20150441 Ver 1_Shoreline Stabilization_20150504

20150441
construction DUKE
Application ENERGY
��, version 13p .
Water Strategy, Hydro Licensing and Lake Services
Duke 9Y
�Mn PO Bo 06
n.
Charlo , NC 2820 PD
I. DATE OF APPLICATION" I *-;L ?, 15 I Permit/Tag #
Name* n i V L-Ac le-aA,-n
Address* o s h
City* �oore le State *J�j Zip Code *��
Email*
In, ; 'ft 77 1t
Primary Phone*
Secondary Phone DO-0-7 . 9111
Fax Number I
��III.�PROPERTY=INFORMi4TION (location�ofypei�mit)� " � =`
;*t .kri - ^�F -..�3s `'= ter x =s;' '�. -^ `s' `' - 'n,N'sx �"A
Address* �(o S U nc F'� Wrt�J� f-0 County* --re- d e l l
City oo re ),j (l State* R Zip Code* I I 1 County Parcel ID number
(e g Pin, Tax ID, TMS
Lake*� ti+A� Number )
Subdivision Cir�s�w Lot(s) ST Plat Book/Page . 233&/a Z-2 52—
To enter the Latitude and Longitude of the property, please use a Latitude (e g 35 12345)* ��, s f 7Z
service /software to easily acquire the location information Values
should be provided in Decimal Degrees format (35 1245)
Longitude (e g - 8012345)* 80 . 3 6 .
example seancehttp,�litou�hmap com /latlong html xfl `
g � >.
IV:PROPOSED�ACTI I�TY �� Y �;, `.-
<- z -� *' xr6r 1
Q New /Modification of Existing Structure (�; Maintenance of Existing Structure Is Dock
Covered?
(1)/New/Modification of Existing Shoreline Stabilization (` Maintenance of Existing Shoreline Stabilization ❑
Q New /Modification of Existing Structure & Stabilization O Maintenance of Existing Structure & Stabilization # of Slips
( Transfer of Ownership (' Other (please describe below) # of Jetports
Area over land (sq ft) l�I Area over water (sq ft) Total Square Feet
Shoreline Stabilization (feet) Length of Distance From Shoreline
g , Sa
Stabilization '-
Materials -455 r
ofDescription
the Activity I <J,+� ili -,?-e S "(, „►L,
Describe Briefly the Existing
Structures Over Land and
Water (include sq ft)
' -rcved T C V-0 es ; 0 4
6�—
�sd ►'+v JJ►er hK
4 ;a
INgTE �r �; J
BU o n r

'V; Dock'Builder or Engineer
Name /Company
Address
City
G3 t 't
�� State ©
*v-,oA w Phone Number
Zip Code 28115 Email
Lb -C sc.Akv►4
70 � 6040 •S-1I
-its
�1/,I.;Checldist:,o #- Requirei! Dotu'ments (tb °include with Application;Suiimission) �F�' °'
° "�� ` "� »,�`" ' � �;'�`�
"
e acent 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)
[Photos along property shoreline and photos of any existing structures and /or stabilization in or near the water
WApplication 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
0 Habitat Enhancement payment (if applicable)
.,k .e v+^.- `• ' .s `.A ".. 5�. S &'a�P�� NJ > r', ,fin , i S -0•' + a
/� roVahP(OC255 -`a
_'r � .'Ew - ��� -�� �«sw}i.Sf i C �� � ' .3 - +i -rauJ isaul :s�•?M ._ c trees a�'u ^mom �34 "` ,.,a ��K�C�aG ."'f'S' . �b ��at'� ^nom. tiu�3. �i °!-. _ � �,+ �tt� ✓��x �.� _ 4. _4..a� � � v� _ � R
• 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
• 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
7? 9 �o -e, •-t 3 3/ W o AJ W I V1 f" f<eA• /to
Road
Directions by 113,r*-14141 S c.N � R-�. O N ��Q /Vt IM Iq �' K-�� P'4
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, Hydro Licensing and Lake Services -
Duke Energy's
P® Box 1006/ EC12Q
Charlotte, NC 28201
I agree that the information contained within is accurate:

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
PD1vislon kof 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 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699 -1617
I. Applicant Information [15A NCAC 02H .0502(a))
1
Owner Information
Name: V_f✓an cA C14�oP�eS y
Mailing Address. I C) L'Ao tA= C-7
M otces 0 11 (e nTxc at8 11 -7
Telephone Number- 9¢90 - 7 2 Z- G i 3 y Fax Number.
E -mail Address- P-PC[42o P. /e-s _(9) q i
2. Agent/ Contact Person Information
r
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 /rel;docs /Permits /SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name-
Company Affiliation:
Mailing Address.
Telephone Number:
E -mail Address:
r:
Cx
/n 3'9 ©A-kr_ dq- Fhv-m *%YJ
r I S
70q. 660 -5-1I ( Fax Number: 70 f. �60.s`%G9
G6G. -3eA &,L* 05 w ; wd s%re*m,- Net
Person to receive the Certification Approval: C k i h R r g'C-s
II. Project Information [15A NCAC 02H .0502(a) & (b))
1. Attach a vicinity map (i a 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 3

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
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 Location of the property (where work is to be conducted)
County 11.trCAC'(( Nearest Town. rn04�/GS�JcT�(�
Subdivision name or site address (include phase /lot number) "1-.c, 3Poi IbT +651f
Directions to site - please include road names and numbers, landmarks, etc :
77 t�• - o e4c,- 3% W oti W; II; 50 t Rd 1, -P- &V f3,r &wIC7
SGk oo1 I�cQ• , �4 oilwe- tMM"I�t -r j .
Latitude (in decimal degrees) 3 5 • S I 72-- Longitude (decimal degrees) g0' (33 4 1
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): re,5i4e ^A•A-( W %-H, &44-_51112
6 Property size (acres)- 0- (01
7 Lake/ river/ ocean adjacent to property: (_4y_f- 1&rV.0-Al
8 Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary) 4 PY-W-A-t.y'oSf o#,/
9. Will work be conducted from land? 12, 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:
2_'X 100
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 l X /8O
12. Please describe the vegetation above the normal pool lake level/ Nor I Water Level and
50 feat landward to be i pacted (number of trees, for instance):
Owner /Agent's Signature* [15A NCAC 02H .0502(f)]
'112, ,3
Date
!Agent's signature is valid only if an authorization letter from the owner is provided
FORM SSGP 10 -2013 Page 2 of 3

Lake
(At Full Pond/ Normal Water Level)
Full Pond/ �] /
Normal Water Level
Shoreline
� cu ya=
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 Pond/ 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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