20160925 Ver 1_More Info Received_20161027

0�261
1 V� State of North Carolina
Department of Environment and Natural Resources
DWIK Division of Water Resources
i5A NCAC 02H .0500—Water Quality Certification,Shoreline Stabilization
Division of Water Resources FORM: SSGP 10-2013
5A-oYr_(-N,,- Trrn6,+ Application Form
Four copies of the application (including attachments) and the application fee should be sent to:
Division of Water Resources Q
401 & Buffer Permitting Unit
1650 Mail Service Center
Raleigh, NC 27699-1650 ' 7 '016
. q
1. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Inf2L)41M
ation /
Name: L4 Na2E_*1_9e,?YA1Afif�
Mailing Address: tP- 56) 6�:19 A rev- 74 1,A/.
Telephone Number:4;-3. 7,37 Fax Number:
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.armV.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FOR df) must r be attached if the Agent has signed this application form.
Name: " /'5r- -e 5
Company Affiliation: C 5TbA✓c '` ec ��'.v
Mailing Address: 639 w
611-11rC51v�`*, /YC 1;V11
Telephone Number: 70 (11)• /!/ Fax Number: 0 �oGd 5
E-mail Address: 5 .FG1s G(Jit/�s�r���• �dc
Person to receive the Certification Approval: °Q 143._.'d2 GS
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

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: _ Nearest Town: UG
Subdivision name or site)a dress (include phase/lot number):
Direc ions to site- pleasQ includeroad name numbers, landmarks etc.:
P b Al AItr I
� cc
, 47
Latitude(in decimal degrees) 3�_3_3 71 T1 Longitude(decimal degrees) --go, �5 J�`1 d
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped,etc.):
6. Property size(acres): 0.5,74 �t.
7. Lake/river/ocean adjacent to property: !/O,4-a,:, -
8. Describe proposed work(include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Sv-PAz H: r /7
�n !>' �a� I`� Yd 1 vtP.iY� r. ,/1 0.,✓ CA-�?�q, T I'e�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:
'ff s
11.Total amount of disturbance(including all clearing, backfill,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:
12. Please describe the vegetation above the normal p6ol lake level/Normal Water Level and 50
feet landward to be impacted (number of trees,for instance): fe,.tXI4 /5 5•-�.��
/��J.A 4�9iv��N�2UNNEIZ �
Owner/Agent's Signature* Printed Name Date
[15A NCAC 02H .0502(f)]
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM:SSGP 10-2013 Page 2 of 3

Lake
(At Full Pond/Normal Water Level)
Full Pond/ C
Normal Water Levelel ! �
Shoreline
�©�e
I �
00
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 INTERNAL USE ONLY: Construction
KE
Date Received: FAF Paid Application ` s
,Knbn 13p \Z.., E N E RG
Application Complete
Permit No. Water Strategy,Hydro Licensing and Lake Services
HEP Fund Duke Energy
PO Box 1006/EC12Q
Site ID Close-Out Date Charlotte,NC 28201
I.DATE OF APPLICATION* (O Permit/Tag#.:
-11.APPLICANT INFORMATION(applicant mailing address and contact information) M
Name* -7AN, �� � UN N e"Primary Phon ���-3� ��_-�y
L ��.a...
AD M
Address* 12-730 k(6W w0 P,— UJ
Secondary Phone H�3 5
City" I CAA E,1 lI State*W Zip Code* Fax Number
Email*
Ill.PROPERTY INFORMATION(location of permit)
Address" �3o W 1 C1,� a 'r� L IJ County" M,SC<L.<-L IJ 8 U(AL3
City- G(�Q R(tj j jE State*Rl Zip Code* County Parcel ID number
(e.g.Pin,Tax ID,TMS
Lake*: (�(� ,d I NZtAP0 LAKE Number_)
Subdivision I Pt4V )aP l Lot(s) 5`3 PlatBook/Page l
To enter the Latitude and Longitude of the property,please use a Latitude(e.g.35.12345)* 3S 3 3 7/757171
service/software to easily acquire the location information.Values
should be provided in Decimal Degrees format(35.1245).
. : .:. gL7... . - Longitude(e.g.-80.12345)* ' , ?53 g
Wimple seMce: httik//itouch;;�p„comAaTIT9PubmI
IN.PROPOSED ACTIVITY
('New/Modification of Existing Structure r Maintenance of Existing Structure Is Dods
Coveredl
)V/New/Modification of Existing Shoreline Stabilization ('Maintenance of Existing Shoreline Stabilization
C'New/Modification of Existing Structure&Stabilization r Maintenance of Existing Structure&Stabilization sof Slips 1
C'Transfer of Ownership C'Other(please describe below) #of Jetports
Area over land(sq ft) Area over water(sq ft) —� Total Square Feet
Shoreline Stabilization(feet) Length of 'OQ t Distance From Shoreline W // p f/eW ;r t 5 ,0-rr `.
Stabilization Mat
enas
Sa�G✓r S(o l��� 1/1��. {'l�C-�i� of�1� '��� ��`�
Brief Description I
of the Activity
Describe Briefly the ExistingLS
Structures Over Land and
Water(include sq ft)

V. Dock Builder or Engineer
Name/Company C i-, ke-e-!qj;
Address Phone Number
5t e
city S 1A f ate Zip Cod Email (-L-5 ct
Checklist.1 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
LTJ structure and/or survey of the existing or proposed stabilization)
[.'photos along property shoreline and photos of any existing structures and/or stabilization in or near the water
[R'Application fee(check only,payable to Duke Energy) Signed User Agreement Letter
—< Plan and profile drawing showing all measurements and elevations
❑e Applicable local,state,and federal permits ❑
Habitat Enhancement payment(if applicable)
V11.Approval Process
• 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 retumed 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.
VIII.Directions by 4oad
I A Al 4),l 54-0 OJ
Directions by
Road*
we'A `.�/.
9
IX.AppUcation 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,Hydra Licensing and Lake Services Plint Form
Duke Energy
POBox 1O06/EC12Q
Charlotte,NC 28201
I agree that the information contained within is accurate* 49�WL

`I CERTIFY THAT TH15 MAP WAS ORAWN UNDER MY SLPERVISION FROM AN ACTUAL SURVEY MA13E LINOER
MY 9 PERVISiON: THAT THE BOUNDARIES NOT SURVEYED ARE IAAICATED AS ORAWN FROM REFERENCED
MAP; THAT THE RATIO OF PRECISION OR POSITIONAL ACCURACY EXCEEOS I:J84500: AND THAT THIS
MAP MEETS THE REDUIREMENTS OF THE STANDARDS DF PRACTICE FOR LAND SURVEYING IN NORTH
CAROLINA 121 NCAC 56.16001.'
�
rii S I GNED
DSK JPPPS3 SKJ0� D. LOWERY NCPLS L-40
53
APRIL 17TH. 2013
THE IMPERVIOLS AREA FOUND TO BE WITHIN THE BOUNDARIES OF THIS LOT IS AS FOLLOWS: `,��•`�H,(`,A���i���
HOUSE: 3157 SF Q� ....... .��
DRIVEWAY 8 SIDEWALKS;I 1487 SF 9 SF O.PQFESS/p�;/2
PATIO: N/A = Q :9
MISC: N/A MM NTAIN ISLAND LAKE _ SEAL
TOTAL IMPERVIOUS AREA; 4662 SF L2 L-4530
MAX. IMPERVIOUS AREA ALLOWED: 5085 SF S 13.11'55'E 61.92' <9 OQ ;' 2
le' 0/S �i
ZONE le.-EKA FLOOD
—-- O LO`i' •'
VICINITY MAP INTSI
817E LOT 53
25947 SF
FPE•657.0
p1 /6 N
100, UNDISTURBED WATERSMW m
--w -- s
io
m
io �
LOT 54
z I m LOT 52
I Y°
10
TWO STORY =
BRICK/STONE
"T-00x.04
' • •zMae
..4 sap
� �•/1.4\ a.e
' IPF IPF
J ?
6�
Gov c/ t �
TIES:
IPFIAI N I1'09'15'14 107.00'
TO A NAIL IN®/C
/4._4!C /A/ IPF 161 TOGA NAIL3IN B/C 15'
CC//�� Raw ��
LINE BEARING DISTANCE
L I S 02'09'50-E 30.00'
L 2 S 15•I6'35'E 43.33'
CURVE DELTA ANGLE RADIUS ARC TANGENT CHORD CHORD BEARING
C 1 22'45'00- 175.00' 69.49' 35.2t' 69.03' N 19'12'32-E
NOTE: U.G. UTILITIES IN AREA
SERV 1NG OTHER PRl]PERTIES.
THIS PROPERTY SIJMT TO ANY EASEMIDM
AND/OR RIGHT-OF-WAYS OF RECORD.
SEE REC07DEC PLAT FOR FURTHER NOTES.
IPF - IRON PIN FOUND
A - IRON PIN SET PHYS I CAL SURVEY
BC - BACK OF CURB
MP - EDGE OF PAVEMENT OF
pme- PLIC STORM DRAIN 2730 HIGHWORTH LANE
EASEMU4T LOT 53 OF PRESERVATION POINTE
S T - S 1G 14T TRIANGLE
FY - FRONT YARD PAW CREEK TOWNSHIP. MECKLENBURG COUNTY. N.C.
SY - S I C E YARD PROPERTY OF ADAM 8 .EARN I FER LANGENBRU/NnER
NY - REAR YARD
FPE - FLOOD PROTECTION ELEVATION
JEW LNS 8 LOWERY PLS PA
AREA RY CY71RIl I NA TF rrT4P1 1TAT l nN P.D. PDX 1 169

,q o o soy w mm
56
SHORWNE OLSiGNATION I
NDEX
102
t9 100
MOUNTAIN ISLAND LAKE 39 \�\\ p„a; / a �- --.-w� t.. ••'
J,
I Amvmmnall
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9 " -_-Z------ MOUNTAIN ISLAND LAKE
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SITE 105
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103Jai Af�
106
OCAlION MAP-NOT TO SCALE ------ 36
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--------- GRAPHIC SCALE
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K MERECORD PLAT 61.570 ACRES
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