20150714 Ver 1_Shoreline Stabilization_20150720

;DUKE ENERGY INTERNAL USE ONLY: Construction
y f.. E N E RGYB DUKE
pate Received: I FAF Paid + Application E
r version 13 �� - Application Complete P
{I' ' 'Petmit No. Water Strategy, Hydro Licensing and Lake Services
HEPFund I'
Duke Energy
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PO Box 1006/ EC12Q
I
Close-66t Date 45ite ID I Charlotte, NC 28201
1. DATE OF APPLICATION* I S Permit/Tag
H. APPLICANT INFORMATION (applicant mailing address and contact •information)
Name* I / t "7 (?� Yl Primary Phone* ''j�Yi
Address* 13q (f S h a roy- We K" R-00, 0C Secondary Phone
City* I C hay (,`+P State* J Zip Code *I 2g:z2 Fax Number I __
Email* �/Vo h i9 e-tx 11 ' �00 • C6 '/L_ a�
111.1PR6PERT1f perrnit)
Address* 16 0.)q;-
.) /4- WI 0 -5 - S v e;t k AD o, - _ County*I U, /a,
City* 16100 -(p'ff Q State* F Zip Code*I 2 9 2 County Parcel ID number
(e.g. Pin, Tax ID, TMS l / 3 �q 00,72, 3 7
Lake *: I L 0. �� L (� Number...) V
Subdivision I Lot(s)1- Plat Book/Page (AI vbopr_ 3 'M1 c- 570
To enter the Latitude and Longitude of the property, please use a 35.12345)*
g.
service /software to easily acquire the location information. Values Latitude (e.
should be provided in Decimal Degrees format (35.1245).
-Longitude (e.g. - 80.12345) *I . 0062,
I;.a`• J,,�;example'ser vice: �Fittp'J lifoucti `map4comLlationgyhtml,�- dL_ <.�
IV: PROPU$ED ACTIVITY: »r =,�`' ` {�. •mss, F,:__ ,. F . -
C New /Modification of Existing Structure C Maintenance of Existing Structure r Is Dock
Covered?
C` New /Modification of Existing Shoreline Stabilization Maintenance of Existing Shoreline Stabilization
C, New /Modification of Existing Structure & Stabilization ( Maintenance of Existing Structure & Stabilization # of Slips
C Transfer of Ownership (' Other (please describe below) # of Jetports F
Area over land (sq ft) Area over water (sq ft) Total Square Feet
Shoreline Stabilization (feet) Length of Distance From Shoreline
Stabilization - - �
Materials I V& - F c%4156,ve yd-14(ef' ,; & tl/%
Brief Descriptionj✓J�T%��� .¢ V,4 1� / /C/ e- U<3 e(./Q er �4
of the Activity
Describe Briefly the Existing
Structures Over Land and Y^LS f� W4-; A" d 'M<- W T
Water (include sq ft)
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JUL 2 '0 � U
•2015
DENR . WATER
- 0,1,,8 SU ER RE430URCES

V: Dock guilder or Engineer 1=
Name /Company I ��
Address I � 009 r' F�rM / -NY Phone Number 17Q�f. 1C6Q • S///
City V /[GOI' doll{ , State C Zip Code (off$ / /SJ Email / {
' ' � d ith A " I cation 5ulimission _.
VI. Checklist of Requt .d Documents (to ncau e w pp _
�tecent 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)
r,---fhotos along property shoreline and photos of any existing structures and /or stabilization in or near the water
r/Application fee (check only, payable to Duke Energy) r Signed User Agreement Letter
Fo,"Applicable local, state, and federal permits r Plan and profile drawing showing all measurements and elevations
r Habitat 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.
• 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.
- _- -s.. _ - : -tl i:: y_ }�i!i �.,'YT �4;. i- _- ;F��'F _±N i' "e- '..`r' rr3 «N-2•iti; i.,£`i'.'•:.�or`iw7L
VI11: Directoons-by Road`
. .,. ^ .. ,r , _� .�, , .......�.- _,- o- >,..�.... .. - , - _ � - � � - .' : 'r'i� .�C^-.:c... �i �' � r, � . �C. ' t;=v ti'-_ �. ;_.� '�;v.,f,�..`'.:. F- ` ^.:g L:;1•:::..,, .
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Directions by D �� AO �. L��^/ *40.5 500 /h 1U.
Road * -J &—et J
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IX: Application Sybmiission r':.f =� . , . ;��.��. _ ,,;::� . , . � �•.,.,�:.. , °� °, ,?,�,,.. „
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
Printform
Duke Energy �_- - -. � -; :• • .�_.. ^ -
PO Box 1006/ EC12Q
Charlotte, NC 28201
1 agree that the information contained within is accurate: -71112-015
Signed By �

2 p
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources 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 j15A NCAC 02H .0502(a)j
1. Owner Information
Name: X&L Te" ri rq
Mailing Address: 9 P�
Telephone Number: '-70+ qb�- 368S Fax Number:
E -mail Address: X r0 li YI e "t—GZ -VI Cj 13 2 6) ya`.(•►On
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
htti): / /www.saw.usace.armv. mil / Portals /59 /docs /regulatory /regdocs /Permits /SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name:
Company Affiliation: L'__":> C �Q n ( & 1Z2C yG 1 n 9
Mailing Address: 6 j g Da it Yl 0�q to 4W
M0orPSVi( (to , /1/C Z 'S 11_57
Telephone Number: .70q-- -b6O 9-111 Fax Number: 704 -&ad -,5-'?
E -mail Address: `1DC 5 e4i.J A-J(s rvfn�d sir e-Arn - /(Z'
Person to receive the Certification Approval: C4;p 13 ri61gLs
11. Project Information (15A NCAC 02H .0502(a) & (b)]
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 of3

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) % f�
County: /� CZK-1 GJ 1kV"1J Nearest Town: ��rlo ix
Subdivision name or site address (include phase /lot number):
S 4ktps 5x,� k V'
Directions to site - please incl a road name and nu hers, I ndmarks etc.: ieS 74
Latitude (in decimal degrees) cam• $ % Longitude (decimal degrees)
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): �-G 5idew-A, komc-
6. Property size (acres): A7. 41-,C 7
7. Lake/ river/ ocean adjacent to property: 4AKe W4
8. Describe proposed work (include discussion as to how h`ardenii g of sl preline has bb en
avoided, or why it is necessary): 574"1 � � �S�E� ( /fie - � �'��'� r' csl �R �
9. Will work be conducted from land? 211' 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:
�X lb©
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: f/ X 166 /
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 feet landward to be impacted (number of trees, for instance): J r-6 5 s
Owner /Agent's Signature 15A NCAC 02H .0502(f)1 Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10 -2013 Page 2 of 3

1 RrG'ST(R[D ZURV[YOR STATZ OF NORTN CAROLJINA
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C1tRVEY OF

Lake
(At Full Pond /Normal Water Level)
2' 3
I �'IOLJ
Full Pond/
Normal Water Level
Shoreline
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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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