20160036 Ver 1_Shoreline Stabilization_20160111

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State of North Carolina
DWR 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 2 0 1 6 0 0 3 6 0 bl
Raleigh, NC 27699-1617 PJEM 1 1 2016
Applicant Information [15A NCAC 02H .0502(a)]
1. owner Infnrmntinn
Name:
Mailing
Telephone Number: /q'iL7f-7-0az/Fax Number:
E-mail Address: rlACLO 5�) A?VOJNG 'i ; LUyI
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http://www saw usace army 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:
Mailing Address:
Telephone Number:
E-mail Address:
Person to receive the Certification Approval:
Fax Number:
II. Project Information [15A NCAC 02H .OS02(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 of 3

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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: �l �L157d.� Nearest Town: U1)
Subdivision name or site address (include phase/lot number): (Ok l e-✓ i zZ
5611)/, I (b " S� o ✓,
Directions to site - please include road names and numbers, landmarks, etc.:
t 0-7 � P i VV-- 3t��10,-d ' _o t J vd 3 Gl-14_41
-I-fmli vlotco(,/ f -V of Z"a I.,g v_�-e- _ems
Latitude (in decimal degrees) 35- l! o7l 3 Longitude (decimal degrees) 1 & WRY
5. Describe the existing land use or condition of ,the site at the time of this application
(residential, undeveloped, etc.): A eS(c%ed1%4 (
6. Property size (acres): -7 (o
7. Lake/ river/ ocean adjacent to property:(�,� �1�c /
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): )l,�O f'`� 5e LtA, /! ' `2A � ';�q
9. Will work be conducted from land? ❑ From water? 13
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:
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:' ._'� cje
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): ✓ 74"w5
4/ jVC 5-6�f�b 5
Owner/Agen s Signature* [15A NCAC 02H .0502(f)] Date
Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013
Page 2 of 3

r
La ke
(At Full Pond/ Normal Water Level)
Full Pond/
Nnrmal Water I evel
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.
S. 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

DUKE Lake Services
ENERGY. Duke Energy
526 South Church Street
Charlotte, NC 28202
Mailing Address.
DUKE ENERGY NANTAHALA AREA (DENA) PRIVATE FACILITIES EC120i Po Box loos
"USER AGREEMENT" LETTER Charlotte, NC 28201-1006
(You may use this letter and fill in the requested information. Please Print)
Date
TO: Duke Energy
c/o Lake Services- EC 12Q
P. O. Box 1006
Charlotte, NC 28201-1006
RE: (LakeName),i��1t/il/L/-/�
(Street Address) h6
(Subdivision / Lot #) 1! PT—
I ✓ fii �N16' }r v��
(Applicant's full name) 4y A _5 hereby agrees to comply with all requirements
and conditions set forth by Duke Energy's Lake Services' office, or any federal, state or local agencies
pertaining to our Private Facilities application to construct a � 4 .5-00K. L. -1/
on Lake PG In addition, Five have read and agree to comply with Duke Energy's Shoreline
Management Guidelines (SMG) and understand that written authorization must be obtained from Duke's
Lake Services' office prior to beginning any activity/construction within the Project boundary. The
construction will be completed as described in the approved private facilities program application and within
twelve (12) months from the date of approval by Lake Services. Failure to complete construction within the
build -out period will require the applicant to file a new application within the then -current guidelines. The
filing will include any applicable fees and security deposits.
I/we attest to be the owner or lease holder of the tract of land immediately adjoining the Project boundary
where the proposed facility is to be constructed.
Uwe understand the physical location on my/our lot in relation to the common property line with Duke Energy,
the FERC Project boundary, and any deeded flood easements or required building setbacks.
I/we understand that this lake was constructed as a working hydropower reservoir for the primariy purpose of
producing cost-effective electric energy and that this remains as the lake's primary purpose. I/we understand
that the lake and its associated hydropower station are operated by DENA under the terms of a license issued
by the Federal Energy Regulatory Commission (FERC) and that there will be no change in hydro project
operations as a result of the construction and/or use of any facilities that Uwe may be allowed to place within
the FERC Project boundary or on DENA-owned property.
I/we understand that lake levels will rise and fall over time in response to weather events and hydro project
operations.
DP NA PRIVATE FACILITIES USERS AGREEMENT Rnal Rev 10.1101
Page 1 of 5

Uwe acknowledge that DENA provides no guarantee of any specific quantities (except those identified in the
Low Inflow or Hydro Project Maintenance and Emergency Protocols) or quality of water in the lake.
Uwe acknowledge that DENA does not guarantee that an approved facility will always have sufficient water
depth to be accessible by boat or for other water depth related recreation activities.
Uwe understand that the structures to be installed are my/our property and Uwe therefore agree to be fully
responsible for the permitted reservoir use including maintaining structures in good repair. If the facility is
deemed unsafe by a Lake Services Representative, Uwe agree to repair or remove the facility at my/our own
expense and within the specified timeframe. This responsibility is considered to transfer automatically along
with ownership and leases of the adjoining tract.
Uwe understand that as an owner or lease holder of property directly adjacent to DENA's Project boundary
Uwe enjoy the same rights and privileges for general recreational use and enjoyment of the Project lands and
waters as are afforded the general public. Uwe understand that as an adjoining property owner Uwe may, with
proper written approval, be considered for expanded privileges as specified in the DENA SMG.
Uwe understand that certain activities specified in the SMG are prohibited because of the DENA lakes small
size, environmental concerns, boating capacity limitations, safety considerations and other reasons.
Uwe understand that ownership/interest in a Common Use Facility eliminates the option for me/us to also have
a separate facility on any other lot within the affected subdivision that I/we own or Iease.
Itwe understand that Lake Services' approval of the requested reservoir use in no way constitutes assignment
of an interest in real property (i.e. land rights). The approval is granted and maintained solely at Duke's
discretion. I/we also understand that 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 Lake Services.
Uwe specifically waive any claim for consequential damages arising out of or relating to this application,
Duke's approval or denial of it, or Duke's subsequent revocation of approval, and Uwe specifically understand
and acknowledge that, because Duke Energy can revoke the permitted use at any time, I/we are not entitled to
reliance damages.
Uwe understand that there will be no change in hydro project operations as a result of construction and/or
utilization of the permitted proposed structures.
Uwe understand that the proposed structure will be used only for the purposes described in the information
submitted to Lake Services and other appropriate governing bodies for approval.
Uwe understand that this lake is open for use by the general public and that maintaining safe and lawful public
use is one of the primary lake management objectives of DENA.
Uwe understand that the use for which we are applying is a private use and it should not interfere with the
general public's safe and lawful use of the lake.
Uwe understand lake use permit holders have the authority to prevent others from trespassing on the structures
they have built. Uwe also understand that Uwe, however, do not have any authority to impede anyone from
DP NA PRIVATE FAC1Ln'>ES USERS AGREEMENT Final Rev. 10'13/03
Page 2 of 5

pursuit of the lawful public recreation enjoyment of FERC Project lands and waters. Except as specified
otherwise in the SMG or other DENA documents (e.g. Public Safety Plans), anyone may fish around/under
structures built by others, may walk/wade/fish within the FERC Project boundary or any DENA-owned
peripheral strip, boat in the lake's waters, etc. without having to get anyone's permission to do so. Boaters may
not block ingress/egress to piers/docks.
Uwe understand that every reasonable effort must be made to minimize any adverse impact on fish, wildlife,
and other natural resources.
1/we understand that trees and vegetation growing within the Project boundary 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. Itwe also understand that unauthorized removal of
shoreline vegetation (i.e. button bushes, willows, cattails, etc.) and/or disturbance of the shoreline buffer may
result in suspension or denial of lake use permitting requests and require me/us to re-establish the vegetation, if
the disturbance is found to be in violation of the state or county watershed buffer regulations or Duke Energy
Nantahala Area Vegetation Management Requirements.
Uwe agree to notify Lake Services when construction is completed. During the construction period, the
weather-proof "Duke Energy Approved Lake Use Activity" sign (to be provided by Lake Services) must be
posted at the job site, visible from the water's edge.
Uwe agree to notify Lake Services if the property is sold and provide the name and address of the new owner.
The new owner has 180 days following the date of closing on the property purchase to sign this agreement and
its conditions.
Uwe agree to fully disclose all information regarding the approved private facility to any prospective
buyer/leaseholder of the property and any new owner/leaseholder. Uwe agree that Duke Energy Lake Services
will be notified immediately of any sale/transfer of the property and the transfer of the permit to the new
owner/leaseholder.
Itwe agree that Duke Energy may enter into agreements with third parties permitting use of the Project property
that'promotes the overall recreational purposes of the Project.
Uwe agree that this agreement confers no right to construct or maintain public and private beaches, marinas or
campgrounds.
Uwe agree that the adjacent Duke Energy Project property shall be used exclusively for non-commercial
recreational purposes.
Uwe agree not to rent, lease or otherwise allow third parties (except for temporary use by guests, family
members, and renters of the residential property) to use any structures permitted to me/us by DENA.
1/we agree not to allow any use of the adjacent 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.
DP NA PRIVATE FACILITIES USERS AGREENMNT Final Rev. 10/13/03
Page 3 of 5

Uwe agree to exercise all care and due diligence to preserve and maintain the character of the DENA's adjacent
property. Uwe agree to comply with the DENA Vegetation Management Requirements. I/we 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 adjacent property.
I/we understand that as an adjoining property owner Itwe can make no change in land form of land within the
FERC Project boundary or land owned by DENA, such as grading, excavation or filling without prior written
approval by Lake Services.
I/we agree that only floating piers/docks (unless otherwise authorized by DENA in writing) will be placed on
the Project property and that no piers/docks or structures will be built on Project property without prior written
authorization by DENA.
I/we agree for myself/ourselves, members of my/our family, guests and invitees that Uwe assume all risks of
personal injury or property damage incident to my/our occupancy and use of the premises; 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 hydro electric facilities. I/we as the adjoining property owner further agree that I/we 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 my/our family,
guests, and invitees arising or claimed to have arisen in connection with their occupancy or use of the DENA-
permitted facility(s).
I/we agree to comply with all FERC orders (as modified or interpreted by FERC), with all other applicable
FERC Rules and Regulations imposed by Duke Energy, and with all rules or regulations imposed on Duke
Energy by any governmental agency.
I/we understand this user's agreement does not have an expiration date and is transferable to the next property
owner provided the new owner signs a new agreement within 180 days following the date of closing on the
property purchase.
I/we have included a check for the applicable filing fees and security deposits and copies of all other necessary
permits.
I/we acknowledge that DENA has the right to charge reasonable user's fees for private use of its property and
that 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.
I/we 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 camping is only allowed in designated areas.
I/we recognize that Itwe have the continuing responsibility to ensure that the constructed structures are
maintained in good repair, including, but not limited to maintenance of the dock and boat slips, and proper
erosion control within the permit area and along the shoreline, and agree to take all reasonable steps necessary
to meet this responsibility. Itwe agree to maintain all structures within the Project boundary on DENA-owned
property in a sound condition and in a neat appearance and pay all costs for said maintenance.
DP NA PRIVATE FACILITIES USERS AGREEMENT Final Rev. 10113/03
Page 4 of 5

y
t/we agree that if any action is taken by Duke Energy to enforce any provision, covenant or agreement
contained in this user agreement or DENA SMG or if Duke Energy is required to retain an attorney to enforce
any provision, covenant or agreement contained in this user agreement or SMG (including, without limitation,
the payment of fees due hereunder or the removal of an encroachment constructed in violation of this user
agreement or SMG), then Duke Energy shall be entitled to recover all of its reasonable costs associated with
such an action, including but not limited to, attorneys' fees and court costs incurred in such action and/or
enforcement; provided, however, that the undersigned shall be entitled to recover all of its reasonable costs
associated with such an action, including but not limited to, attorneys' fees and court costs incurred in such
action and/or enforcement if judged to not be in violation of any provision of the User Agreement or SMG.
Uwe agree that I/we have read and will abide by the DENA SMG published under separate cover.
Uwe understand that Lake Services representatives may issue Stop Work Directives for any violations of the
SMG or engagement in prohibited acts or activities on DENA property as specifically identified in the SMG.
Uwe understand that persons found to be in violation will be subject to DENA sanctions which can include: 1)
restoration of the impacted area at the person's expense; 2) loss of consideration of any future lake use
permitting activities for up to five years for improper vegetation removal or until vegetation is satisfactorily re-
established (even if there is a change in property ownership); 3) revocation of a previously issued permit and
loss of consideration of any future lake use permitting activities and/or reinstatement of the revoked permit; 4)
increases in fees; 5) modification or removal of noncomplying structures; and/or 6) further legal action being
taken by DENA.
Sincerely,
.�(-4 2
A plicant's Name)
Lake Street Address
L,k-AWk/-L
City/State/Zip Code
Lake Phone Number
(Designated Duke Energy Agent)
-
Appli of Signature
Home Street Address
City/State/Zip Code
/-f �ql - 75 y
Home Phone Number
Date:
Date:
DP NA PRIVATE FACILITIES USERS AGREENIENT Find Rev. MUM
Page 5 of 5

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