20160647 Ver 1_Shoreline Stabilization_20160629

DUKE ENERGY INTERNAL USE ONLY:
Construction
Date Received:
L---= FAF Paid Application [0&'
Application Complete -MI'm 13n
HEP Fund Permit No Water Strategy, Hydro
Duke Energy
Site ID �— Close -Out Date PO Box 10061 EC12Q
Charlotte, NC 28201
_
I. DATE OF APPLICATION* d�� Permit/Tag #. l_—
IL APPUCANT INFORMATION (applicant Mailing address and Contact information)
Names f}TT VA-y-ae I Primary Phone'
Address* 35CheL5 ld, /
_� N • Secondary Phone
City" ppr G$ U% State* Zip Code -1-2-911-7 Fax Number
Email* v N e, AA
III. PROPERTY IWFO
R6MATION ation of permit)
Address* Ck e -S Alm- - ---. _ .-- - - --- -- -----•--- --- --
N County, r t:
City- BOrG3vi State` k( Zip Code* g j County Parcel ID number
Lake':o f a I (e.g. Pin, Tax !D, TMS
Number._)
Subdivision - G- - Lot(s) `� o
PLatiltude
_ Plat BooWPage OTo enter th-16
e and Longitude of a property, please use a _ •._ --
servicelsoftware to easily acquire tate location information. Values Latitude (e.g. 35.12345)* Y5
should be provided in Decimal Degrees format (35.1245).
M example service: http:llltOuchmaP.com/iationg.html I Longitude (e.g.,80.123d5)'
IV. PROPOSED ACTiVffY - - -- - - - - - - - ---
New/Modification of Existing Structure r~ (' Maintenance of Existing Structure Is Dock -
New odif cation of Exlstin horeline Stabilization (' Maintenance of Existing Shoreline Stabilization Covered?
( New/Modification of Existing Structure & Stabilization (-Maintenance of Existing Structure & Stabilization ii of slips
( Transfer of Ownership (' Other (please describe below)
--- 47 of Jetports
Area over land (sq ft) II Area over water (sq ft)
Total square Feet
Shoreline Stabilization (feet) Length of
/ D O I Distance From Shoreline t w �i.5 . s
Stabilization 6 —
_ _- Materials I e -y OUB
BriefAccnpyon( ����)% j7 tvc� nOuC SrO�'C�lhre
of the Activity II vt ••��``�I (� rl
Describe Briefly the Existing
Structures Over Land and
Water (inciudezq ft)
Q P ri IM IA�G '. A --&A-0 +'I- •c -e-
s �5 c� itis s

V. Dock Builder or Engineer
Name/Carr
Address Vp- 3662AKY•'/ C y,, J Phone Number `�Q AGO • S/( �_
City / / —j ` � I State [4 Zip Cade ,Fi 1— Email C 1{� 1�') �5 i,J r AI S CA�►'1 . /�/rG�
VI. Cheddist of Required Documents (to include with Application Submission)
Recent Survey (stamped/signed by a professional licensed surveyor showing the location of the existing or proposed
structure and/or survey of the existing or proposed stabilization)
1Photos along property shoreline and photos of any existing structures and/or stabilization in or near the water
Application fee (check only, payable to Duke Energy) Signed User Agreement Letter
{Applicable local, state, and federal permits ❑ Plan and profile drawing showing all measurements and elevations
C] Yabitat Enhancement payment (if applicable)
VII. Approval Process
• Application is reviewed and determined if complete. Fields with an asterisk are required.
• If application is not complete or does not include all items and information listed in the checklist, the
application will be returned as incomplete.
• A Duke Energy representative will visit the site to conduct a visual inspection.
e Applicant will be notified of approval or denial.
• Applicant is to have the notice, to be supplied by Duke Energy upon application approval, posted and
must be viewable from water. The notice must remain posted until a representative inspects the
project and determines the project is complete and within the application specifications.
All. Directions by Road
Directions by
Roads
z ? 7 33, w o� 'I fi-rv13o�! >Qi� L�'a •� �r
too Rel lr oov 45ee c4i �� f��I.� f��e � C�1 e s��rwf ��
OL Application Submission
Please complete, print and sign this application. Then enclose all items from the checklist above in an envelope and
submit all the information to the address below
water Strategy, Nydro Licensing and Lake Services
Duke Energy Print Form
PO Box 10061 EC120
Charlotte, NC 28201
I agree that the information contained within Is accurate: A /'/1MI r Y�/L
Sioned By

20160647
State of North Carolina
Department of Environment and Natural Resources
DWR$-�'
Division of Water Resources
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:
1.
Division of Water Resources
401 & Buffer Permitting Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Applicant Information [15A NCAC 02H .0502(a)]
Owner
Name:
Mailing
Telephone Number: 10A.:56 Z • O 2.24axumber:
E-mail Address: VALOAk M tAA I GOm
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http:/ v4ww.saw.usace.army.mil/Portals/59/docslregulatory/`regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM. df) must be attached if the Agent has signed this application form.
Name: B iel c' s
Company Affiliation: c8t _57VA/G r XeCijC
Mailing Address: 6-3 ✓;d r k/
Int) A.Pr sJiAi' e /Il i 25111
Telephone Number: 70 (o 6 0. JT /1I Fax Number: DAt. 0/p 0.
E-mail Address: CS 5 dein/'_51r-,CAM , A
Person to receive the Certification Approval: CArp 13v',41 is
II. Project Information [15A NCAC 02H .0502(a) & (b1]
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 end of this
application form.
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: -y-"J6 f Nearest Town: Mppyy_s JdIL
Subdivision name or site address (include phase/lot number): .. &CCA-�L►'C G 13p -y 1,,p7 �
Directions t.te - please include road n mes and numbers, landmarks, etc.: r717;V
-4600.,7_33,o Gt r /�;,-,3on/ 4 13✓p-w/'
t<PV-a^/42e4 74
,4
5. Describe the existing land use or condition of th site at the time of this application
(residential, undeveloped, etc.): 1''e7� GG eA7L-;A-
6.
i A
6. Property size (acres): _ 0. F
7. Lake/ river/ ocean adjacent to property:
8. Describe proposed work (include disc ssion s to how hardening of s oreline has b n
avoided, or why it is necessary): 3 d /' Z 4f fLo"JiWe c�l�i'i✓ �roSie�
9. Will work be conducted from land? From water? V
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the norm
'Al pool I)ke level/ Normal Water Level in square feet or acres:
D X 2
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: _.zoo Ii %
12. Please describe the vegetation above the normal pool lake level/ Nor I Wpter Level and.
50 feet landward to be impacted (number of trees, for instance): � ��I r /
X %w� '- ___(,Xg1 /'-10/n
Owner/Agent's Signature* f 15 NCAC 02H .0502(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

c�-I belc (A)
{� C.? G G"� C"i p Q U G
'Normal elate~ Leve! e3 L3 0 0 Q 0 G=
Shorel'r cs G
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 fond/ 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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