20150815 Ver 1_Shoreline Stabilization_20150812

DUKE ENERGY INTERNAL USE ONLY:
Construction � � D���
Date Received: I I FAF Paid ( Application' �����` S
� Application Complete version 13P �`
Email"
fl 4 n Ike- Vq, 4 ro y &k oo. Cora
III. PRO ARTY INFORMATION (location of permit)
Address* 1 4-337 T cxk-x Rd. I
City* (,&1moAj/`T 1 State* ® Zip Code -I Vo1.Jj
Lake *: U6 i o I
Subdivision ra <ey- �p�}p Lot(s) 3
To enter the Latitude and Longitude of the property, please use a
service /software to easily acquire the location information. Values
should be provided in Decimal Degrees format (35.1245).
example service: htt0 /itouchmap.comAatlong.html
IV. PROPOSED ACTIVITY
County*I 6�4s7_nn/
County Parcel ID number
(e.g. Pin, Tax ID, TMS 3593
Number ...)
Plat Book/Page &777,p-36
Latitude (e.g. 35.12345)*
Longitude (e.g. - 80.1230"1 61vi/ , L9,31-6
(' New /Modification of Existing Structure C1 Maintenance of Existing Structure Is Dock
Covered?
(;� ew odification of Existing Shoreline Stabilization C Maintenance of Existing Shoreline Stabilization ❑
(' New /Modification of Existing Structure & Stabilization C Maintenance of Existing Structure & Stabilization tr of Slips
( Transfer of Ownership C' Other (please describe below) # of Jetports
Area over land (sq ft) Area over water (sq ft)
Shoreline Stabilization (feet) Length of /
g /f�10
Stabilization
II Total Square Feet 1
Distance From Shorelin4) //A 11#0 e, jj ,�✓9
Materials rip r A F
Brief Description - A,l f Le :SAP r i �v 'Cf Vti`j 1 ev-05 L
of the Activity
Describe Briefly the Existing )e f 1
Structures Over Land and (/(, ( lr per(
Water (include sq ft) I
Permit No. 4
Water Strategy, Hydro Licensing and Lake Services
HEfl Fund
Duke Energy
Site ID
Close -Out Date II
I
PO Box 1006/ EC12Q
Charlotte, NC 28201
I.
OF APPLICATION *'
�- 7 /!5 „ »« ^^µ£
( Permit/Tag� #..
„DATE
11. APPLICANT INFORMATION (applicant mailing address and contact
information)
Name*
LS.J v A AwE- !' l VAS " kElvjVE -m // VA�
Primary Phone'
Address'
14:2 6 7 RAehe1 AA(ME- ,Dr .
I
Secondary Phone 1 1&4- 8 83 ,x443
City-
MmbllT
I State*
®
Zip Code*I
i
Fax Number
I I
Email"
fl 4 n Ike- Vq, 4 ro y &k oo. Cora
III. PRO ARTY INFORMATION (location of permit)
Address* 1 4-337 T cxk-x Rd. I
City* (,&1moAj/`T 1 State* ® Zip Code -I Vo1.Jj
Lake *: U6 i o I
Subdivision ra <ey- �p�}p Lot(s) 3
To enter the Latitude and Longitude of the property, please use a
service /software to easily acquire the location information. Values
should be provided in Decimal Degrees format (35.1245).
example service: htt0 /itouchmap.comAatlong.html
IV. PROPOSED ACTIVITY
County*I 6�4s7_nn/
County Parcel ID number
(e.g. Pin, Tax ID, TMS 3593
Number ...)
Plat Book/Page &777,p-36
Latitude (e.g. 35.12345)*
Longitude (e.g. - 80.1230"1 61vi/ , L9,31-6
(' New /Modification of Existing Structure C1 Maintenance of Existing Structure Is Dock
Covered?
(;� ew odification of Existing Shoreline Stabilization C Maintenance of Existing Shoreline Stabilization ❑
(' New /Modification of Existing Structure & Stabilization C Maintenance of Existing Structure & Stabilization tr of Slips
( Transfer of Ownership C' Other (please describe below) # of Jetports
Area over land (sq ft) Area over water (sq ft)
Shoreline Stabilization (feet) Length of /
g /f�10
Stabilization
II Total Square Feet 1
Distance From Shorelin4) //A 11#0 e, jj ,�✓9
Materials rip r A F
Brief Description - A,l f Le :SAP r i �v 'Cf Vti`j 1 ev-05 L
of the Activity
Describe Briefly the Existing )e f 1
Structures Over Land and (/(, ( lr per(
Water (include sq ft) I

V. Dock Builder or Engineer
Name /Company
S Oil/ S �P/9 4
Address 41-A r✓dAi�4 1 -C Phone Number 1 ��.¢, 8(G. 671
city G� �� I State ZipCode ���o�� I Email
Vi. Checklist of Required Documents (to include with Application Submission)
, eecent Survey (stamped /signed by a professional licensed surveyor showing the location of the existing or proposed
t� structure and /or survey of the existing or proposed stabilization)
ER/Photos along property shoreline and photos of any existing structures and /or stabilization in or near the water
[v]'Application fee (check only, payable to Duke Energy) ❑ Signed User Agreement Letter
5?rApplicable local, state, and federal permits ❑ Plan and profile drawing showing all measurements and elevations
❑ Habitat Enhancement payment (if applicable)
VI1. 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.
V111. Directions by Road
7'$5 s,{ ff C. H H :-73� 5ou+k oA1 S0CAJ4•Fo1QJ- % dl. K. +O^/
Directions by -7Z-C- Ker R U 1, �J
Road" ,
IX. Application 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.
Water Strategy, Hydro Licensing and Lake Services I
Duke Energy Print Form
PO Box 1006/ EC12Q
Charlotte, NC 28201
I agree that the information contained within is accurate:
Signed: Bye

2015 -08 -07 15:41 MDVAMILK 1806867580 >> Fax Server P 1/3
State of North Cao liirb 1 5 O
Department of Environment and Natural Resources 8
Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10 -2013
Shoreline Stabilization Application form
" PAID
Four copies of the application (including attachments) and the application fee should be sent to:
Division of Water Resources ?�(� �V7
401 & Buffer Permitting Unit {;
1650 Mail Service Center AUG 1 2 2015 i
Raleigh, NC 27699 -1650
DENR • WATER RESOURCE
I. Applicant Information ]15A NCAC 02H .0502fal] 401 & BUFFER PERMITTING
-
1. Owner information `
Name: &,�-A k(ET_N f JO—Att/ofcC Vi45
Mailing Address: /a 6 7 1'?Acj e,1 ,4^lN'c- P✓
—13-e- IAoWf /YG
Telephone Number: 70 Fax Number:
E -mail Address: 6.Q A(eV.As e-zp{+oo•Go1'h
2. Agent/ Contact person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
httL[ /wwvv .saw.usace_a{mv,nytUPt�rtals 9 iatgry/rqgcipcs �ermits /SAMPLE AGENT AUTH
ORIZATION F2RM.pdn must be attached if the Agent has signed this application form.
Name:��Y� /��
Company Affiliation. *,O 111 P -�OA(:S G—i'A D r Nq
Mailing Address: '6 S (f,4r4otl d,4 Ore Dr.
Telephone Number: 70 gl (o. �(67J�Fax Number: -70e- C4 !J , (,p �lj L
- -�---
E -mail Address:
Person to receive the Certification Approval: 4W61V D"/
IL Project Information T5A NCAC 02H .0502ia�& (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 wails, docks, impervious surfaces,
FORM: 55GP 30 -2013 Page 1 of 4

2015 -08 -07 15:42 MDVAMILK 1806867580 >> Fax Server P 2/3
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.)
d. Location of the property (where work is to be conducted)
County: -fA rnn/ Nearest Town: _ ,&il
Subdivision name or site address (include phase /lot number): :1 Y' RoAd /0 P'F' 5
Directions to site - lea include road names and numbers landmarks etc.:
� �-
S. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): ` IC-5 et-1 -i A-1 �T
6. Property size (acres); d. q;l 5
7. Lake/ river/ ocean adjacent to property: ",KC-
S. Describe proposed work (include discussion as to how ha enin ree of shoreline has b
avoided, or why it is necessary): _�� i ter o rc. e!c -f� �prtY�nl e rag �oAf�
r
9. Will work be conducted from land? From water? []
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool lake lVel/ Normal Water Level in square feet or acres:
/-/'x lZ) b
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: / �X to 6 1 —
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 feet landward o be im a ed (number of trees, for i"ance):
GAD o d�e-go o ( <5 ic e, ,Oko- 7fV s )
I
9 .5 _
Owner/ ent's Signature" j15A NCAC 02H .05021fl1 Date
*Agent's signature is valid only if an authotlzown letter from the owner is provided.
FORM: SSGF 10 -2013 Page 2 of 3

2015 -OS -07 15:42 MDVAMILK
1806867580 >> Fax Server P 3/3
Lake
(At Full Pond/Normal Water Level)
4 b s
F �
Full Pond/
Normal � W�s: WI
Shoreline
e G • o o '`'� t
1
C
q(V Ok,��9
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as loft x loo ft)*:
1. All proposed vegetation clearing
2. • Location of rip rap or fill to be placed above the l=ull 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 1)
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4337 Tucker Rd - Google Maps
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