20160592 Ver 1_Shoreline Stabilization_20160613

DUKE ENERGY INTERNAL USE ONLY:
Date Received: FAF Paid
PAID 20180582
_ Construction
,1 Appiication
r
❑ Apocationeomplete .. „3n GI
MEP Fund L Petted No. Water Strategy, Hydra Licensing L41
Duke Energy
Site ID �- Close -Out Date PQ Box 7046/ EC):ZQ
Charlotte, NC 28241
_ --
I. DATE OF APPUCATION* - �p j (� permitiTag #.•
11. APPLICANT INFORMATION (applicant niao" address and Ct?ft m mfurmarm)
LSV D
��32016� �
Name* D 01 Y'CS Primary Phone" %� 6
Address* (Z'aj.� Secondary Phone
City- 1AT L - State's Zip Code* � 8�� Fax Number
Email* . e /,
GiX Q a 4 `�w/� rotes Q. C
�ili. PROPERTY INFORMA C?N pocation of `-
Addles!;* 3 (.40 srcv i A PA -r-9 w i;� M -County'L. * A T A -W -4
City" p t4 State' R 2ip Code* -'86 t) County Parcel ID number
Lake*-. OY WI N mPber?ax ID, TARS + 71,0 b J 2-6+6 Z
5ubdfvision' O
_ L-_-_ 5_--... r' q Lot(5) ��� -0 Plat eooW3Page Z %S
7o enter the Latitude and Longitude aE tfie property, please use a
service/software to easily acquire the location Womation. Values Latitude (e g. 35 7 2345)'
should be provided in Decimal Degrees format (35.1245).
exampleservice. htttoucouchmap.com/lationghtm! Longitudefeg.-s4,i2345)'
Ell. P'ROPOSEO ACTIVITY
C' New/Modiikation of ExIsting Structure µ w C' Maintenance of Existing Structure Y _O Is Dock
ftcation of Existing Shoreline Stabilization ( Maimenance of Existing Shoreline Stabihzatton
ONew/Modittcatian of Existing Structure & Sta6ifization (-Maintenance of Bdsting Structure & Stabilization tt of SHPS El
r Transfer ofownership r Other 1please describe below)6 of ktports, D
Area overland Uq ft)
Aran over water faq fit)
Total Squame Feet
Shoreline stabobMist7l (teen tenTh of Distance From Shorelbtg�� .
Stablilzation
job cvi! �ue� 5 4r Ne—
Materials
Brief Desaiption � 5 PA- t1 *At es -k IMIk� t), L' e- Ca u -v-5 es a* Ked �
of the Activity
F401
Describe Briefly the ExionX'ej,4hWiPoc,
StructuresOverlandandWaxer ii(include sq ft)nd lc�, �OrG� f r f f� r
to

V. Dock Sunder or Engineer
Namexompany
Address 3S af}}� rr e r—Aevn 41J Phone Number E
City �c pi G State Zip Code .2 Email G StAt�1 AGI S ` GJi NOI gd �'rsi l�'►, /V e
lit, Cheddtstof Required Doconents (to indede witty Apptication Submission)
...,,Recent Survey (stamped/signed by a professional licensed surveyor showing the location of the existing or proposer!
IIS structure and/or survey of the existing or proposed stabilization)
P. otos along property shoreline and photos of arry existing structures andlor stabilization in or near the water
Application fee (check only. payable to Duke Energy) 0<19ned User Agreement Letter
[v�Applicable local, state. and federal permits ❑ Plan and profile drawing showing all measurements and elevations
C] Habitat Enhancement payment Cif applicable)
NNI. Approval Process T
9 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.
Directions by
Road'
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Please complete, print and sign this application. Then enclose all Items from the checklist above in an envelope and
submit all the /(formation to the address below.
Water Strategy. Hydro Ucensieg and take Services Print form
Duke Energy
PO Box 11006il=c120
charlotte.Nc28209
I agree that the information contained within is accurate.,

State of North Carolina
> Department of Environment and Natural Resources
nAILIDivision of Water Resources
Division of water Resources 1sA 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
Raleigh, NC 27699-1650
1. Applicant Information {15A NCAC 02H .0502(x))
1. Owner Information/ L
Name: �abefT �roST
Mailing Address: 3(o CC(urrc. M f!FNcr
rti4—,.-k ifQ_ Nr .2 -$i -?7
Telephone Number: I Fax Number. _
E-mail Address: �-2S4'C-e2 Aeu44,Areho,, t�qq r�
m . Ale -
2. Agent/ Contact Person inforattio
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
htt2://www.saw.usece.army.mil/Partaisl59/docslreRulatory/regdocsLPermitr>/SAMPLE AGENT AUTH
ORIZATION FOR.Ddi) must be attached if the Agent has signed this application form.
Name:fC5
Company Affiliation: gff�kv_ l (14,1rt-04 564ioe.5 Se�r�r�c�s
Mailing Address: 8 0#k r; c1 c_ (`form 4 w
1M oore,>yiUe C .)LL9/15—
Telephone Number: 7-d i. 60. -57/// Fax Number: 76 �. 41601
E-mail Address: C 5rF;L6dA us tv al;nr4/,Are.4m _ nri >�
Person to receive the Certification Approval: c b
11. Project Information 115A 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 a prop rty (where work is to be conducted)
County: Aw 4 Nearest Town: elF-r-�,,vA R
Subdivision name or site address (include phase/lot number): 45i -D riA 40
Directions to site - please include road names an numbers, landmarks, etc.��/X
PON ka rr/ /3tvol Rtow
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.):
6. Property size (acres): C)•5
7. Lake/ river/ ocean adjacent to property: "A � �i/ci rMA n/
8. Describe proposed work (include discussion as to how hardening of shorelinjhas been
avoided, or why it is necessary): %&Ji 2-e � -d-We- ✓c�/f" mos i a J
9. Will work be conducted from land? Q 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:
00 /X S
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake level/ Normal W ter Level and 50 feet land -ward in
square feet or acres: _ /0 0
12. Please describe the vegetation above the normal pool take levell Normal Water Level and
50 feet landward to be imtra ed�(nt�mber of trees, for instanCe3: �¢ a�� s
J� 4 s
�G
Owner/Agent's Signature` 'X,//& 4L__ '50- /16
[ISA NCAC 02H .0502(/)) Date
Agent's signature is valid only if an authorization letter from the owner is provided
FORM: SSGP 10-2013 Page 2 of 3

Pull Pond/
Normal Water Level
Shoreline
La ke
(At Full € and/Normal, Water Level)
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as loft x looft)-:
I. 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 Malls, docks, etc.
S. location of any excavation or dredging below the hull Pond/ Normal Water Level elevation
6. Location of construction access corridors
FORM: 55GP 10-2023 Page 3 of 3

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