20170275 Ver 1_Shoreline Stabilization_20170308

DUKE ENERGY INTERNAL USE ONLY: CpnStt'UCtlOt1
Date Received: FAF Paid Application ENERGY
�D^ �,,Ut! ��E(��4
❑Application Complete
version 13p E E � � E R �+ t�
HEP Fund Permit No. Water Strategy, Hydro Licensing and Lake Services
Duke Energy
PO Box 1006/ EC12Q - ; 7 0 2 5
Site ID Close -Out Date Charlotte, NC 28201
1. DATE OF APPLICATION* I, 6 Permit/Tag #.YR_
If. APPLICANT INFORMATION (applicant mailing address and contact information)
PrimaryPhone'
Name* '50
e
Address* ,5 a C D Y Dr. Secondary Phone I �FSQ, 3-87971
City* ,(�D State* Zip Code* Fax Number LE a N
- l
1
Email* �� �� //
CWC0I0 5D� `1i ane -
i
III. PROPERTY INFORMATION (logon of permit) 1
Address* 3 95 /' 0 r �r • County* i'�X to 1 FFER PERMIT'it
City* ,+ r-lp State* Zip Code* O oZ� County Parcel ID number
(e.g. Pin, Tax ID, TMS D 3 >� 3
Lake*: p '� �Sr/Q Nd Number...)
Subdivision f S rC �v D�� Lot(s) 7-7 Plat Book/Page S 70
To enter the Latitude and Longitude of the property, please use a 3 �/
service/software to easily acquire the location information. Values Latitude (e.g. 35.12345)* < Qi0
should be provided in Decimal Degrees format (35.1245).
example servi1. ce: IhttpJ/itoucbmap.coni/latlonc hirial Longitude (e.g. -80.12345)* 8D , 8 Tj3 88
1V. PROPOSED ACTIVITY
(` New/Modification of Existing Structure ( Maintenance of Existing Structure( Is Dock
El CnvPrPri7
t�New/Modification of Existing Shoreline Stabilization
/r New/Modification of Existing Structure & Stabilization
C Transfer of Ownership
Area over land (sq ft)
C Maintenance of Existing Shoreline Stabilization
(' Maintenance of Existing Structure & Stabilization
C Other (please describe below)
Area over water (sq ft)
Shoreline Stabilization (feet) Length of
Stabilization 130Q
Total Square Feet
4 of Slips ❑
# of Jetports ❑
Distance From Shoreline ,/02�; ;,y .S rr..�;,✓e
Materials I C/*ss /3 Y' Tp r,
5h549�r� s�to iue/ iNs /
Brief Description
of the Activity
Describe Briefly the Existing I%� � we -
Water
' lD
Structures Over Land and Ire 5 r r A- I
Water (include sq ft) /
N9 a C14s5 /3 r"p rpr

V. Dock Builder or Engineer
Name/Company
Address 14 59 /)A,/✓-'dIt- VJ4rM
Phone Number 76 6 • S11
City DD resv�j� State © 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
L� structure and/or survey of the existing or proposed stabilization)
2/Photos along property shoreline and photos of any existing structures and/or stabilization in or near the water
Er Application fee (check only, payable to Duke Energy) ['Signed User Agreement Letter
[Applicable local, state, and federal permits ❑ Plan and profile drawing showing all measurements and elevations
❑ Habitat Enhancement payment (if applicable)
Vit. 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.
Vill. Directions by Road
Directions by
Al � /- o Al/�'(�� s It �`f �,(DO r
Road*
#X. 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
Duke Energy Prin31 orm
PO Box 1006/ EC12Q _
Charlotte, NC 28201
I agree that the information contained within is accurate: C--`- `'"— `�

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
W,
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:
1.
Division of Water Resources
401 & Buffer Permitting Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Applicant Information [15A NCAC 02H .0502(a)]
Owner Information
Name:
Mailing
Telephone Number: 7W Ft4,3-2-6O Fax Number:
E-mail Address: S o & 4r4l/ftp • GD Yn
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.army.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM. df) must be attached if the Agent has signed this application form.
Name: r' l rn /- r iyc 5
Company Affiliation: �13GN�-
Mailing Address: l .3 g doi*k cid
/f%o resv:/le . A?
Telephone Number: 7qf. GG 0 - X57
E-mail Address: P
Person to receive the Certification Approval:
Fax Number: AW "6`74f
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 grope /7 (where work is to be conducted)- �/
County: t�lfl�r Nearest Town: efjA F, 7
Subdivision name or site address (includ phj se/lot number): -5'c A<Jtr I T77
Directions to site - please/ inclu a r%pad names and numbers, landmarks, etc.:
'
) ,-4J1�511 /'l' e tr T) r
Latitude (in decimal degrees)a5. 3 3 06 5 / Longitude (decimal degrees) gL./O 5 3 SO
5. Describe the existing land- use or condition of the pte at the time of this application
(residential, undeveloped, etc.): V C 5�►�
6. Property size (acres)
7. Lake/ river/ ocean adjacent to property: ��OCtNTrr-%� h4W--14XKC-
8. Describe proposed work (include disc si/on as to ho/w' hardening shoreline h s been
avoided, or why it is necessary): /�✓4✓C�OsiO�✓
9. Will work be conducted from land? I] From water? ❑
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool �ake level` Normal Water Level in square feet or acres:
43
11. Total amount of disturbance (including all clearing, backfill, excavation, rip rap, retaining
walls, etc.) above the normal pool l9ke level/ Normal Water Level and 5o feet land -ward in
square feet or acres:
13 X If
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): G-kI_7 GC S
5tfe .dl%m,�
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

Full Pond/
Normal Water Level
Shoreline
Lake
(At Full Pond/ Normal Water Level)
cD <I- OC;IQ�� <> C7 C) %=
7r��d v a � c r3_a© Q vC;Z�p D
©�UQpC�(Jd d
le -
h de,
s
ISep s.
P.
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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