20231127 Ver 1_Shoreline Stabilization_20230811

RECL-IVED i
AGENT AUTHORIZATION FORM AUG 2023
PROPERTY LEGAL DESCRIPTION: // I De
LOT NO. 21 2 g PLAN NO. PARCEL ID: �0 i0 Q L UF1 E j RU RCE3
MNO
STREET ADDRESS: S r
Yl C 2S(c$ 2
Please print
PropertyOwner:_ kendc-'u- �I c�-
The undersigned, registered property owners of the above noted property, do hereby authorize
Sl err L)SL -----,of LcuiC.— n6 rma.-->n �e t rL
(Contractor i t Name of consulting n9 firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
Telephone: 1 d 1-1- Kl- y 3H2
We hereby certify the above information sub mitbed in this application is true and accurate to the
best of our knowledge.
Aut horiz Siignature
Date: 1/3 a--3
Authorized Signature
Date:

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address. County: Ca
Owner: If rVil -O l I- � �4 V
Print
Contractor/agent:
Print
Signature
The approval is for the purpose and design described in your application. Impacts not indicated in the
application is a violation of the Buffer Rule. Site specific work should be provided in the application. [15A NCAC
02H .0506 and 15A NCAC 02B .0243(8)]
Trees are not allowed to be removed from Zone 1 of the Buffer (within 30 ft of the full pond elevation), unlesit
approved. Exception, those trees that are severely undermined along the immediate shoreline can be removed.
Minimal shaping and sloping along the immediate shoreline is allowed. [15A NCAC 02B .0243(6)]
Benching and grading in the buffer is not allowed. Excessive disturbance of ground cover. [15A NCAC 02B .0243
(6)]
Beaches, impervious patios, impervious walkways, etc. are not allowed in the buffer unless specifically approved
by the Division. There are limitation on size for decks. [15A NCAC 02B .0243(4) and (6)]
Work to be conducted from land must indicate an access and indicate any trees that are to be removed. The
work corridor should be described. The approved access corridor shall be restored. Staging, spoil, construction
material must be outside the buffer. [15A NCAC 02H .0502 and 15A NCAC 026.0243 (4), (6), (8)]
Stormwater cannot be piped or channeled for direct discharge to the lake. All constructed stormwater
discharges must be at the natural elevation and discharged prior to entering the buffer directed as diffuse or
sheet flow at non -erosive velocities to the lake. [15A NCAC 02B .0243(5), (6)]
Acknowledgement of Notification
I, _ K e n V ai� / v 0'� --reby state that I have been informed of the Catawba
Riparian Buffer Rule. Any work conduc i the buffer, not specifically stated in the application and approved
by the Division of Water Resources (DWR), is a violation and subject to enforcement. Due diligence will be
taken such that the construction will be built within substantial compliance and intent of the 401 Water
Quality Certification and Buffer Rules, the approved plan(s) and specification(s), and other supporting
materials.
Signature (owner): Date: V �-�

Excavation Project User's Agreement Letter
(Please fill in the blanks. Please Print)
Date _ 23
TO: Duke Energy
c/o Lake Services - EC12Q
526 S. Church Street
Charlotte, NC 28202
RE: Excavation For (Subdivision and Lot Ws or Otter Project Name)
r l-
(Lake/County/City) / CGt,%-�� ha- / +er re 1!---
(Applicant's full name) 4,� r�d 0--LA- N Q ' .-eby agrees to comply with all
recommendations, requirements and/or conditions uke Energy, General Permit(s) (if
applicable) and other federal, state and local agency requirements pertaining to the application to
excavate for the purpose of a S.h o re h � e
In addition, I/we have read and agree to comply with Duke Energy's current Shoreline
Management Plan (SMP) or other applicable guidelines, much of which is repeated herein, and
understand that written authorization must be obtained from Duke Energy prior to beginning any
activity within the Federal Energy Regulatory Commission (FERC) project boundary or on Duke
Energy property associated with a reservoir, collectively referred to as Project Boundary. The
excavation will be completed as described in the approved application and within eighteen (18)
months from the date of written approval by Duke Energy, unless specifically noted otherwise in
the application or unless I/we obtain approval for a single, time extension (maximum of one year)
in writing from Duke Energy. I/we understand that if the SMP or other applicable guidelines or
rules change during any extension period, I/we will be expected to comply with the new
requirements to the maximum extent practicable. l/we also recognize that failure to complete the
excavation within this build -out period will require the filing of a new application within the then -
current SMP or other applicable guidelines and the new application must include any applicable
fees and security deposits.
I/we attest to be the owner(s) or lease holder(s) of the land immediately adjoining the Project
Boundary where the excavation activity is to take place, or if not the owner or lease holder, I/we
have included proof of title to the property and written authorization from the owner(s) or lease
holder(s) to carry out the proposal within the Project Boundary adjacent to their land.
I/we attest to be the owner(s) or lease holder(s) of the land that will be used for equipment
staging and disposal of excavated material or if not the owner or lease holder, IAve have included
proof of title to the property and written authorization from the owner(s) or lease holder(s) to
carry out the work on their land.
Duke Energy Page 1 Rev: 4/6/2020

I/we understand that all excavation work must be done directly in front of my/our property and as
specified in Duke Energy's approval. I/we also understand that access channels must run
perpendicular to the shoreline while within the third of the cove area that is nearest my/our
property.
I/we understand that for proposed excavations, I/we must notify the appropriate local, state and
federal agencies in advance of the activity by sending them a completed copy of Duke Energy's
Excavation Permit Application Form and other required information. I/we understand that
written authorization and/or other permits may be required by some of these agencies and such
required authorizations must be obtained before I/we submit the final application to Duke
Energy.
At FERC-licensed reservoirs, Urve understand that except for maintenance excavations, any
excavation exceeding 2000 cubic yards of material removed or any excavation or shoreline
stabilization work needed to support an application that requires FERC review does itself require
specific review and approval by the FERC before Duke Energy can issue any approvals.
Uwe agree that unless specifically approved otherwise in the application, explosives will not be
used as part of this excavation activity.
I/we understand that every reasonable effort must be made to minimize any adverse impact on
fish, wildlife and other natural resources.
Ifwe understand that applicants in South Carolina proposing excavations that are not covered
under the General Permit, or are greater than 150 cubic yards, must receive prior written
authorization from the South Carolina Department of Health and Environmental Control
(SCDHEC) or the US Army Corps of Engineers (as applicable) before submitting the completed
application to Duke Energy.
I/we agree that excavation activities will not occur during the months of March, April, May and
June because of the potential impacts to fish spawning areas.
1/we understand that trees and vegetation growing within or adjoining the lake play an important
role in its overall environmental condition, and the ecological benefit the vegetation has on fish
and wildlife habitat directly supports a sound and healthy lake environment. I/we also understand
that unauthorized removal of shoreline vegetation (e.g. button bushes, willows, cattails, etc.)
and/or disturbance of the shoreline buffer may result in suspension or denial of lake use
permitting requests, forfeiture of security deposits and require re-establishment of vegetation at
my/our expense, particularly if the disturbance is found to be in violation of state or local
ordinances or impacts FERC project buffers.
I/we agree all excavated material will be placed in upland areas, landward of the Project
Boundary, and confined to prevent erosion and sedimentation back into the lake or nearby
streams.
Duke Energy Page 2 Rev: 4/612020

Uwe agree to adequately stabilize all excavated material and all disturbed shoreline to prevent
erosion and runoff into the lake.
Uwe understand that the double handling of excavated material will not be allowed; therefore, all
excavated material must be placed above the Project Boundary in one handling.
Uwe have designed the hydraulic excavation process (if any will be used) so that return water re-
enters the lake in the same general vicinity and cove as the excavation, to the maximum extent
practicable.
Uwe agree that the proposed excavation will not be for the purpose of creating additional
shoreline, will not alter the Project Boundary or the full pond contour, and will not impact
threatened or endangered species, historic properties, or environmentally -important areas, unless
special public entity provisions were made in the application.
Uwe recognize that it is my/our responsibility to clearly locate in the field and label on my/our
work area drawings any areas that require specific protection or avoidance during this excavation
work. Examples of these protection/avoidance areas include but are not limited to, any
Environmental Areas, Natural Areas or Impact Minimization Zones as identified by Duke
Energy; jurisdictional wetlands; historic properties; rare or threatened species; and buried gas,
water, sewer, electric or communications lines. I/we agree to provide my/our contractor with a
copy of these work area drawings showing these areas to stress the necessary protection
measures.
Uwe agree that if any archaeological resources (e.g. pottery shards, Indian artifacts, etc.) are
discovered during the excavation, work shall be halted immediately. 1/we will then notify Duke
Energy and the State Historic Preservation Office to determine what measures, if any, I/we must
pursue to protect or salvage the archaeological resources.
Uwe agree that any excavation from within the Project Boundary will not exceed the volume as
outlined in the application and will remove and disturb only what is absolutely necessary to
achieve the project's stated purpose.
I/we agree to be fully responsible for the permitted lake use and I/we understand that this
responsibility is considered to transfer automatically along with ownership and leases of the
adjoining tract.
Uwe understand Duke Energy representatives may issue Stop Work Directives for violations of
the SMP or other applicable guidelines and other consequences may result from such violations,
including but not limited to suspension or cancellation of approved permits, increases in fees,
modification or removal of non -complying structures and restoration of disturbed areas at my/our
own expense or loss of any consideration for future lake use permits. Uwe agree to immediately
comply with any Stop Work Directives, to fully cooperate with Duke Energy and other agencies
as necessary, and to perform the necessary remedial actions within the specified time frame.
Duke Energy Page 3 Rev: 4/&2020

Uwe agree to develop any required mitigation plans and to complete any required mitigation
activities at my/our own expense within the specified time frames. I/we recognize that the
excavation work is not considered complete and deposits will not be refunded until the
mitigation requirements (if any) have been satisfactorily fulfilled.
I/we agree to notify Duke Energy Yphone when the excavation is initiated and to ensure that
during the excavation period, I/we will post Duke Energy's approval letter in a clear waterproof
bagat t the job site and visible from the water's edge.
I/we agree to notify Duke Energy in writing when the excavation is completed (including any
required mitigation measures) and that the excavation was completed per the approved
application, so a close-out inspection can be performed.
1/we recognize security deposits will not be refunded if any violations of the SMP, other
applicable guidelines, or this user's agreement occur.
I/we understand there will be no change in hydro project operations as a result of the excavation
and/or utilization of the excavated area.
I/we agree to maintain the work area in a safe condition and to fully indemnify and save Duke
Energy harmless from any and all claims, liability, loss or damage that may arise from this
excavation project.
I/we understand that this user's agreement does not, in any way, constitute the transfer of any
rights in real property and that my/our use and enjoyment of FERC project and Duke Energy
lands and waters shall not hinder the general public's lawful use and enjoyment of the same.
Sincerely,
4 QQ N!tI Y_
Applicant's Name (Print Applicant's Signature
Co -Applicant's Name (Print)
Co -Applicant's Name (Print)
Co -Applicant's Name (Print)
Co -Applicant's Name (Print)
Co -Applicant's Signature
Co -Applicant's Signature
Co -Applicant's Signature
Co -Applicant's Signature
Duke Energy Page 4 Rev: 4/6/2020

DUKE ENERGY PRIVATE FACILITIES
"APPLICANT'S USER AGREEMENT"
(Fill in blanks with required information. Please Print)
Date S - 2_�o - L
TO: Duke Energy
c/o Lake Services - EC 12Q
526 S. Church Street
Charlotte, NC 28202
RE: (Lake Name) I Ii 6 r M G.r\
(Lake Address) `J vC
Te,r r l N Z-56821
(Applicant's full name) L i,P VL d a-L < lam ` I hereby
agrees to comply with all requirements and conditions set by Duke Energy Lake Services
("Duke Energy"), and any federal, state or local agencies pertaining to my/our application to
construct and/or maintain a Sho t e 1 t r%Q
(collectively, the "Facility" and together
with the right to use any Facility the "Permitted Use") on Lake ("Lake").
In addition, I/we have read and agree to comply with Duke Energy's applicable shoreline or lake
guidelines (collectively, the "Guidelines") and understand that written authorization must be
obtained from Duke Energy prior to beginning any activity or construction, including changes to
land form such as grading, excavation, or filling, within the area subject to the Guidelines.
Approval of the Permitted Use is granted and maintained solely at Duke Energy's discretion. Uwe
understand the Permitted Use may be revoked at any time by Duke Energy or its successors for
any reason whatsoever. If the approval is revoked, Uwe agree to remove the Facility at my/our
own expense within the specified timeframe set by Duke Energy.
Uwe will complete construction approved as a result of my/our application as described in the
approved application and within twelve (12) months following the date of approval by Duke
Energy. Failure to complete construction within the 12-month build -out period or any Duke
Energy approved extension will require me/us to file a new application that complies with the then -
current Guidelines. Ilwe agree to notify Duke Energy when construction is completed and during
the construction period, lfwe will post the Duke Energy approval provided by Duke Energy at the
job site visible from the Lake.
Page 1 of 5
Rev 10fM021

Uwe attest to be the owner or lease holder of the tract of land immediately adjoining the area subject
to the Guidelines where the Facility is to be constructed. 1/we understand the physical location of
mylour lot in relation to the common property line with Duke Energy (if any), the Federal Energy
Regulatory Commission ("FERC") or non-FERC Project Boundary (as applicable), and all deeded
flood easements.
Uwe understand the Lake was constructed as a working reservoir for the primary purpose of
producing cost-effective electric energy and that this remains the Lake's primary purpose. There
will be no change in reservoir operations as a result of the construction or use of mylour Facility.
Uwe acknowledge Duke Energy provides no guarantee of any specific quantities or quality of water
in the Lake. Uwe understand Lake levels will rise and fall over time in response to weather events
and reservoir operations and Duke Energy does not guarantee the Facility or Lake will have
sufficient water depth to be accessible by boat or for other water -related activities or uses.
Furthermore, Uwe understand that the approval of mylour Facility is for compliance with the
Guidelines and other Duke Energy documents related to the Permitted Use and is not a statement
by Duke Energy that the Facility is acceptable to any other governing body (i.e. a local land use
agencies), nor that the Facility will withstand any wear and tear; weather events; or reservoir
operations.
Uwe understand during drought conditions Duke Energy may request reduced usage or
discontinued usage of any water withdrawal or related systems, until such drought conditions
improve. Failure to do so may cause possible removal of the system or any other Facility that Uwe
may have. The costs associated with removal of any Facility or non -permitted improvement will
be assessed to the lot owner.
Uwe understand the Facility to be installed and maintained are my/our property and Ilwe therefore
agree to be fully responsible for the Facility including maintaining the Facility in good repair. If
the Facility is deemed by Duke Energy to be unsafe or non -compliant with the Guidelines, Uwe
agree to repair or remove the Facility at mylour own expense and within the specified timeframe
set by Duke Energy.
Uwe understand I/we may need to obtain approvals from other entities including, but not
necessarily limited to, governmental agencies, quasi -regulatory agencies, homeowners'
associations, lakebed landowners, and others to authorize mylour Facility or Permitted Use.
Uwe understand ownership/interest in a Common Use Facility or residential marina eliminates the
option of having a separate private facility on mylour owned or leased lot within the affected
subdivision.
Uwe understand lake use permit holders have the authority to take reasonable and legal steps to
prevent others from trespassing on the Facility. Ilwe also understand, however, that Ilwe do not
have any authority to impede anyone from pursuing lawful public recreation or enjoyment of lands
and waters subject to the Guidelines. Except as specified otherwise in the Guidelines, other Duke
Energy documents (e.g. Public Safety Plans), or a separate lease agreement, public recreation and
enjoyment includes, but is not limited to, fishing around/under facilities built by others,
Page 2 of 5
ftV I"r2021

walking/wading/fishing within the area subject to the Guidelines, and boating in the Lake's waters
without having to get anyone's permission to do so.
I/we understand Duke Energy approval of the Permitted Use in no way constitutes assignment of
any interest in real property Duke Energy may have (i.e. land rights).
Uwe agree to exercise all care and due diligence to preserve and maintain the character of the area
subject to the Guidelines. Uwe agree to comply with the Duke Energy vegetation management
requirements as stated in the Guidelines. Uwe agree further to not allow sewage, including
discharge from septic tanks (or similar facilities) or boat holding tanks, garbage, trash, or other
waste material to be discharged or dumped into the reservoir, tributaries or property subject to the
Guidelines.
Uwe understand the Facility shall be used only for the purposes described in the information
submitted to Duke Energy and other appropriate governing bodies for approval. 1/we agree the
Duke Energy property and the land subject to the Guidelines shall be used exclusively for non-
commercial recreational purposes and that 1/we shall not rent or otherwise allow third parties
(except for temporary use by guests, family members, and leaseholders of the residential property)
to use the Facility.
Uwe acknowledge Uwe are responsible for the locating of any submerged utility lines extending
from mylour upland property into the reservoir and ensuring the construction and operation of
mylour Facility avoids adverse effects to said submerged utility lines.
I/we understand trees and vegetation growing within the area subject to the Guidelines play an
important role in the overall environmental condition of the Lake. The ecological benefit the
vegetation has on the fish and wildlife habitat supports a sound and healthy Lake environment.
Uwe also understand unauthorized removal of shoreline vegetation or the disturbance of the
shoreline buffer is not permitted. Unauthorized removal or disturbance may result in the
permanent revocation or temporary suspension or denial of lake use permitting requests for me/us
as well as future owners and lease holders. If the removal or disturbance is found to be in violation
of the state or county watershed buffer regulations or Duke Energy's vegetation management
requirements as stated in the Guidelines, 1/we may be required by Duke Energy to re-establish the
vegetation.
Uwe understand every reasonable effort must be made to minimize adverse impacts on fish,
wildlife, and other natural resources. Uwe agree to maintain any prescribed mitigation activities
that are required in order to gain approval for Facility construction, as long as the Facility exists.
I/we agree that if any historic or archaeological resources are discovered during construction of a
Facility Uwe must stop work immediately and contact Duke Energy. Uwe understand that in the
event that anyone discovers a potential site of archaeological or historic significance (whether
during construction or not) including any gravesite within the area subject to the Guidelines, the
individual must immediately notify Duke Energy.
Page 3 of 5
Rev M282021

Uwe acknowledge Duke Energy has the right to charge reasonable user's fees for private use of
the area subject to the Guidelines and failure to pay any applicable user's fees in a timely manner
can result in the suspension or cancellation of any previously approved lake use permit.
Uwe understand Duke Energy representatives may issue Stop Work Directives for any violation(s)
of the Guidelines or engagement in prohibited acts or activities as specifically identified in the
Guidelines. Uwe understand persons found to be in violation will be subject to Duke Energy
sanctions which can include, but are not necessarily limited to: 1) restoration of the impacted area
at the person's expense; 2) loss of consideration of future lake use permitting activities for melus
as well as future owners and lease holders; 3) permanent revocation or temporary suspension of a
previously issued permit for melus as well as for future owners and lease holders; 4) increase in
fees; 5) modification or removal of non -complying facilities, and/or 6) further legal action being
taken by Duke Energy.
Ave agree to comply with all applicable FERC orders (as modified or interpreted by FERC), with
all other applicable FERC Rules and Regulations implemented by Duke Energy, and with all rules
or regulations imposed on Duke Energy by any governmental agency. Ave agree not to allow any
use of Duke Energy's property, and will exercise due care and diligence to prevent all other persons
that are affiliated with my/our property (including invitees, family members, guests, etc.), to
violate an applicable federal, state or local law or regulation. Examples include, but are not limited
to nudity, illegal discharge of firearms or fireworks, controlled substance abuse, public
drunkenness, public urination or defecation, or other activities determined to be a nuisance by law
enforcement officials.
Ilwe specifically waive any claim against Duke Energy for consequential damages arising out of
or relating to this application, Duke Energy's approval or denial of it, or subsequent revocation of
approval, and Uwe specifically understand and acknowledge that, because Duke Energy can revoke
the permitted use at any time, Uwe am/are not entitled to reliance damages.
Ave agree for myselflourselves, members of mylour family, guests and invitees that Ilwe assume
all risks of personal injury or property damage incident to mylour occupancy and use of land owned
by Duke Energy or any land subject to the Guidelines, including, but not limited to, any personal
injury or property damage which may be sustained as a result of flood waters or in connection with
the rise and fall of water in the reservoir as a result of floods or of the operation of Duke Energy's
reservoirs. Uwe as the adjoining property owner(s) further agree Uwe will indemnify, protect,
defend, and save harmless Duke Energy from any and all loss, cost, claims damages, expenses,
judgments and causes of action for all injuries and damages sustained by the members of mylour
family, guests, and invitees arising or claimed to have arisen in connection with their occupancy
or use of the Facility(s).
Uwe agree if any action is taken by Duke Energy to enforce any provision, covenant or agreement
contained in this user agreement or the Guidelines or if Duke Energy is required to retain an
attorney to enforce any provision, covenant or agreement contained in this user agreement or the
Guidelines (including, without limitation, the payment of fees due hereunder or the removal of an
encroachment constructed in violation of this user agreement or Guidelines), then Duke Energy
shall be entitled to recover all of its reasonable costs associated with such an action to the extent
Page 4 of 5
Rev IUMA21

permitted by law, including but not limited to, attorneys' fees and court costs incurred in such
action and/or enforcement.
1/we agree to fully disclose all information regarding the Facility to any prospective
buyer/leaseholder of the property and any new owner/leaseholder. 1/we agree to notify Duke
Energy immediately of any sale or transfer of the property, including the name and address of the
new owner and to transfer the permit or Duke Energy lease to the new owner.
-e y, 1 V � y j,
Applicant Name ApplicA Signature
1553 �c1e 9532 ISur r
Lake Street Address Home Mailing Address
-ky( ;\( 12,5 6`fi2 rre- \\ I F NC 2 SbtZ
City/State/Zip Code City/State/Zip Code
-1-W3 '164--4ia 4 34�
Preferred contact Phone Number Home Phone Number
Email AAdre4s C yMmi U COMDate
Page 5 of 5
Rev 10l28f2021

DUKE ENERGYINTERNAL USE ONLY
Date Received I App Fee Atnt
Site ID HEP Fee
Lake Permit
Application
versioe 21a
% DUKE
ENERGY
Duke Energy Lake Services
Mail Code EC12Q
526 S. Church St.
Charlotte, NC 28202
I. APPLICANT I PROPERTY OWNER INFORMATION (property owner mailing address and contact information)
Name* Q Primary Phone* DLA-v'-I. H-5
Address* cJ V r ` r Secondary Phone
City* FTri �.� State* �C Zip Code I 2$ t g
Email
If. LAKE PROPERTY INFORMATION (location of permit)
Is there an existing dock or other facilities Yes If yes, include Dock Tag #. If tag
along the shoreline property or over the Lake? ❑ No cannot be located, note that here.
Address* 5-:5r2 Z) I County*
City* �e Y-r<-e State* t")( Zip Code* Z'S to$2 Lake* �O c"�Mq,n —�
Subdivision Lot(s)
Latitude and longitude of the property. Please use a service/software to acquire the location information. Values should be provided
in Decimal Degrees format (35.1245). Latitude (e.g. 35.12345)* 1 3
Example service: http://getiationg.net/ Longitude (e.g.-80.12345)* 1 — 8 b r 01 (v �
III. PROPOSED ACTNITY (check all that apply)
❑ New/Modification of Existing Structure Maintenance of Existing Structure
New/Modification of Existing Shoreline Stabilization Maintenance of Existing Shoreline Stabilization
QTransfer of Ownership (check box if you want a copy Other (Describe below. If the activity involves an irrigation
of permitting history ) withdrawal, include the pump capacity.)
Structure size Is dock covered? Yes MNo Number of slips
(square feet) Is structure a
common use dock? ❑Yes* FINo Number of jetports
'if yes, see special note in Section Vll
Shoreline Stabilization Length of
Distance from shoreline (feet)
stabilization (feet) (p 1
Materials
Brief Description of
the Activity
Describe briefly the
existing structures
over land and water
(include sq ft)

IV. Additional Requirements (Include with application; limit document sizes to 11"x 17' or smaller)
You must inctude the following items with your application (unless specifically excluded for your application type).
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 (not
required for transfer)
El (check only, payable to Duke Energy)
Signed User's Agreement Letter
Habitat Enhancement Program payment (required only for
❑ New/Modified structures at and
lakes and shoreline stabilization at
Keowee-Toxaway)
V. Application Processing
Plan and profile drawing showing all measurements,
elevations, and irrigation line routing (not required for
transfer or shoreline stabilization)
Local and state permits (contact your county for all
❑structure applications in NC; Tego Coy, SC; Kershaw County,
SC, • 1VCDWR approval required for shoreline stabilization in
NC; not required for other applications)
• Application is reviewed and determined if complete. Fields with ar asterisk are required.
• If application is not complete or does not include all items and infcrmation listed in the checklist, the application
will be returned as incomplete.
• A Duke Energy representative will visit the site to conduct a visual nspection.
• Applicant/Property Owner will be notified of approval or denial, typically via email.
VI. Directions by Road
uirections Dy KoaaT
rN c 1 S c CA-S �- 6s;C,- I S i ct r\. C; C �I S-f-
Gate Code
VII. Application Submission
Please complete, print and sign this application. Then enclose all items required per Section IV above and submit to the
address below.
Duke Energy Lake Services
Mail Code EC12Q
526 S. Church St.
Charlotte, NC 28202
I agree the information contained within is accurate.
Property Owner
ature *
Common Use Dock Co -Owner Signature(s) and Information (all owners of common use docks must submit o signed
User's Agreement and application fee) Attach additional sheets if there are more co -owners
Name
Address F Signature
Name
Address Signature

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Director
NORTH CAROLINA Environmental Quality State of North Carolina
Department of Environment Quality
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Shoreline Stabilization Application Form
FORM: SSGP 09-2020
Three copies of the application (including attachments) and the application fee should be sent to:
If sending via US Postal Service
Paul Wojoski
DWR — 401 & Buffer Permitting Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
If sending via delivery service (UPS, FedEx, etc.)
Paul Wojoski
DWR — 401 & Buffer Permitting Branch
512 N. Salisbury Street
Raleigh, NC 27604
NOTE: Before submitting this form, please ensure you have submitted the Pre -Filing Meeting Request
Form as we will not be able to accept your application without this important first step. The Pre -Filing
Meeting Request Form is used in accordance with 40 C.F.R. Section 121.4(a) which states "At least 30
days prior to submitting a certification request, the project proponent shall request a pre -filing
meeting with the certifying agency." In accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5), all
certification requests must include documentation that a pre -filing meeting request was submitted to
the certifying authority at least 30 days prior to submitting the certification request. Click here to read
more information on when this form is needed prior to application submission or here to view the
form.
Attach documentation of Pre -Filing Meeting Request to this application.
Date of Pre -filing Meeting Request: _/_/ (required)
DWR ID #
Version (if applicable)
A. Applicant Information [15A NCAC 02H .0502(a
Owner Information
Name: • Ke nd o,..(- cLA
Mailing Address:
2<R Cps Z
Telephone Number: 'I 01�-V_VL+�) -(? Fax Number:
E-mail Address: C VAPa,Pu I I Shg)(2 00
D E Q��
aa. oi�:l iNA _�
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 1 1617 Mail Service Center I Raleigh, North Carolina 27699-1617
Nl �stl r. �lfEnvi—waaty /�`� 919.707.9000

2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter must be attached if the Agent has
signed this application form. (A form can be downloaded here:
http://www.saw.usace.army.mil/Portals/59/docs/regulatory/regdoclPermits/SAMPLE AGENT AUTHORIZ
Name: �:) he r r�
Company Affiliation:
Mailing Address:
Telephone Number
E-mail Address:
v
ake h60y%an red ►,
Oc� 1 Uh kon Ch
_JDy- 36B- Cam`{ (c, Fax Number:
WIN
0(�, • C
B. Project Information [15A NCAC 02H .0502(a) & (k']
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, buildings, retaining walls, docks, impervious surfaces, 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: C'G+aU) bcl. Nearest Town: r re -
Lake/ river/ ocean adjacent to property: __ ��_�� Y ►'�(,�
Property size (acres): k
Subdivision name or site address include phase/lot number): S'�3�
2 X) r
Lc-Tcr«k� C 2'R 66<61
Directions to site - please include road names And numbers, landmarks, etc.: N C- ISO S�
0) Kkse � Oslo-� (A Rd (C�_F) Ki we Q �+
Latitude (in decimal degrees) Longitude (decimal` degrees) _g
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): 24:h
6. Describe proposed work (include discussion as to how hardeningofshoreline has been
avoided, or why it is necessary):
FORM: SSGP 09-2020 Page 2 of 5

7. Will work be conducted from land? ❑ From water?
8. Total amount of impacts below the normal pool lake level / Normal Water Level
nent impacts (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
Temporary impacts in square feet:
9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet
land -ward
anent impacts (including IN 0
back fill, excavation, rip rap, retaining walls, etc.) in square feet:
rary impacts (temporary clearing, construction corridor) in square feet:
10. Please describe the vegetation above the normal pool lake level/ Nor 1 Water Level and 50
feet landward to be impacted (number of trees, for instance): _ 't-C� SM01
S In Y- vb S
11. Signature
By signing below, I, as the project proponent, certify to the following:
• The project proponent hereby certifies that all information contained herein is true,
accurate, and complete to the best of my knowledge and belief
• The project proponent hereby requests that the certifying authority review and take action
on this CWA 401 certification request within the applicable reasonable period of time
Owner/Agent's Signature` [15A NCAC 02H .0502(f)] Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
12. Please approximately sketch the following information on this plan and provide dimensions for
each item:
a. All proposed vegetation clearing
b. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
c. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
d. Location of any proposed structures such as buildings, retaining walls, docks, etc.
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level
elevation
FORM: SSGP 09-2020 Page 3 of 5

Full Pond/ Normal Water Level
Shorelin _ G
CI4� a0bS G
sma 1 S r q �-T
<-- 3�54)(
Plan View
if+
Full Pond/ Normal Water
'1horeone
1 ft, x 150 ft.
addltional cleerin
' if neceuety
Plan View
La ke
(At Full Pond/ Normal Water Level)
Lake
(At Full Pond/ Normal Water Level)
Existing Dock
3 ftx 150 ft
Below full pond/ NWL
4 ft x 150 ft
Above full pond/ NWL
FORM: SSGP 09-2020 Page 4 of 5

rk
y >0
Lake aD
(At Full Pond/ Normal Water Level)
c
E v
Z N
c
Side View rL
:3
LA-
3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing
`if necessary j
Existing bank
10 ft. bank
Side Vi
FORM: SSGP 09-2020 Page 5 of 5

8/8/23, 1:23 PM
G-io gle Maps 8532 Burley St
8532 Burley St - Google Maps
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Map data 02023 Google 100 ft ,
8532 Burley St
Building
Directions Save Nearby
Send to Share
phone
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STATE Of NORTH CAROLINA, CATANMMy. :!'U
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M[. Crank Towathy Catawba Ceeey,NtrAcrelbe.4"W*Wrhbw
KING Lots Not. 27 and 11 of the e. L. Kiser Subdivision, Mo. 3,:as shown on map thereof
made by Jame C. tialble, Rplstered Surveyor, which pro Ilalnaryrsmf was dated July 23, 190
and the final alof daeed'hhraary 21. 19" and recorded In flat hook Iy at pop 19. office .
of the Register of.DMdf-fOr Catawba County. rotorems to. sold w aw1 dosarlftlew Mersof
is henby.�Isde far a'se" "V0.4l14W desselptloR.::.: "
This preps'tll s411'• he t eed_for jaidsilNei pWp'q aill�..
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ErAT7 Or NORTH CAROU ,ei►
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(Cyb)

NORTH CAROLINA $�41
CATAWBA COUNTY
PHIS DEED, Had@ and emtovid.tato this 15th duly or NO, 1972. b
'fML' L1ll. Ii. of CataM. Caen -Y. North Carolina. party of thefirst .prti to
WARREN P. WLYON and wife. MINRIN B. Nfww(a aea-tiftb ondivided inewrerejl
DAVID GEOROE CRDOLIA and jife.. BOIBIIL R..CNNOLIA (g wvtitN rimdtii}ded tfltstarth
LAMY 0. CIREIC_dN tth.� t1diM 0. Cites (a'oaa:titth wiii�rida/ t+IReiM!)i -J�Ci'
B. TALBm one rLhs olwOFit J. LtlilR! (s,:aia6filtb iidltidpd, tomwt)i set.
MULD im MNY= A wrftftif undivided .lattv"t)., all of lees OirieW.
' lrrtY Caraltari. patiN.et tM Meet Mtti -
r~ that - the said per. it t4- toes! part is consideration. of tM'sii.
o! "a is- hirN :ails" sad otter initahis=moveld rations ee him paid by q1
Parties of the a..enl Met. the resew of which is hereby acknowisda"o .
vas bamplood end sold# end by these presents does bargain, sail. sad
Pay,aate tM said, porgies of the second part and their heirs sad Immoismai OW
airtais treat at peed of Lad located in Catawba County. Nona deallae. 1r =r .!`:
W. Crash Township. OW sore particularly described so tollorei ...
BEING Lots Nos. 27 and 28 of the N. L. Ricer WA44"Ldive. Its. 30'
ae shows an sap thereof wade by James C. Garble. Registered ;.tv�yer. wb�iah
�reliulaary map we dated luly 23, 1%2, and 0be heel amp dated brus
=a . '
1966. and recorded In Plat Book lU at page 19, office of the -goestor or t
Due" for Cetoebs County. rdforeses to amid sup and description thermal is, i `i7
hereby EMU for &�NWO particular description.
This property shall be used.lor eosiMotfsi VdV0ao@@:.owv. TO WAVE AND TO MW tM_.aforesaid.tlml" or Nrael avid" oed-811
privileges and appurtenances 'thlewste beleeslag eo,d* amid portion of tbs
second pn1 r and their holtr sad p.lgaa to-Wom a" the said party of the
first part does covenost that he is "tend a! Said premiums to tom and has the
right tb'asasey tbe se z Wfee e i}s/ILir th.e, for esrr an from and clear at
alI enariranaas.'esd. tot be will warrant and defend the title to the sass
against the alai" of all parsons whensoever eacopt for any Restrtative
Covensate of record, and tie.11ood "assents on said property so reserved
by Duke Power Company.
IN Thy WMRSW, the -amid pony of the first pit has h.n-
auto met his Mod and @Pal# an day 41001,760W first above Wittse,
• eTAn at f Rea(Estebe ;.
i+�+ � ii Ms 1 - •

>1a;1 tn. R.•i•: ttt� ••- ivl:i _ 8,97
P 0 tt.,x ibyl
Salisbury, N.C. 28144 41U
NORTH CAROLINA
W,VU AN1Y DEED
CArAw BA C0UNrY
TI11S DEED, 4-,de thin dtv. ^f April, 1975, by WARRE': p. HYL'1"014 and wife,
K'YI'IIRYN B. HYLTON of Rowan County, NortF. Carolina; DAVID GEORGE CEDOLIA and wife,
BONNIE E. CEDOLIA of Guilford County, North Carolina; LARRY G. CHEEK and wife, ELLEN
G. CHEEK of STANLY COUNTY, NORTH CAROLINA; and JACK K. TALBERT and wife, REBECCA
J. TALBERT of New Hanover County, North Carolina, parties of the first part, to
DONALD REID HANKINS (unmarried) of Rowan County, North Carolina, party of the
second part;
WITNESSETII.
That said parties of the first part, in consideration of the sum of ONE HUNDRED
DOLLARS AND OTHER VALUABLE CONSIDERATIONS to them paid by the said party of the
second part, the receipt of which is hereby acknowledged, have bargained and sold,
and by these presents do hereby grant, bargain, selland convey to the said party
-
of the second part, his heirs and assigns, their four -fifths (4/5) Interest in a
certain tract or parcel of land In Mt. Creek Tow113hip, Catawba County, North
Carolina, bounded au follows, viat
Bging all of Lots Non. 27 and 29 of the B. L. KISEK SUBDIVISION NO, 3, na
abowhi .,n a mapto Map no.!, 13, t pAge III, in the nfr;ro of the Reeister
of Deeds of Catawba County, North Carolina.
And being the identical property conveyed by Phil Lipa, 11 to Warren P. Ilylton,
et al, by deed dated May 15, 1972 and recorded in Deed Book 1001, At page 266,
Catawba County Registry.
'Cho above conveyance is made Subject to A deed of trust executud by Warren P.
Hylton end wife, et al, to William R. pope, Trustee, for the benefit of Mooresville
Foderal S:tvings and Loan A3agcIat1Oil, securing a note in the sun, of $48,000.00,
doted May 16, 1972, recorded in MortRag,• Bonk 1O01, at page 263, the balance of which
is to be nsuumud and paid by the party of the second part.
TO HAVE, AND TO HOLD the aroretald tract or pnrA,ol of land, :tod all prlvtleRes
nud nppurtenauccs thereto belonding, to the said pnrty of th,. --uul part, hL•,
heirs and assigns to his only usa and behouf forever.
And Lha unid pardon of the first part, for themnelvus and their heirs,
exueutors and admiulstrators, covoll:utt With said party of tho +ecund part, his holrs
And AnslRnd, that they are nelaad of sold premiaoy in fee and havo Cho right to
NO REV