20090737 Ver 1_401 Application_20090609

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 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 FILING FEE, PAYABLE
TO DUKE POWER, TO ABOVE ADDRESS.
1. Applicant Information 0 9- 0 7 3 7
A. Name ? iZ I I? ?i ? C;g c
B. Mailing Address r'° D f
? (.'? ?.3?` L? !?. ?'Y?"s v" f``,?x?l S /'? tl-?.? i E. is rar /V 6- '°-t ?Cy? ?
C. Telephone ` I L' y - ; . .4 _.. Ci I -?)'
II. Location of Proposed Project Mw
A. Lake
4 1
B. Street Address f ` Z L 1 ,
C. County / f i~r
D. City, Town, Community or Landmark
E. Section Lot # Subdivision r i ' c l B`4
F. Directions to property by road -
ff11 j s?v\ ?-?C:'l.i;` ???D?r 6a'.? ?'r'?,c;ri ??5f(,rLl??t .tri ?^_?`'? ?
f}?G la CGt1?.k}r• t lJly?LIL/WLs?,Gt? lJC NrCyti ?C t_4 rl (?-?
N' L
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, ww-,?'1 r-A Ssp[IU _coni. Directions: Don't register, click "Maps", enter
address, draw map, select "Map Clicking Will...", select "Lat/Long", click map)
Ill. Description of Project ?@ OWIP
,
A. Length of wall ( 4 ? JUN > 9 2000
B. Material !? r -'WATER QUALITY
C. Distance from property line/shoreline r' BRANCH
IV. Intended Use of Project Area
A. Private X
B. Commercial
V. Applicant Signature f 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: Cyndi
Karoly, PARKVIEW 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
1. Applicant information
1. Owner/Applicant Information 0 9- 4 73 7
Name Dr. Herman Gore
Mailing Address 5060 Cramer Woods Dr
Gastonia, NC 28056
Telephone Number 704-824-5757
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 Randy Clawson
Company Affiliation Clawson Pile Driving & Construction
Mailing Address 5805 Fiesta Dr
Lake Wylie, SC 29710
Telephone Number 704606-7400
Fax Number g O 3 - 5P 31 - (a S
E-mail Address _R L t A'W 5 3 S ?i 671.0.4 l i n k, rt e ?"
11. 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.
1. Location
County Gaston Nearest Town Belmont
Subdivision name or site address (include phase/lot number): Woodland Bay
Directions to site - please include road numbers, landmarks, etc. (This is not necessary
if an adequate vicinity map is included): Sc- AA on how O:R)2-e- 2d &/, 4, -4
I l.c,atj L-&N- a6 a) ud t m .e 13n , 5cc haL J.`s.` - 60 54-R-4i:J-44
d-s
r --yv Q y-f Cam,(-de- - S a-c. - ALL LA-n.. -' W IV' + e 1-u S r
2. Describe the existing land use or condition of the site at the time of this application:

3. Property size (acres): . 31
4. Nearest body of water (stream/river/sound/ocean/lake): Lwk e LUG + -?
5. Describe the purpose of the proposed work:
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6. List the type of equipment to be used to construct the project:
5rnat? Sk,?
?-1-O L- W "+? L -ow
r m P a c i2u r? n. -?- 2 1L ?_
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:

b. Please describe vegetation above the normal pool lake level and 50 feet land-ward to
be impacted (number of trees for instance):
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d r+lonS 5 hon.E- I : f.e?
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Signature Date
(AgwWs sig Wure is valid mW Tian nuftrkaMm h*w from the apphcwt is provided"
Eke (Full Panda
f2\
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 rip rap or fill to be placed above the Full Pond elevation
3) Location of rip 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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DIRECTIONS BY ROAD FORM
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 it along with your completed permit application to:
DUKE POWER
C/O LAKE MANAGEMENT - EC 12 Q
P. O. BOX 1006
CHARLOTTE, NC 28201-1006
1-800-443-5193
Applicant's Name- Dr. Herman Gore
Lake Name: Wylie
Subdivision Name: Woodland Bay
Property Section: Lot (s): 65
City: Belmont County: Gaston
State: NC Zip: 28012
Telephone [phone]
Type of Permit
Requested
"Circle":
Private Facility
Commercial Facility
Exc tion
tabilizatio
Conveyance
Miscellaneous Uses
Directions (from major road or highway): South on New Hope Rd from Gastonia -
Turn Left into Woodland Bay Subdivision - go straight to end of cul-de-sac New
large white house
Descriptive Structure (s) on Property (i.e. brick garage, white fence mobile home
etc.
5221 Woodland Bay Dr
*Note: Please use the back of this form, if desired, to draw us a map to the site.
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