20161229 Ver 2_Shoreline Stabilization_20161212

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r DUPE ENERGY INTERNAL USE ONLY: Construction
Date Received: FAF Paid Application
f—I Application Complete
HEPFund Permit No.
Site ID Close -Out Date
version 13p
4 DUKE
ENERGY.,
Water Strategy, Hydro Licensing and Lake Services
Duke Energy
PO Box 1006/ EC12Q
CiLarlotte, NC 28201
I. DATE OF APPLICATION- I % . � �. a{, �(o Permitrrag #.:
If. APPLICANT INFORMATION (applicant mailing address and contact information)M�V��
Name*eel �s e� Primary Phone* 12114ZZ , 3569
State* 9 Zip Code*
KV-OaW"✓] State* © Zip Code*
o rel q -N
Lot(s) ',� A
County Parcel ID number
(e.g. Pin, Tax ID, TMS
Number.-)
To enter the Latitude and Longitude of the property, please use a Latitude (e.g. 35.12345)*rj ,�ps3�
service/software to easily acquire the location information. Values %
should be provided in Decimal Degrees format (35.1245). U�./\
Longitude (e.g. -80.12345)* ,_� oc,7
example service: http: itoucbmap corxi/lationg html
N. PROPOSED ACTIVITY
(' New/Modification of Existing Structure C Maintenance of Existing StructureIs Dock
11 Covered?
New/Modification of Existing Shoreline Stabilization
C New/Modification of Existing Structure & Stabilization
C Transfer of Ownership
C Maintenance of Existing Shoreline Stabilization
(-Maintenance of Existing Structure & Stabilization # of Slips
C Other (please describe below) # of Jetports F]
Area over land (sq ft) I I Area over water (sq ft) I I Total Square Feet I I
Shoreline Stabilization (feet) Length of Distance From Shoreline ftp; J1,4111,0, exp a ,
Stabilization /�D
Materials i jrC Y 1�0 ex-
Brief
K
Brief Description
of the Activity
S%�- � 5 �t r�� e. ,� �o ►�,c-1.'�rc � r'nrS�i¢1 r' �t �'-{�% � •` Y'i V r �' �o c /C. r
A CL0,VK pA6f '4'kis4
Describe Briefly the Existing
Structures Over Land and
Water (include sq ft)
% NJeAII; IF YIO ! P cr

V. Dock Builder or Engineer
Name/Company I CA C On% ? Xe
Address 0-1(V'r t A -V -M ( Kr Phone Number % (0 (P o•
City PL•SYi�IG State Zip Code Email �S/+t • Mc�
C:t7C3tAKJAi�S Q6c,JiN
VI. Checklist 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
IIJJ structure and/or survey of the existing or proposed stabilization)
Y"Photos 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) arfigned User Agreement Letter
2'Applicable local, state, and federal permits ❑ Plan and profile drawing showing all measurements and elevations
❑ Habitat Enhancement payment (if applicable)
Vll. 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 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.
-Vlll. Directions by Road
/Sa 1 K T sal Kd•1
Directions by
Road k-1 $ i /%iDYr; Arm� L— onl
ADR �,0,4
IX. 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 Piro Foim
Duke Energy
PO Box 1006/ EC12Q
Charlotte, NC 28201
I agree that the information contained within is accurate: ' I I
Signed By

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
JDWR
Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSCP 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(a)]
1. Owner Info m
Vion
Name: edLr
Mailing Address: _ • O �� I--_COY-Fie-1; its,
Telephone Number: W. 61Z-3561 Fax Number:
E-mail Address: k" 4 s er 0 ou ROOK.. COON
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
htta://www.saw.usace.armv.mil/Portals/59/docs/reeulatory/reedocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: Ch c s
Company Affiliation: C-4 C -5-1-oArc. ? Re"e_Uejej
Mailing Address: 3g w,
oorcgv; tl.f C SJ
Telephone Number: _,P4. (PIPO. 5-111 Fax Number: D -(00.
E-mail Address: e-hc Co >ve-
Person to receive the Certification Approval: A i p BnAk c j
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:
Subdivision name or site address (include phase/lot number):
Directions t% site - please include road names and numbers, landmarks, etc.:
�J 0 At /�j�►t!y A/ �t 1t' �1 /� •, ��oN STAre
7 74 �6 N 46'rri tp0N F4 -r -A?_, 1,-�—Onl /7"14- e- —,Fo d
Latitude (in decimal degrees) -35: (05.3 4.17L Longitude (decimal degrees)—Y
� 115325-7
5. Describe the existing land use or condition of thsite at the time of this application
(residential, undeveloped, etc.): lrc 5 o Ae,JZ,
6. Property size (acres):
7. Lake/ river/ ocean adjacent to property: A-AKc NO rh *01/
8. Describe proposed work (include discussion to ho h"ard�ening of shoreliWer
s been
avoided, or why it is necessary): Z���/�ZL s �l•N� 74 rc%'eg)o-4
9. Will work be conducted from land? M 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:
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: X t
12. Please describe the vegetation above the normal pool lake level/ NormalWaterLeve and 50
feet landward to be impacted (number of trees, for instance): t ees
Owner/Agent's 6gnature*
Printed Name
[15A NCAC 02H .0502(f)]
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSCP 10-2013
Date
Page 2 of 3

Lake
(At Full Pond/ Normal Water Level)
Full Pond/Ci a v O o UO
O Ooa (3 Po op Db vU
Normal Water Level C� oaw
Shoreline v Co c:;'A Acre ss
10
X60
l�
8 �-• Yes
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10ft t 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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DATE 9-15-16 DB: 2260 PG: 587 PHYSICAL SURVEY
DEDMON SURVEYS DB: PG:
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PROPERTY WY9E su9.IEc1 ro REDa+DED DR SCALE: 1" 60' PB: 59 PG: 715 FOR
'0 INIR ORDEO RWM a WAYS OR EASEMENTS
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STATE RARN RO x � NOR To ANY � ON CHUCK POOVEY, PLS #3762 �I T
x DIMENSONS a ALL IMPROVEMEMS ' N ON ROBERT DEDMON, PLS #3899 FALLSTOWN TOWNSHIP YY , KENDALL FOSTER
$ a Des PUT s"ouO NOT 9E scwED OR QExn
g uPON FOR D'OscN ON CONST*== YYNOM 3704 NC HIGHWAY #16 NORTH IREDELL COUNTY, NC
gi A n— VVNFCAT OF ALL DINENSGN$.
4 ` LRMr& CDPRS OF Tm ELLE ARE FMR REFERENCE P.O. BOX 494 —DENVER, NC 28037
ONLr AND wY q x usfD M DESIGN NONN. PHONE: [phone] APACHE RD — TROUTMAN, NC
10' DRNN.OE : utILRY EASEMEW ALONG LOT LINIM FAX: [phone]
NO DEomnc MONUMENT FOUND W -PN 20001 a PROP". 1
SUIN. BY: WT DRAWN: RD JOBA X15APACHE LOT #2A, PLAT BOOK 59, PAGE 115

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NOTES:
PROPETIV MAY BE SUBJECT TO RECORDED OR
• NOT OPo(aiTS OF WAYS OR EASEMENTS
' REGUTA
PRI, ANKPLANNNG OR S AND NIG
CONSTRUCTION.
' �Slq LD N09 �VEMENTS SNOWN aN
UPON FOR DESIGN OR CONSIRUCTpN WTTIOIIT
A FIFLp yERIFNwTgN OF ALL OUIENSIONS.
DIGITAL COPIES OF TNS FEE ARE FDR REFpEPICE
ONLY AND WY OF BE 115EO FOR DESON WORK
f0' DItA1NA[U: a: UTILITY EASEMENT ALONG LOT LINES
NO GEODETIC MONUMENT FOUND W I N 2000' OF PF
DEDMON SURVEYS DATE 5-8-12
SCALE: 1e - 60'
CHUCK POOVEY, PLS #3762
ROBERT DEDMON, PLS #3899
4837 NC HIGHWAY #16 NORTH
P.O. BOX 494 .- DENVER, NC 28037
PHONE: [phone]
FAX: [phone]
CPOOVEYI ®GMAIL.COM
PN
1844 PG: 1348
PG:
52 PG: 27
FALLSTOWN TOWNSHIP
IREDELL COUNTY, NC
SURV. BY: CP I DRAWN: CP I JOB/ APACHE
700
PS
52-27
1906/2422 CARDEN
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120 180
GRAPHIX: SCAB — �.
EXEMPT COMBINATION MAP
FOR
AP ACCHE RO/'AD
F/
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PLAT PREVIOUSLY RECORDED IN PB 52 PAG 2;
THE PURPOSE OF THIS MAP IS TO COMBINE TRACT #2B
WITH EXISTING LOT 1700 OF PUT BOOK 52-27
& ALSO SHOW REMNNDER TRACT.

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