20160333 Ver 1_Shoreline Stabilization_20160404

DUKE ENERGY INTERNAL USE ONLY:
Construction
Date Received: FAF Paid f?Application� y�`
C0w0,
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[I Application Complete vealan13y N � 016
HEP FundE::::= Permit No. Water Strategy, Hydro Lic £G)R
Duke Energy 401 &BUFFER PERMIT
Site ID Close -Out Date PO Box 1006/ EC12Q
--- •-- __ _ __ _ Charlotte, NC 28201
1. DATE OF APPLICATION* -- -
II. APPLICANT INFORMATION (applicant mailing address and contact information)
Names' - --
1 I tl!Ur' Prima Phone" JD 005 . 3
Address*Ap 5 Ra� ) /
%� �fi'i / Secondary Phone
City gYmc State* K Zfp Code a -f / Fax Number
7Tb J-5- -�-O 71,
Email*
Ill PRO
- 5 . CD +h
WFORMATION (location of permit)
Address*
5D r/'n�1►+�tS I'+A�I ��'. J County7TMS
City N�iState` Zip Code• $D3 County PLake`: �,r �/ (e.g. Pin, Number.
Subdivision /V Lots) ��
�.�_ _ Plat BooWPage
To enter the Latitude and Longitude of the ro - "` '--'- —. . _ _
service/software to easily acquire the location information. Values ___
Latitude (e.g. 35.12345)- S ,7�
should be provided in Decimal Degrees format (35.1245).
- example service: httpJ/itomlLongitude (e g. -80.12345n/atlong.html
IV. PROPOSED
C' N /Modification of Existing Structure - y i Maintenance of Existing Structure Is Dock -
New/ odiflcation of Existing Shoreline Stabilization (" Maintenance of Existing Shoreline Stabilization Covered?
Modification of Existing Structure & 5tabili2ation C' Maintenance of Fxlsting 5tructure & Stabilization Of Slips
(' Transfer of Ownership r Other (please describe below)
4 of Jetports
Area over land (sq ft) Area over water (sq ft)
Total Square Feet
Sharellne Stabilization (feet)
Length of/5,� Distance From Shoreline Cali r -40j1 --j 5/ S ,;� e�,,�
Stabilization
- Materials �G
Brief Description
of the Activity
Describe Briefly the Existing I
Structures Over Land and r't° S t CttOl� Tz�EF ( /W -MCI 4•-4. $ c 4�;G 5(5ee X e
Water (include sq ft) J

V. Dock Builder or Engineer
Name/Company
JIV/1/'L f ee i' G %
Address f I'd �' Phone Number
City + State W Zip Code Email
VI. Cheddist of Required Documents (to include with Application Submission)
,Recent Survey (stamped/signed by a professional licensed surveyor showing the location of the existing or proposed
M structure and/or survey of the existing or proposed stabilization)
[fhotos along property shoreline and photos of any existing structures and/or stabilization in or near the water
[Application fee (check only, payable to Duke Energy) ❑ Signed User Agreement Letter
applicable local, state, and federal permits ❑ Plan and profile drawing showing all measurements and elevations
❑ Habitat Enhancement payment (if applicable)
VII. Approval Process L
• 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.
VIILDirectionsbyRoad �� ----- — .._..__ __._.__., _ _ _ _.__ �� _ _ _�__._ ___--•-- -
Directions by
Road*
IJOJ SA-rM VJ, ~� �a,✓
/Uo �rn 4-s J
M 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
Duke Energy Print Form
PO Box 1006/ EC120
Charlotte, NC 28201
1 agree that the information contained within is accurate:

Y
D_ W_R
Division of Water Resources
201 60333
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization,L", �i J
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
Raleigh, NC 27699-1650
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: Z-1-1,
Mailing Address: 05-
Telephone Number: mos/c�h Fax Number: %O</-
E-mail Address:
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/reRdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: ✓ 461e_S
Company Affiliation: - 37vnrL r k9P C /'i N
Mailing Address: $ �/4�K✓ id C rM
_,a oorr s Ja` lI { , M' Orli
Telephone Number: d D• S 1 Fax Number: �Gl�((00• G
E-mail Address: —C.& 5PAu/AGIS e ");Wd'5 4 -y -A'", A/cf
v
Person to receive the Certification Approval: fir';cly.Cs
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 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: �%,� c,/� Jie , Nearest Town: 61R /UGG/Gc.s
Subdivision name or site address (include phase/lot number): /1/0AAe_,,
Directions to site - please include road names and numbers, landmarks, etc.:
'
77 — ;�eo 7 6rz �5_,*1�9 �v e2 ,�� 4 i*S/_ 7-
S.
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): /-e
6. Property size (acres): . 9.12-
7. Lake/ river/ ocean adjacent to property: .4_r4pe A/o riYlAA�
8. Describe proposed work (include discussion as to how hardenin of shoreline has been
avoided, or why it is necessary): A/iZe 5rcvt,J� 6V'p510n/
9. Will work be conducted from land? 9-- From water? ET
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: SO 1 X / ,
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):
AJi¢ I
7�
Owner/Agent's Signatures (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

Full Pond/
Normal Water Level
Shoreline
Lake
(At Full Pond/ Normal Water Level)
1 bdtLo
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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