20151292 Ver 1_Shoreline Stabilization_20151214

DUKE EN®tGY INWINAL USE ONLY:
Date Received:—= EL FAF Paid Construction � DUKE .: t.
Application . :-. ENERGY
1:1 Application Complete
NEP Fund Permit No. Water Strategy. Hydro Licensing and Lake Services
Duke Energy
Site ID Cl05e-0ut Date PO Box 10061 EC T 2Q
- - ...-- Charlotte, NC 28201 ' (j �j �-
1. DATE OF APPLICATION'S U V L
. APPLICANT INFORMATION (applicant mailing address and contact informatioit) .4.- �1�
Name F E V- --
11 ill I r
Primary Phone*
Address* / �j . 11/'� w_ r �p
Secondary Phone
City nsK�1 f� states C
Zip Code � ZW71
Fax Number
Email* yo em earn/•, co hj
111. PROPE w INFORMATION tion of permit}
Address* _
Countyk C+7-md 3 i
City -/1W C
VEIrp
Code;
State* R--
o'Z$� %
County Parcel tD number
Lake*: 0 rM A
(e.g. Pin, Tax ID, TMS
Number.._)
0'/v 3 3 r��� 02
SubdivisionE==== Lot(s) /®
.e
To enter the Latitudeand
PlatBook/Page %8
longitude of theroppi
rty,
p arty, please use a
`
- -
.
service/sOftware to easily acquire the location information Values
should be provided In Decimal
Latitude (erg. 35.12345)*
a� • 3 3 5
Degrees format (35.1245).
example service: hitpc/Atoucfimap.com/latlong.html
Longitude (e.g. -80.12343)* y B D gZ
IY. PROPOSED ACTIVITY
r N Modtficatlon of Existing Structure ._ <` Maintenance of ExLsting Structure
Is Dod
ew diflcation of Exerting Shoreline stabilization Covered?
f•' New/Modification ofi3dsting Stnuture &StabiGzallon Maintenance of Existing ShoreDne St*1I mu
C' Maintenance of Existing Structure & Stabilization S of Sups
i Transfer of Ownership
r Other (please describe below) # of Jetports
Area over land (sq R) Area over water ( ft)
� Toial square Feel
Shorei)nestabilitwon (ffto —
Length of
Stabilization
Distance FromShordinelwl//
Materials I Va, , Fie
F r'
/ f r
Brief Description rjJ g t -A' 1/( et� L s
of the Activity ,ir �p r 14
YCrnAlrlfltU 5rG1�Ke, J
Describe Briefly the Existing
Structures Over land and y - e- 51C ad 6-14t e, jJ1I 'fJre,4-
Water (Include sq ft)

V. Dods Builder or Engineer -
Name/Con
Address
�— J
city D013Vi'l t ( State Zip Code
Emaii /
-C A- 5 iJrN�S ►^�14n1
Checldist 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)
6?"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
[?/Applicable focal, state, and federal permits ❑ Pian and profile drawing showing all measurements and elevations
❑ Habitat Enhancement payment (if applicable)
V11. Apprgval process - _ ....
m Application is reviewed and determined if complete. Fields with an asterisk are required.
a If application is not complete or does not include all items and information listed in the checklist, the
application will be returned as incomplete.
o A Duke Energy representative will visit the site to conduct a visual inspection.
m Applicant will be notified of approval or denial.
o 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.
Vlil.DirectionsbyRoad
Directions by / V J iiFnl S
Road} POA✓ b4K4&4d %
1)f. 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, Kl dro Licensing and take services
Duke Energy Print Form
PO Box 10061 ii c120
Charlotte, WC 28201
i agree that the Information contained within is accurate:

State of North Carolina
Department of Environment and Natural Resources
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
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 le
Raleigh, NC 27699-1650
1. Applicant Information 115A NCAC 02H .0502(a)]
1. Owner Information
Name:
Mailing Address: _5X (.0- V..x r
Telephone Number:'Fax Number:
E-mail Address: P'JV cvX" f 9-v,.c1
2. Agent/ Contact Person Information
*Zq
2R 1 C
20151292
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http://www.saw.usace armv mil/Portals/59/docs/reeulatory/reedocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM. df) must be attached if the Agent has signed this application form.
Name: (' ;r) Ar-idAeI-
Company Affiliation: (/!) & 5 T'DAre-
► ee l ;
Mailing Address: $ kr_ f14 C_
Telephone Number: 0.5/// Fax Number: 7,011. IP pd • 0(e 9
E-mail Address: c Ce -4 ti.41/5
,a w; "W5 f e -CAM , Ne �—
Person to receive the Certification Approval. C n 1 12 D r i
II. Project information r15A NCAC 02H .0502(a) & (b)1
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: ,¢u1,d g Nearest Town: VeAtV e r
Subdivision name or site address (include phase/lot number): % /o/
Directions to site - please include road names and number, I ndmarks, et
sC.
_/6d kftJPC7 IrI tt�
�h1k_
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.):
6. Property size (acres): %, (x'70
7. Lake/ river/ ocean adjacent to property: IA,'�'e mgrA f},rJ
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): s7-,4 &kf; zu i otil
9. Will work be conducted from land? N 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:
moa / X �
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake leve Normal Water Level and 50 feet land -ward in
square feet or acres: �?-o 0 X
12. Please describe the vegetation above the normal pool lake level/ Normal Water and
50 feet landward to be impacted (number of treIr
es, for instance): Ms ic� eAl t_ A- I
rk5
M",
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: 5SGP 10-2013 Page 2 of 3

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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) *:
I. All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
I 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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