUR LINE PER Q
ACTUAL FIELD SURVEY / O
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/ 5G N
ENCROACHING
GRAVEL DRIVE
/ 120 P
34.3'
59.9' 2a MOB\E? NOME
LOT 127
N W FRED CLINE
Gv'?1?F ° =
0 10•
LOT 128
1.14 AC.
0
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METAL 17.5
WELL HOUSE
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SETBACK I RFeq
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'?Fey _ . _ - `_ 117.1 T
R=2184•13?
POWER Rp BEAR ING)
OVERHEAD S 21-04'00" W /cS g.26' 25' W
0 4-b 26.96' \ 117.16'
°h b)
DSTONE ROAD
N
M00, / ROU (PAVED)
o? 0' 30' 60' 100'
' I I I I
JENKINS
1097/24
k?? LEI' ?
NOV f? 0 2008
DENR - \NATEF WALITY
V1ETLANDv AN0 5TORM'IK TER f
NOTES LEGEND
1) THIS PROPERTY MAY BE SUBJECT TO SCALE IN FEET -Q, = P.P. = POWER POLE
ANY EASEMENT AND/OR RIGHTS-OF-WAY I I ' `,
OF RECORD. PL I --I Y S I C ALSURVE Y R/W = RIGHT-OF-WAY
2) AREA COMPUTED BY THE COORDINATE
METHOD. =WELL
3) EXISTING 760' & 761' CONTOUR ELEV- OF
ATION BASED ON LAKE NORMAN LAKE 1359 ROUNDSTONE ROAD
LEVEL AT FORD DAM (READING
ON 7/01/98) 8) ELEVATION: 757.8' LOT 128 CRESCENT LAND & TIMBER CORP., SECT. 25
SCALE _1" -= 60' -------- CATAWBA TWSP., CATAWBA CO., N.C. FIELD BOOK: 502
FILE: 8231
ACQUIRED BY: GINA M. MALVASO DC FILE:
TAX MAP N0: 461902680907
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