20161011 Ver 2_Shoreline Stabilization_20161117

EfJERf �\� U
Y INTERNAL USE ONLY:
Construction
Date Received: FAF Paid Application
Application Complete
Permit No.
HEP Fund
Site ID Clo e utI
I. DATE OF APPLICATION* Permit/Tag #l.:
version 13P
4 DUKE r
ENERG)
Water Strategy, Hydro Licensing and Lake Services
Duke Energy
PO Box 1006/ EC12Q
Charlotte, NC 28201
IL APPLICANT INFORMATION (applicant mailing address and contact information)
Name* DI GLr)e p rcr) Primary Phone 754 - 54o -Z4-01
Address" �4p� S�allv�o��h `�r Secondary Phone gStpO
City- State* UC Zip Code* Fax Number p
Email*
Ill. PROPERTY iNFORMATiON (location of .permit)
Address* L%`j52-ND-Ss 1I- r, County* C testa FF R PE `11MITT NG
ES
city- Te rr-e-lk State* E Zip Code* 2$(P $ County Parcel ID number
(e g. Pin, Tax ID, TMS 619¢ 7/7 /
Lake*: NoYw n Number...)
Subdivisioni�Ct'—)Ads S Lot(s) (� Plat Book/Page [ a % y5 d 566
To enter the Latitude and Longitude of the property, please use a ,
service/software to easily acquire the location information. Values latitude (e -g-35-12345)- 55
should be provided in Decimal Degrees format (35.1245). Longitude (e g.-80.12345)'LEO. WeXG
exarr?lple 3ervrce itp,/Irtou#�rnap cortallatlorrc� iitri#I .
IV, PRoRi` P0, ACTIVITY
(' New/Modification of Existing Structure f Maintenance of Existing Structure Is Dodc
Covered?
(' New/Modification of Existing Shoreline Stabilization (' Maintenance bf Existing Shoreline Stabilization ❑
('
New/Modification of Existing Structure & Stabilization (' Maintenance of Existing Structure & Stabilization 41of slips
C Transfer of Ownership (' Other (please describe below) # of Jetports
Area over land (sq ft) Area over water (sq ft) Total Square Feet
Shoreline Stabilization (feet) Len hof j/, Distance from Shoreline dlf fIIi/w c�(j ; n/y S�" `?" A/e.
Stabilization / v a t t C 6 —T
Materials �`V
po R�
Brief Description
of the Activity
StA/l 2, I-ic, SAA", e/J/IAiWCC ��Cr rip r�� -� /Oo
5 &AY'e 1 G / A✓
Describe Briefly the Existing • / pie v, e
Structures Over Land and i' _5,i e /N
Water (include sq ft)
y / 1W;1 A/ A0411i 6M -14 r-
Af47.
t
I f

DUKE ENERGY INTERNAL USE ONLY: Construction U
KE
Date Received: FAF Paid Application
Application Complete �}�t;-r�/��
version 13P ' ENERGY,
Y,
(]
Hermit No. Water Strategy, Hydro Licensing and Lake Services
HEP Fund Duke Energy
PO Sox 1006/ EC12Q
Site ID Close -Out Date Charlotte, NC 28201
1. DATE OF APPLICATION*
Permit/Tag #.:
IL APPLICANT INFORMATION (applicant mailing address and contact information)
Name* ..�. D 1 Q-Yley...-.,.__,_... P,i't3f1- PrimaryPhone*'1p4 - 540-(040 ( 77] ..
Address* Secondary Phone 7c* -(017-8S O
City's clwY c- State*[wC Zip Code* ZSZ2{, Fax Number
Email*
ill..iFftOPgRTYINFORMATiON-(location of permit) -
Address* I %q5Z tA55 mac. County*[—C Q}Qw ba
City's T",re-li StateR] Zip Code* County Parcel ID number
(eq. Pin, Tax ID, TMS `6Q•¢ %%
Lake*': Nornv-n Number...)
Subdivision w�jG� 5 Lots) !,6 Plat BooldPage 9'S d solo
To enterthe Latitude and Longitude of the property, please use a Latitude (eg. 35.12345)*litz
,r5 T
service/software to easily acquire the location information. Values
should be provided In Decimal Degrees format (35.1245). Q
.q����Jfi#9Ju�r��+cc►t�9ai,#on��iLrA1 - Longitude (e.g.-80.i2345)` (/
71
IV. PA*0P ;9Q ��71V1�Y
(' New/Modification of Existing Structure f Maintenance of Existing Structure n Is Dock
Covered?
r New/Modification of Existing Shoreline Stabilization (' Maintenance cif Existing Shoreline Stabilization
C New/Modiftcatlon of Existing Structure & Stabilization ( Maintenance of Existing Structure &
C. Transfer of Ownership C Other (please describe below) .
Area over land (sq ft)
Shoreline Stabilization (feet) Length of
Stabilization
Brief Description
of the Activity
Area over water (sq ft)
Total Square Feet
# of Slips
# of Jetports
Distance from Shoreline Q10-0 l ilt S /
laatic6
Materials
R) R�
5�A �a
VA�
�iG%15AreeAfCe
JV 14 5 /1 e J -e /'Al `
Describe Briefly the Existing , / /1. jAw ' � Pi e r %C e ,D 4,9
Structures Over Land and r °LSI a /� '�^�- l
Water (include sq ft)
5 A- ',A/5 4.V/j J*VAt 1 74r
pP
t
F f

_ V.+Dodc Builder or Engineer
Name/Company 'b , -5 tune- S- (R"CiArig
Address b 38 ©a,�4-jcj j�, Far m 4 -u - Phone Number [ -C4- - (a (Q0 —5 11
city Roo Wsuille 5tate R Zip Code 2g I l5 Email Cbe.seawaus e (,vire�s%'ea-m • net
VL Checklist of Required Documents (to include with Application submission) _� ,� _ -__ -.. _ -�✓
ecent 5urvey (stamped/signed by a professional licensed surveyor showing the location of the existing or proposed
LI structure and/or survey of the existing or proposed stabilization)
[✓j'Photos along property shoreline and photos of any exiXed
ructures and/or stabilization in or near the water
[Application fee (check only, payable to Duke Energy)
User Agreement Letter
applicable local, state, and federal permits and profile drawing showing all measurements and elevations
f -I Habitat Enhancement payment (if applicable)
�lll. 'Approyal 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 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.
Vlli. Direction i;tsad
Directions by
Road'*
a::--77 �Xi} 3(oj vues+ ori F
teak on lesser T41.1oV)d Rd.�
�CLSs r ` o -A A -he Vf-rl
0 (52 on r i 9hi
.tsol
end oX V ---,ser 17slanvA
`13C,.Appil�ttio�.�rubtriissian'. - _ - .
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
PfMt
Duke Energy
PO Box 1006/ EC12Q
Charlotte, NC 28201 A - n
I agree that the information contained within is accurate:

State of North Carolina
Department of Environment and Natural Resources
DWR_11 Division of Water Resources
Division of Water Resources 15A 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 1`15A NCAC 02H .0502(a)l
1. Owner Information
Name: �DAnf 2 CA m Cion! fg
Mailing Address: 5403 5-rA/A)0V �r
Telephone Number: 7(5�0 . �*( 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 army mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FOR df mush be attached if the Agent has signed this application form.
Name: I i� fJr� 1C.S
Company Affiliation:
Mailing Address:
y Aec9c , w
Telephone Number: 7K "oFax Number: -Lo f/6/1
E-mail Address: C4e,5;eA %S 1,0j 1.15t-e.*m• ^ve-f
Person to receive the Certification Approval: cA; a /3 r Ae_5
11. Project Information 1`15A NCAC 02H .0502(a) & (b)l
1. Attach a vicinity map (Le_ 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: Q_0_+Qwba- Nearest Town: i c r r
Subdivision name or site address (include phase/lot number):
5.
6.
7.
8.
Directions to site - please include road names and numbers, landmarks, etc.:
-1-17 tx44- 3C., vve5{ on N -t y 150 , lel+ un K� serl`sland RJ..
Cin A -m t o
Ci f MayshQll Steam Plan}) aA- A -he e.nd o�
I-' -r-, in r�I P3'lzi'_ or, ri ahi
Latitude (in decimal degrees) J -65�_ Longitude (dedmai degrees) �� 7
Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): rescde�aL
Property size (acres):
Lake/ river/ ocean adjacent to property: Norrna�
Describe proposed work (include =discsion as to how harde ing of oreline hasbeen
avoided, or why it is necessary): ri ew 6.'o_5,0 ✓
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:
doe x 3
11. Total amount of disturbance (including all clearing, backfill, excavation, rip rap, retaining
walls, etc.) above the normal pool lal a level/ Normal Water Level and 50 feet land -ward in
i
square feet or acres: /Qd X
12. Please describe the vegetation above the normal pool lake level/ Normal Water Lev 1 and
feet landward to be impacted (number of trees, for instance): Yf¢55 Z'
A�,,.� Iigry Cam do 16-77-1%
Owner/Agent's Signature* Printed Name Date
115A NCAC 02H .0502(f)1
Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3
S

Lake
(Atfull Pond/Normal Water Level) �O ld
i
3
Full Pond/
Normal Water Level
on, im
Shoreline
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ftx 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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STATE OF NORTH CAROLINA
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PAUL. J. CAMERON t JOHN B. CROUCH JR.
11D, 7327 IPARCEN. NO 49471 MO 31471
SURVFt AND NAP PRIPAN I Sr. LEGEND
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PAUL. J. CAMERON t JOHN B. CROUCH JR.
11D, 7327 IPARCEN. NO 49471 MO 31471

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