20200354 Ver 1_Shoreline Stabilization_20200305

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Contractor/agent:
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"te ap4aoval is Yar - ----
application is a 'violation o of B
02x .astf� � �. • a��,;
NCAC and t5A NCs�C0Buffer Rule. Site speei c ork Should be provide tecf �.
t31d s(g)) the
Trees the application, [15A
are not alIjowed to
be reinoved approved. Eviceptiorr tx trees thatfr°rn ° 1 °t the Buffer
infnzal spa ring and sic si are severely' and . (within 30 ft of the toll
n$ along• pl2e Irr: ermined along the immediate sho Pond elevation) media#e shorerirte arlo atian), unless
Benchi , wed. 05AlVCAC dine can be removed.
(6)) `$ ��ng m the buffer is 02D .0243(g)]
nvt alk+wed, 1Y-�e"essivc distur
bttnoe ofground -lover, [15A NCAC^ 02B .0243
Beaches, impervious patios irtr approved by the Division. Pervious walkways There are ftmitation Y etc. are not allowed
on size for decks. m the buffer
Worts to be conducted [15A NCAC 02B4O243(4) unless specifically
Work corridor s � lance and (6)1
should be described
must
rrrctrcare an access
ust lzc and indicare any
material uz Timed. The ed access corridor
buffer. l5 �Pprov rhat are to
oulsrde the bu. A NCAC 0, O5i12 and 15shall be NCAe rest,",
tB d Staging, s oireConstruction ed The
`i:nrnwf,:* m 4243 (4l Cis), (g
discSheet 1ar8ea must teat the natural e-rep' :o £° ec: e;sc3rr )1 flour at non -erosive 1� atron and disct�ed -ge :o
velocities to the lake. USA NC 2 z43or �ee �the �ffer�d�#ed;:
AC 0
Acknrrn�l� () (6)J as dif Se or
grerrl ofNohfic'7tiarr
— Kt� V
Ri
Parian B�rffer'�` __
�' Div` ° Y work conducted in ' hereby state drat 1 have been pia
taken such that W-%Urees Q— the buffer, not speciftcallTmed'ofthe
C y the construction will h U *sistat C nott r stated in the a Certtficatian and Buffer +ill be built Within pPhcation
Rules, the approti,� Otrn substantial com li t; Due dili and approved
plan(s) and P anee and intent of 1 will be
Peeification(s), and other .3 the 401 Water Snatur (owner); �'jPPortin Quality
----•--_-__� `-'CJ"'�--C.� %materials.
./ �- ---- -•-- Dare:

State of North Carolina
DeRartment of Environment and Natural Resources
pl,w�.,'
Division of Water Resources
111"mn of Water Resources 15A NCAC 02H .0500 - Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent to:
Division of Water Resources
401 & MerPernabiqg Unit
1617 Mail Service Center
Raleigh, IBC 27699-1617
Applicant Information U1 A_ NAr
I. Owner Information
Name: Nth L-- VOvoz
Mailing Address: \ 1\ G^O(J
"0' C4e-S\')C- (-'-�
Telephone Number: 1 - UQ A- fax Number:
E-mail Address: n1E ram) e ; 6,r re 0 ho�it�-��
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
htt : www.saw usace a m . if Portals 59 does re u1a o re does Perm is A P E GENT AlT
Rt2QQK FORM df� must be attached if the Agent has signed this application form.
Name: QSN Sa i j C p rr�^cii
Company Affiliation: LA w �J
Mailing Address: ---V'3 '2 OAS
Telephone Number: —
E-mail Address:n L f k n J
Person to receive the Certification nJriY1e' Approval:
it. Project Information 115A NCAC07W 0502ta1 0- lhit
1. Attach a vicinity map (i.e. street map) clearly showing the location of the respect to local landmarks such as towns, rivers, and roads. Property with
2- Provide a detailed site plan showing property boundaries and proposed locations of
vegetation cfearing, structures (buildings, retaining walls, docks, impervious surfaces, etc.),
rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations, and
FORM: SSGP 10-2013
Page 1 of 3

Fup Pond/
Noun Y
S repine '
� i7-
jy
Lake
(At Full Pond/i waW 1W 8te, I,svel)
4 Y '
t
J�Tyj�
�
r
f k "�•bi f
E l "3 i
.r s.
Please aPPrwBmat* sketch the following information on this Plan (provide ddi nsforu foreach
itevrr, such as 10 ftx 100 ftJ*:
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 buil+de
S• Location of any excavation or dredging below the Full Po d/ Normal$Water dackfLe el elevation
6. Location of construction access corridors
FORM: SSGP 10-2019
Page 3 of 3

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. L€Wion of tMO
perty (where work is to be conducted)County Nearest Town:
Subdivisi n name or site address �'nclude phase/lot number):
C�� -- t 3
Directions to site - please Include road names and numbers, landmarks, etc.:
QAAe S(;",,1 S�+vt'� (eve
Latitude i►n dedmal ft&w).L]S . s 3J s 6 Longitude tdedmar_go. 1,0o? 6
5. Describe the existing land use or condition of the site at the timf this application
(residential, undeveloped, etc.): l�t�'t6
6. Property size (acres): I
7. Lake/ river/ ocean adjacent to property: IUD 1LA
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): il-c R
9. Will words be conducted from land?
10. Total amount of disturbance (including all excavation ba iFrom water? [�
below the normal pool lal�e level/ Normal Water Level in square feet or acres:
8 waifs, etc.)
11. Total amount of disturbance (including all clearing, back.fill, excavation, rip rap, retaining
walls, etc.} Jq§02 the norpa1pool lake level/ Normal
square feet or acres: Water Level and 5U feet land -ward in
12. Please describe the vegetation above the normal pool lake level/N rmal Water Level and 50
feet landward to be impacted (number of trees, for instance):
K7�c V'['_.JM.* v t-..t
�� ��cu rvarne
i15ANCACO2H nSmrf►J Date
Agent's slgnatune Is valid only fan authorization letter from the owner is provided.
FORM: SSGP 10.2013
:;)2,-.-)
Wage 2 a5 3•

Date Received: FAF Paid Construction
pli
El Application Complete Apcation DUKE
HEP Fund Permit No. "",.n "P t ENERGY,
Duke Energy Lake Services
Site ID Mail Code ECI 2Q
E===C1bse-Out Date 526 S. Church St
Charlotte, NC 28202
L DATE OF APPLICATION* go 2 0 P
---------- exmitfTag
11. APPLICANT INFORMATION (applicant mailing address and contact Information)
-----------
Name* .........
L V e U VOZI
Pv Primary Phone*
Address* Secondary Phone
----------
CIV n�3- State* jJC, Zip Code*
FA1:,1 Fax Number
Email*
I Ir IMPORMATION (IOCaflon
Address* ---------------
County* ke �-D Gf L-
Cv
State- Zip Code*
9 County Parcel ID number
Lake*.- No V-nrl� (e.g. Pin, Tax ID, TMs
Subdivision (fj me 4, Lot(s) FA--C-Z-Z�� Number-)
Plat Book/page
and Longitude of the property, please use a
-fo enter the Latitude 2-133
service/software to easily acquire the location Information. Values Latitude (e.g. 35, 12345)* should be Provided in Decimal Degrees forrnat (35.1245). 35,
'Idl
httP://Itouchmap.comAatlong.htrym�li-
corn
example servIce--ttp://1-touchmap Aa, Longitude (e.g. -80.12345)*
PROPOSED ACTIVITY
I uunication of existing Structure
New/Modification of Existing Shoreline Stabilization
New/Modification of Existing Structure & Stabilization
Transfer of Ownership
Area over land (sq ft)
ShOrellne Stabilizagon (feet) Length of
Stabilizat
ion
Brief Description VJ
of the Activity
Maintenance of Existing Structure
Maintenance Of Existing Shoreline Stabilization
Maintenance of Existing Structure & Stabitizatia
Other (Please describe below)
Area Over water (sq ft)
Describe Brieflithe Existing
Structures Over Land and
Water (include sq ft) I - 0 \k-11
Distance From Shoreline ,fin
Materials
® Is Dock
Covered?

V. Dock guilder or Engineer
Name/Company 1.A1.vtJ$L,l�i� (, V �1UVc-nip►'✓ T'NL -
Address I Po (�,� '3�� Phone Number ��(� --� (, _ �,3
City �`iJ�! 1��"i State ® Zip Code a1�11'% Email
Vi. Checidist of Required Documents (to include with Application Submissio") _.
Recent Survey (stamped/signed by a professional licensed surveyor showing the location of the existing or proposed
structure and/or surrey of the existing or proposed stabilization)
❑ Photos 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
[] Habitat Enhancement payment (if applicable)
Vii.Approva[Proceiss
• 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.
o A Duke Energy representative will visit the site to conduct a visual inspection.
• 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.
Vill. ®irections by R®u,d""�'""'�-'�'�-wM•-�------�.,....,m...
�jn9vle-� C) ✓�
Directions by
Road*
113r G 11a (tc/
Idf. k9ppiication 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.
Duke Energy Lake Services
Mail code EC12Q Prfnt Form
526 S. Church St.
CharrlottO, HC 28202
I agree that the information contained within is accurate:

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DATE OF I
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SURVEY AND MAP PREPARED 9r
LAKE NORMAN SURVEYING
l& MAPPING PLLC'-arsa
137 Jennings Rood, Surfe G
StotaSVI71e, North Cororrno 28625
l(-704)876-4450 Fox (lad) 876-445,

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