20170154 Ver 1_Shoreline Stabilization_20170202

DUKF, ENERGY INTERNAL USE ONLY:
Construction
Date Received_ FAF Paid Application - DUKE
version 13p � ENERGY.,
F] Application Complete
HEP Fund
(� Permit No. Water Strategy, Hydro Licensing and Lake Services
lLDuke Energy
PO Box 1006/ EC12Q
Site 1D �— Close -Out Date Charlotte, NC 28201
I. DATE OF APPLICATION; a-0 f' Permit/Tag #.:
11. APPLICANT INFORMATION (applicant mailing address and contact information)
Name* e iS S M,4 NN Primary Phone* 33 0 . 50. 30Z
Address* �O io 1�'Q/1j�}-/y(� G_T;�—A4-1 Secondary Phone
City. +N ��,/� - State* Zip Code Fax Number
Email* —t— 1 f .
COM
Ill. PROPERTY` FORMATION (location of p mit)
Address* (a G(�p�,� Kt County* c e -
City* f} �G8 �!i L'�t-� State* © Zip Code*
County Parcel ID number
Lake*:(e.g. Pin, Tax ID, TMS `i7N 7 7G 46 3
D jr• mn d Number_)
Subdivision u Lot(s) Plat Book/Page 6 5
14
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)* 5. 5 `fn
-
should be provided in Decimal Degrees format (35.1245).
, ¢ 3
example service:' htipJ/itouchrnap;cor-,
html Longitude (e.g.-80.12345)*�•
IV. PROPOSED ACTIVITY
(' New/Modification of Existing Structure (' Maintenance of Existing Structure Is Dock
ew/ odification of Existing Shoreline Stabilization Covered?
(' New/Modification of Existing Structure & Stabilization
C' Transfer of Ownership
Area over land (sq ft)
k Maintenance of Existing Shoreline Stabilization
(-Maintenance of Existing Structure & Stabilization I # of Slips ❑
C` Other (please describe below)
Area over water (sq ft)
Total Square Feet
Shoreline Stabilization (feet) Length of Distance From Shoreline w� / 4 /1 li
Stabilization / 50
Materials Ar y -
Brief Description '�,,��
of the Activity ' '" S '' 1 I r I i /� 4 GC Ctr Y'1 r /4
# of Jetports F
�a
Describe Briefly the Existing 1 � � � �WU
Structures Over Land and
Water (include sq ft) 2 2p1%
/ln_
r_e, /, Aa

V. Dock Builder or Engineer
Name/Company C 5TOaC- ; 2 04C .) /4I
Address 300 A-x-ry t ory-m W Phone Number t{
City State © Zip Code (s EmailrbC 5 61,(4 Af :�2, 'r& ►+ • MCI—
VI. Cheddist of Required Documents (to include with Application Submission) r
ecent 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)
[I"Photos along property shoreline and photos of any existing structures and/or stabilization in or nearthe water
Application fee (check only, payable to Duke Energy) (Signed User Agreement Letter
[J'Appiicable 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.
Road* Directions by W. � S '�'c„r -� � Orp" L- V -e P r - i 1J FIS 154a j I
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
Duke (Energy i'rin# Fgrm
PO Box 1006/ EC72Q
Charlotte, NC 28201
I agree that the information contained within is accurate:,"L�i.�

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
D.,
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources 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 [15A NCAC 02H .0502(a)]
1. Owner Information '' -- t/fy �DD
Name: Lm4t-
Mailing Address: a��s !'� a —rr-4 -
Telephone Number:33&-0250. 3027 Fax Number:
E-mail Address: Y'e-i SSMANN Pa rnA;I.e6hn
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 FORM.Pdf) must be attached if the Agent has signed this application form.
Name: ck; P Alts
Company Affiliation: C 13C 51aWc- Re s�%(,-N 4
Mailing Address: in 3 9 04K r%
oresville
Telephone Number: ?off (,(�Q. S/) Fax Number: 20-1
E-mail Address: C6C _,5e_ 4 WAd5 C�2GtJrA! S A A7
Person to receive the Certification Approval: Gh % /fid q[_
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,
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) 1
County: Nearest Town: SfiA Tesy' ���
Subdivision name or site address (include phase/lot number):
Dirgctio s to site - please include ad names nd nu ers, landmarks, etc.: r77
-r' e 14Wq 70 . s� Cie moat* J Iku A I�- s I�
Lt4Kc �1'• i w
Latitude (in decimal degrees) 35.70 572 /T Longitude (decimal degrees) p (9 7 9 `�` 3
5. Describe the existing land use or condition of the a site at the time of this application
(residential, undeveloped, etc.): rt5Ia t-Jt-�'p
6. Property size (acres): 1 • 00
7. &river/ ocean adjacent to property: /V V V_ rA A fJ
8. Describe proposed work (include diiscussio� as to how hardening of shoreline has been
avoided, or why it is necessary): 44r l,�'� 5JrJ,ove- .,D 6r SrdA/
9. Will work be conducted from land? IA, 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:
lsd /xZs'
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: /,50 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):
[15A NCAC 02H .0502(f)l
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3
7

Full Pond/
Normal Waite Level TNIM
Shoreline
I
`a 00 -
Lake
(At Full Pond/Normal Water Level)
a
!S^00.
Wow
i
a - -
,�• Au-c5s
go 00
lo' v
147"-•
�tsvi�l, NC_ I7?
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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/David M. Waldman
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Job Number.
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