20150748 Ver 1_Shoreline Stabilization_20150728

DUKE ENERGY tNTERi1tA1 USE ONLY-
Construction ~- C
Date Received:
l I FAF Paid , ApplrgCaCdO11l
[] Application Complete veftLm'3P of 8 B R
(/FF P ESOVR
HEP Fund I Permit No. ( I Water Strategy, Hydro Licensing an
Duke Energy
+ PO Box 1006/ ECI2Q
Site ID I { Close -Out Date j Charlotte, NC 28201
1. DATE OF APPUCATION* ' f / � 4 Permit/Tag
It. APPUCANT INFORMATION (applicant mailing address and contact information)
Name* 1 104' x- f-i- �' f{ %�/% ) Primary Phone' �7U�1(• 5Z) L . (e / 5Z —
Address* I a �A �/ ��� ��� Secondary Phone ,
City` DOrStli ?IEI State *® Zip Code *1,j /J7 I Fax Number I
Email*
111. PROPERTY INFOI2fl9AT10N (location of permit)
Address* I ,213.27 COUNT,<J,V (-,/ai Dr. County-1 Meu,(1Cpj j&r
9
City" r Ui State* R] Zip Code *,,;7,YQ 31 I County Parcel ID number
Lake *: (e.g. Pin, Tax ID, TMS DD ) /
I /Y0,2,n ,4a/ Number...) / 1°
Subdivision' I Lot(s) Plat Book/Page 4531
531 /g4-
To enter the Latitude and Longitude of the property, please use a
service/software to easily acquire the location information. Values Latitude (e.g. 35.12345)* I r3� s-0 )
should be provided in Decimal Degrees format (35.1245).
I example service: http / /itot chniap.tom /latlong.htm! j Longitude {e g. - 80,12345)' $� , 3Y.59
IV, PROPOSED ACTIVITY
i New /Modification of Existing Structure r Maintenance of Existing Structure Is Dock
f" New /Modification of Existing Shoreline Stabilization (— Kaintenance of Existing Shoreline Stabilization n Covered? ❑
T NewlModiiication of Existing Structure & Stabilization (' Maintenance of Existing Structure & Stabilization 4 of Slips
(` Transfer of Ownership (' Other (please describe below) # of Jetports El
Area over land (sq ft) L I Area over water (sq ft) I Total Square Feet
Shoreline Stabilization (feet) Length of Distance From e6 I (�� W i S ilv ��jo ✓2 l /N
Stabilization _
Materials 1\44, s-1 DM b0 kldcv- r i p,r��pQ&-
whA ,L
p -
Brief Desoiption S )"L . �i e Wl�� N�' bO Gt'Id lX r i f /41a (en/���
of the Activity l
Describe Briefly the Existing
Structures Over Land and r c- S t ae i AI A-t hA UVt e— IJ MI�
Water (include sq ft)

V. Dock Builder or Engineer -
Name/Company C f3 C, I
Address I b38 DA-K Y^i A Pi°rr"M phone Number 170 7 666
city pp�gUj aC i State Zip Code �>� T� I Email r if
Vi. Checklist of Required Documents (to include with Application Submission)
ecent 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)
[�'f hotos along property shoreline and photos of any existing structures and /or stabilization in or near the water
[5"Application fee (check only, payable to Duke Energy) ❑ Signed User Agreement Letter
❑ Applicable local, state, and federal permit ❑ Plan and profile drawing showing all measurements and elevations
❑ Habitat Enhancement payment (if applicable)
VII. Approval Process -
e 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.
VIII, Directions by Road
E77 1Y. TD dx i � 96, W o N C4 4-A -Lo b,4 r9-vc s , f�`� DA)
Directions by
Road'
iX. Application SubmissionF
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 I Print Form
PO Box 1006/ EC12Q
Charlotte, NC 28201
i agree that the information contained within is accurate: r.-.A /,,L
Siqned By

State of North Carolina
VNI la In 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
Four copies of the application (including attachments) and the application fee should be sent to:
Division of Water Resources
401 & Buffer Permitting Unit
1650 Mail Service Center $ PAW
Raleigh, NC 27699 -1650
Applicant Information (15A NCAC 02H .0502(a)j
1. Owner Information /�
Name: ��}L{L. f7• N P N/
Mailing Address: 9 ,�� I/ 5#01 E �.DO j�
M 008E5 V le_, /1/C :ZBi /7
Telephone Number: 7D'f SD(o • f 5a1 Fax Number:
E -mail Address:
2. Agent/ Contact Person Information
'20'vr0T
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
htti): / /www.saw.usace.armv.mil/ Portals /59 /does /rep-ulatory /reRdocs /Permits /SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: l A'0;d qLS
Company Affiliation
Mailing Address: f I)A-K Y' e F,4r n 14w -
1�(oor�s�i es I
Telephone Number: Fax Number: 7.0
E -mail Address: Ck,544u>A-lls EUjArO'st-e� Al . Ne,?4
Person to receive the Certification Approval: a/p 13rid1cs
� v
11. Project Information f15A NCAC 02H .0502(a) & (b)j
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.
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: Me -C-14 ea 11-q Nearest Town: ( /A✓NGI�u -5
Subdivision name or site aidress (include phase /lot number): -1/ 3 P- 7
Directions to site - `please include road names and numbers, landmarks, etc.:
7 7 fit/ s.-V 64 TX &Ji4 Aer • ��'o.� �r�wc �
-ze-I
1
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): YYl;6Je l / �i4.( %l Mx_ IAI,.A ski cr
v
6. Property size (acres): Q. L/ 9
7. Lake/ river/ ocean adjacent to property: A*Kc IVI)r"W
8. Describe proposed work (include discussion as to how hardening of (Jshoreline h as bee n
avoided, or why it is necessary): !A(51A// tht e/alw4mr- 404,9 - r-,� -.4p
9. Will work be conducted from land? ❑ From water? ❑✓ (B#ty —)
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:
,5 ' x is s '
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake jevel/ Normal Water Level and 50 feet land -ward in
square feet or acres: / x / g- S
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): G rA45S
a
Owner /Agent's Signature 1`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

Lake
(At Full Pond /Normal Water Level)
I
3
Full Pond/ �4
Normal Water LevelC'�
C . & "' 4.: '. . b + '• ' . -- .'F x,. -�y? —1 am--11 - — 4 �.etl+" �iL' I.�aTc: S.a�c
Shoreline
N/
I 0-� oJe-
� -
C /� 5 �
I g5G4`. Yd -5
Please approximately sketch the following information on this plan (provide dimensions for each
item, such os 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

(Page 1 of 2)
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