20170013 Ver 1_Shoreline Stabilization_20161230

DUKE ENERGY INTERNAL USE ONLY:
Construction DUKE
Date Received: FAF Paid Application
jApplication Complete version 13p - E N E RC)
] ,
HEPFund Permit No. Water Strategy, Hydro Licensing and Lake Services
Duke Energy
Site ID — � Close -Out Date Ch Box 1006/ EI 3
Charlotte, NC 282018201 7 U
I. DATE OF APPLICATION" a PermitfTag #..-
If. APPLICANT INFORMATION (applicant mailing address and contact information)
Name* f�l I 4DW Primary Phone" 7Q� oZ
Address' �' E Secondary Phone
City" pprC$V1 t State` WA Zip Code` Fax Number
Email" �K
111. PROPERTY INF RMATION (lo
M,4-i/Com
of {permit)
Address 1167 eqC I//eW ;9r . County -1
i
City' State* R Zip Code* e2�// 7 County Parcel ID number ERMi
(e.g. Pin, Tax ID, TMS 55736(4(5
Lake*: Number...)
Subdivision rp Pe- Of ;P/pje� Lot(s) 31 32=— Plat Book/Page �j � 7?b
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)*
3 Jr. 53 89�a
should be provided in Decimal Degrees format (35.1245). Longitude (e.g. -80.12345)' 0 6. X06 34-0%
example service: httpJfttouchmap.com/lationg.html
IV, PROP0SE0 ACTIVITY
C New/Modification of Existing Structure C Maintenance of Existing Structure
ZKNew/Modification of Existing Shoreline Stabilization C Maintenance of Existing Shoreline Stabilization
r^ New/Modification of Existing Structure & Stabilization C Maintenance of Existing Structure & Stabilizatic
C Transfer of Ownership
C Other (please describe below)
Is Dock
Covered7
# of Slips
# of Jetports
Area over land (sq ft) Area over water (sq ft) Total Square Feet
Shoreline Stabilization (feet) Distance From Shoreline i �k1
Length of / 3o IN S �/✓ 5
Stabilization
Materials i /`C nR
Brief Description -/ �'KL B/'t /� �� ��D `5 }�Rlt'Inu S ope W i ; t
of the Activity �- y,� t I l b e- e-omP � ( C 0 V Cr W i 'f ok -C616C--/ ` 't^! C
r-- t 14
Describe Briefly the Existing •� W4 �i e
Structures Over Land and }
Water (include sq ft)

V. Dods Builder or Engineer
Name/Company WNSGAPe5 0 /4/(@ 9,0VwtA^/, —A(C-.
Address Q %30X 3 B7 7 Phone Number ��Q (P �. 63 13
City /Vlpq� r) I StateZi Email
© p Code %8/17 /lZw4(SG.4 peS el -1,4 t A(Ov-MRI. Corn
Vl. 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
uu 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
Q Application fee (check only, payable to Duke Energy) [✓j"Signed User Agreement Letter
[Applicable local, state, and federal permits ❑ Plan and profile drawing showing all measurements and elevations
❑ Habitat Enhancement payment (if applicable)
Vill. 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
Directions by
Road C� „ r, `° (•) �-�— vnl .L7 �� o-�, �f NC' 3 y �..+ 0/dFiGh Y i G W .
J
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 Print Form71
Duke Energy
Box 1006/ EC
Ch 1
Charlotte, NC 26201201 /
I agree that the information contained within is accurate:

State of North Carolina
Department of Environment and Natural Resources
DWR
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
Three copies of the application (including attachments) and the application fee should be sent to:
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: k` FiA 9-di;d q -kw
Mailing Address: IV 6Vc, Gefe.K l..00p
NI DO�GSV i �e r N e W11-7
Telephone Number: 70Lf 744_ q -6f -Z Fax Number:
E-mail Address: kj( Ed4 Af4Alq �• C'0
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 AUTHO
RIZATION FO�iRM.pdf) must be attached if the Agent has signed this application form.
Name: Ams,o,W G t/?- roe -y
Company Affiliation:
Mailing Address:
es
rrn !ZC
F& r3©x 3 877
Mooresv t 11e A C_ "11-7
Telephone Number: FaxNumber:-7 040-46'11J'
E-mail Address: Lg wN5C4 pe�l� G, 'Y% "etk#JWee._ C_*W .
Person to receive the Certification Approval: 'V5.01V Co
II. 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, etc.),
rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations, and
FORM: SSGP 10-2013 Page 1 of 3

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: ::;2cd e 4 Nearest Town: I " DDres-0;m-
Subdivision name or site address (include phase/lot number : =J I c o+ Ft Ne. s
/D7�GA-'r,�ii/iek )i' vermesY�1/�/17 10 3( ;, 32
Directions to
- please include road names and
:s».r4
fibers, landmarks, etc.: l 77 /V
v; e- V Zlr.
Latitude (in decimal dearees)35. 53 Y112— Longitude (decima►degr+ees) 8D . % olr 3!b7
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): re5iJe1u-s' 4(
6. Property size (acres):
7. Lake/ river/ ocean adjacent to property: I-AAAL &irMA*J
S. Describe proposed work (include discussion as to how hardening of horeline has been
avoided, or why it is necessa ) 1 rt r
Y necessary):- Ke nufwoa[t�u�l-u, b1�i �a 5 flopc w:'t'�^
nb rA 0*4 " ver W; +A, 46 1-;c- i dos R V-Z!PrP V
9. Will work be conducted from land? 1 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:
I30r X ¢I
11. Total amount of disturbance (including all clearing, back fill, 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: l 3 0! X I r
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): !J(-0-551 s C 6U.pt'c o �4Y'te 5�
Agent's
Printed Name
�( 5e- e G A-0 A) 7
Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

Full Pond/
Norm
c
Lake
(At Full Pond/Normal Water Level)
1-50-
24-0 «. yd s
to'
1,07 ,per.
t4o'er"V flOI C.
-:r�Sjt &F P',we-> Iofs31 i
Please approximately sketch the following information on this plan (provide dimensions for each
item, such os 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

Google Maps
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Map data 02016 Google 200 ft
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