20170102 Ver 1_Shoreline Stabilization_20170123

DUKE ENERGY INTERNAL USE ONLY:
Construction DUKE
Date Received: FAF Paid Application N�GY
Application Complete version 14p • EPermit No. Duke Energy Lake Services
HEP Fund Mail Code EC12Q
526 5. Church St.
Site ID Caoe-hut Date Charlotte, NC 28202
I. DATE OF APPLICATION' �/— g- ,U 1-7 Permit/Tag #.: G
UU
11. APPLICANT INFORMATION (applicant mailing address and contact information) J
Name* Ma iWe— efjAAI-64-- Primary Phone* p p /
01 R
Address* B��p �j/cj.; r 0.4K br-. Secondary Phone
City* , err; 15 State* ki-] Zip CodeFax Number
Email* A D Flo /1l • dA -/2/ vt- e "/ Coln
III. PROPERTY INFORMATION (location of permit)
Address* !`oto Arm+ r L'�i4/t br. County* 61-r7W 4
City* E(r f%S Fr4 State* Zip Code* (, %3 County Parcel ID number
(e.g. Pin, Tax ID, TMS Z 9© 3,01756 7
Lake*: or '+d Number...)
Subdivision �/ VjeAW A*- Lot(s) 3 Z Plat Book/Page 5
To enter the Latitude and Longitude of the property, please use a
service/software to easily acquire the location information. Values
should be provided in Decimal Degrees format (35.1245).
example service: http://itouchmap.com/lationg.htmi
Latitude (e.g. 35.12345)* 35.6 3 ,f o
Longitude (e.g. -80.12345)* g0 9Z
IV. PROPOSED ACTIVITY
(' New/Modification of Existing Structure C Maintenance of Existing Structure Is Dock
El Covered?
(jf New/Modification of Existing Shoreline Stabilization
New/Modification of Existing Structure & Stabilization
(' Transfer of Ownership
(~ Maintenance of Existing Shoreline Stabilization
C Maintenance of Existing Structure & Stabilization # of Slips
(' Other (please describe below) # of Jetports
Area over land (sq ft) Area over water (sq ft) Total Square Feet
Shoreline Stabilization (feet) Length of// Distance From Shoreline Ali* � jI�i.! �js „tf Are
Stabilization (e� 5
Materials C S WC- (,cif1
Brief Description
of the Activity
Describe Briefly the Existing
Structures Over Land and
Water (include sq ft)
X10ojd res4t^'A',f/ /o�—

V. Dock Builder or Engineer
Name/Company
Address
Phone Number
City State Pa Zip Code ® Email
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
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
Application fee (check only, payable to Duke Energy) M Signed User Agreement Letter
Applicable local, state, and federal permits ❑ Plan and profile drawing showing all measurements and elevations
❑ Habitat Enhancement payment (if applicable)
VII. 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.
VIM. Directions by Road
Directions by l� �c3r_"."0 L -Q
Road
IX. Application Subndssion J
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.
Duke Energy Lake Services Print Form
Mail Code EC120
526 S. Church St.
Charlotte, NC 28202
I agree that the information contained within is

State of North Carolina
D Department of Environment and Natural Resources
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
Applicant Information [15A NCAC 02H .0502(a)1
1. Owner Information
Name: _bck Q
Mailing Address: a50 �c� c r da�� ci1
SLj._ rf s rV.0 A ,J C_ 7-
i� 3
Telephone Number:"l4>4 00S,:P T% -I Fax Number:
E-mail Address: of Q '(_. n - d A p Line— (0 G"n t , Lc,�,�,�
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 FORM.pdf) must be attached if the Agent has signed this application form.
Name: J),4h h A<e HVblW Lr
Company Affiliat
Mailing Address:
GrS
P750 —A• i e 644 lir.
SAer r; !(s F0_ rot C 7 3
Telephone Number: 7W -903-J-717 Fax Number:
E-mail Address: _� p KON . d4a hKG
Person to receive the Certification Approval: dAEtiNe- W-49 Ne -v -
II. Project Information f 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: Nearest Town:
Subdivision name or site address (include phase/lot number):
Q6N(1Vt__ 0 LA_e� 0 rc n -baE_
Directions to site ,—leass�e ro as and number , landmarks, etc.:
Latitude (in decimal degreesJA- k3% Longitude (decimal degrees) p - Z
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): 1'?Q�'► ��-'����s )LQc�_
6. Property size (acres): _ . 5
7. Lake/ river/ ocean adjacent to property: LjmJA_V_
8. Describe proposed work (include discu sion as to how �nhardening of shoreline has been
avoided, or why it is necessary): K,4 +-N� rag idd
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:
1,2 5 'x 2-
11.
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake lev el/ Normal Water Level and 50 feet land -ward in
square feet or acres: / rI 5 X %
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level 4nd 50
feet landward to be impacted (number of trees, for instance): DDG
Owner/Agent's S' ature* Printed Name Date
(15A NCAC 02H.0502(f))
Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: S5GP 10-2013 Page 2 of 3

Lake
(At Full Pond/Normal Water Level) Li
1 �
Full Pond/
NormallAULLeal
Shoreline
a ass 12.150 :SIP
I�GCGS$
fir.
,50e 5 A
C
7
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
I 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 10-201.3 Page 3 of 3

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