20160724 Ver 1_Shoreline Stabilization_20160725

State of North Carolina
�A, D Department of Environment and Natural Resources
DWRDivision of Water Resources
Division of Water Resources 15A — ater 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 UnitZ i 6 0` T?
1650 Mail Service Center T 2 4 _-- - -�
Raleigh, NC 27699-1650 rl!I0D
-20161
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: S•G(LL 1 VAAf
Mailing Address: 83 2 a4TE ST
7J_5E-_P,0.cLL, AIC 8�
Telephone Number: a5. X60. 7/�1' Fax Number:
E-mail Address: St, If u,. n 7 Z Q tf A-60 . Co
2. Agent/ Contact Person
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. df) must be attached if the Agent has signed this application form.
Name: C � I) %3riA4 e 5
Company Affiliat
Mailing Address:
Telephone Number:
E-mail Address:
-c -�. R ecUe (; A/
7
DOr SV'i 11c
•S�� Fax Number:
n/c
Person to receive the Certification Approval: 13 r'ilfgC S
I1. 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

t
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: (A -TA b.l 4/+ Nearest Town:
Subdivision name or site address (include phase/lot number): 4&ry )d C-abb c
16-f- 3 3
Directions to site - please include road names and nu%l ers, landmarks, etc.:
/ 36Int 6N4P+-Ofj
Iso L4-oN .5h"YL its
t R o cz OU • S L A- r•e 5r r' r_c -i—
Latitude (in decimal degrees).35 i 59 i 4o Z% Longitude (decimal degrees)90.9 754 94
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.):
6. Property size (acres): • 416
7. Lake/ river/ ocean adjacent to property: e A& Y' IK AA
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): ,re� e b e i+r A -Q1 'd5 -S
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 level/ Normal Water Level in square feet or acres:
film
11. Total amount of disturbance (including all clearing, backfill, excavation, rip rap, retaining
walls, etc.) above the normal ool lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres:
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): ArA4-55 1i Sew` �
-Fy-ees rse a�
Owner/Agent's Signature*
Printed Name
115A NCAC 02H .0502(f)1
'Agent's signature is valid only if an authorization letter from the owner is provided.
Date
FORM: SSGP 10-2013 Page 2 of 3

R
Normz
S
I ---k Le
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

DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
FOR DUKE ENERGY USE ONLY
Duke File No.
Application Fee $ Security Deposit $ Check # Date Recv'd Initials
Date of Duke Energy Lake Services, applicant and/or contractor on-site inspections Date Initials
Date Final Protection/Avoidance Area Markings Field - Verified
Approved to Start Work By * :
Date Completion Required
Date Passed Closeout Inspection*
Initials
(P�*d) (sign)
_ Date of Any Approved Extension Initials
Initials
Date
Any Stop Work Orders or SMG Violations"? (check one) OYes ONo (If Yes, explain in PART V)
Date Deposit Refunded Initials Date Permit Database Updated Initials
' Forward copy of approved application (all pages, plus any attachments that Duke Energy changed) back to applicant
with Approval Letter and highlight any changes. File copies of Approval and Close-out Checklists and any Stop Work
Orders with application.
PART L - APPLICANT INFORMATION (Please Print)
Name S'�A W� Sty 11 l \%A N Telephone ( 603, 860. 7/4 7
Lake Address 83 5 q 51 -AT -E7 S MFlr T
2-
Su� s 7Z • C,ow.
wN
Contractor Company
3C 5-M E f P
^ J
Contractor Contact Person C_A t p B r i� i e -q
Mailing Address
(If different)
e Fid Awy. /Y #0v-csy&* 1Jf, A/(
Telephone (� l �� .�� 1
LAKE LOT INFORMATION T
Lake a rlvt pN County nkw F3 A city 1 ern- I i State t4 C Tax Map No.4 2-4-5-Z2—
Subdivision-rAGi S 1 AV OI A Ci"7 pffi C I Lot / Section No. S Lot Size . (.10 Acres
Are there any Co -Applicants*? (check one) OYes ON* (If Yes, include names, addresses, phone nos., lot nos., lot
sizes in PART V – ADDITIONAL INFORMATION) + Co -Applicants exist when the proposed work is being done under a
single application, will be performed by a single contractor as one continuous project and is done to benefit multiple owners /
lease holders of project -front properties within a single development. The check for the application filing fee and security
deposit should be from the party shown as Applicant and not several checks from the Applicant and Co -Applicants.
Do not continue the application until an on-site inspection has been conducted between a Duke Energy Lake Services
Representative (DELSR) and the applicant and/or the excavation contractor. NOTE. Inidaliting this pordan of the
AppUaadon by a DELSR in no way consdaam Approval or eminent Approval of the eacanWon or any other lake use
Date of on-site inspection Initials (Duke Energy) (applicant/contractor)
Duke Energy Page 1 of 14 rev 9/19/14
Excavation Program
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application 113 10.docx

DUKE ENERGY EXCAVATION PERMFT APPLICATION FORM
PART H. - DESCRIPTION OF PROJECT
A. BASIC INFO
1. Type of excavation: (check one) New excavation D Maintenance excavation
2. Purpose of excavation: (check one) Boat Access Channel D Water Intake Channel
D Wastewater Discharge Channel D Other (spec):
3. Lake user category: (check one)nvate OResidential Marina DCommercial Marina
Public i COther (spec): 15
C "}INCL
4. Max. Excavation Area Dimensions (ft): Length `T"9 Width io 0 Depth ( 0
(Note: include additional area dimensions if necessary so response to #5 below equals maxarea dimensions in #4)
5. Volume of Excavated Material (TOTAL for the project): 1 I 10 Cubic yards
6. Type of material removed (applicant determines by field sample if practical):
7. Excavation Site area: 0- 02 Acre (s)
Disposal Site area: 0. 0 9 Acre (s)
8. Total Disturbed Area (including equipment staging area): 0, 8 Acre (s)
9. Does the project meet the requirements of the applicable General Permit? (check one) lyes DNo
10. Do you claim title to the disposal area? (check one) Yes ONo
11. Do you claim title to the equipment staging area? (check one) Ves DNo
12. Are there any water -treatment facilities within 50 feet of the proposed excavation area? (check one) Oyes 00
(YYes. specify):
13. How will the excavated material be enftzWed and
disposal area design): 7i re dq L d i 5
14. Type(s) of excavation equipment to be used:
see attached erosion �pntrol plan and
r,44' hu 1AN4
wY�• long rtl�� bAc,K1u-�
15. Will waters or wetlands be crossed in transporting equipment to or from the site? (check one) DYes 1l0
(IDW, explain)
16. Will return water w enter the reservoir? (Check one) DYesJo EWA (If Yes, specify point(s) of re-entry and
show on Excavation Area Drawing)
17. Is there an existing facility (e.& pier) that access is being maintained to by conducting the excavation?DN
(If Yes, specify the existing permit number. If No, include a scaled drawing of the proposed facility). Permit 3 0
18. Total planned duration of thew rk (Include fust equipment mobilizati excavation through final mitigation measures
complete): START/ J& FINISH / J(�
( ) (Y ) (� (Year)
Duke Energy Page 2 of 14 rev 9/19/14
Excavation Program
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application 113 l0.docx

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DUKE ENERGY EXCAVATION PERNUT APPLICATION FORM
C. APPLICANT'S SIGNATURES
Comments:
2�Z-(o I�FKes re �Y--. ��49 SLS 57'
AEAlNETK /-• Woo-z-c,,,j
9561 �-Afe 5T
Applicant Name (print)
Applicant Signature*
Co -Applicant Name (prim)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (prim)
Co -Applicant Signature*
Co-Applicaut Name (prim)
Co -Applicant Signature*
Lot # -� 3
3i
Date '7- l4' 2414
Lot #
Date
Lot #
Date
Lot #
Date
Lot #
Date
Lot #
-Date
*Per my signature, the information provided in fids application is correct to the best of my knowledge.
BEFORE YOU MAIL TBE APPLICATION TO DUKE ENERGY LAKE SERVICES ENSURE YOU HAVE:
• CHECKED THE INFO THOROUGHLY
• MET ALL REQUIREMENTS FOR A COMPLETE APPLICATION (see cover letter of application package)
• INCLUDED A SINGLE CHECK TO DUKE ENERGY FOR THE APPLICATION FILING FEE AND SECURITY
DEPOSIT
• INCLUDED ALL AGENCY PERMITS OR COMMENT LETTERS AND RESOLVED ALL ISSUES RAISED
• INCLUDED ALL REQUIRED DRAWINGS (INCLUDING PROPOSED FACILITIES), IES), PERMIT # FOR EXISTING
FACILITIES, SURVEYS AND PLANS
• INCLUDED COPIES OF DEEDS AND AUTHORIZATION LETTERS
Duke Energy Page 6 of 14 rev 9/19/14
Excavation Program
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application 113 10.docx

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DUKE ENERGY DIRECTIONS BY ROAD
Lake Use Permit Applicants and contractors: Ease of locating the proposed project site can
have a big impact on permit processing time. Please complete this form and return in along with your
completed permit application to:
Duke Energy
C/O Lake Services — EC12Q
526 South Church St
Charlotte, NC 28202
1-800-443-5193 and select Option 5
Applicant's Name: Shawn Sullivan
Street Address (at Lake) _8359 Slate St
Subdivision Name:_ _N/A Lot (s) 33_
Tax Parcel ID (if known):_4628929067
City:—Terrell
State: NC
Latitude: 35.5819
Telephone: [phone]
County Catawba_
Zi p:_28682
Longitude: -
80.9750 -
Directions from major road or highway):
1-77 North to exit 36 — West on Hwy 150 —Left on Sherrills Ford Rd right on Flat Rock RD ell —
Right on Slate Rd
Descriptive Structures- (s) ( i.e. brick garage, white fence, mobile home, etc)
8359 Slate Rd

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