20170339 Ver 1_Shoreline Stabilization_20170322

DUKE ENERGY INTERNAL USE ONLY: Construction E�
KE
Date Received: FAF Paid Application rV
[3 Application, Complete version 13p ENERGY,
Permit No. Water Strategy, Hydro Licensing and Lake Services
HE' Fund Duke Energy
PO Box 1006/ EC12Q
Site ID Close -Out Date Charlotte, NC 28201 2 7 7 0 3 3 9
1. DATE OF APPLICATION* 3 / 7 Permit/Tag
If. APPLICANT INFORMATION (applicant mailing address and contact information)
Name*�
r Primary Phone' 7 7&/..
Address* 7 75 0r Ar, iwc Cir Secondary Phone
City" 7) CA✓l/'e✓ State* FV& Zip Code* 0,37 Fax Number
Email*
Ill. PROPERTY INFORMATION (location of permit)
Address* 7750 14)1 Qi i We c— County" WCp Oil
IUE 1A1.
City" �l/� State* R Zip Code* ��.3 7 County Parcel ID num & BUFF RES URCI-INS
(e.g. Pin, Tax ID, TMS 7
Lake*: Q Y -M Number.-)
Subdivision n/ ; Lot(s) Plat Book/Page b /r7 ,Q o23�t—
To enter the Latitude and Longitude of the property, please use a Latitude (e.g. 35.12345)*
service/software to easily acquire the location information. Values
should be provided in Decimal Degrees format (35.1245). Longitude (e.g. -80.12345)* 80. 99 / 767
example service:' ;http //rtouchrriap corxillatlorugtrtml .
IV. PROPOSED ACTIVITY
(` New/Modification of Existing Structure (` Maintenance of Existing StructureI Is Dock
Covered?
1/New/Modification of Existing Shoreline Stabilization
- New/Modification of Existing Structure & Stabilization
C Transfer of Ownership
C Maintenance of Existing Shoreline Stabilization
C' Maintenance of Existing Structure & Stabilization # of Slips
C Other (please describe below) # of Jetports
Area over land (sq ft) I Area over water (sq ft) I I Total Square Feet I I
Shoreline Stabilization (feet) Length of
Stabilization
-3110 Distance From Shoreline r1� ; 5 �
k �
,
Materials d u' 2'e CAP I
��r✓le✓� ;: Sf��^r,J r' p r mri Y�Slti+l�oG Y'Ls//o/�e- est/ 3 /o ' a 4- sl+ev�/,w�/
Brief Description �� a Gfeis 1�� n +r a & �✓'�j4 �✓ e � r� p f
of the Activity //V S <j 17 ) p r/ `f /
Describe Briefly the Existing
Structures Over Land and
Water (include sq ft)

V. Doric Builder or Engineer.
Name/Company /7
Address 3 tOAY—Y i dt,C �/g'1''i�'I Phone Number
City _..n or/ srf�l� �. —State © Zip Code oZB��s .r. Ema Gs �-rl 1W;Ad ST
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
LuJ structure and/or survey of the existing or proposed stabilization)
g Photos along property shoreline and photos of any existing structures and/or Stabilization in or near the water
Ef Application fee (check only, payable to Duke Energy) rpl'�igned User Agreement Letter
['Applicable local. state, and federal permits ❑ Plan and profile drawing showing all measurements and elevations
[' Habitat Enhancement payment (if applicable)
m.m.x�mr..�.�r.. - •-a.x�.•vsr - _— __
VH. 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.
-VW. Diretg";,byamd
Directions by
Road*
ix. Appli�gtis+iK Suttrnissiotr
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 Form
Duke Energy
PO Box 1006/ EC12Q
Charlotte, NC 28201 �.,
I agree that the information contained within is accurate:

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
AMEND Wi
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
I. Applicant Information [15A NCAC 02H .0502]
1. Owner Iti
72owtzi
on ,/
Name: & f� i to
Mailing Address: 7 5ro�-
edy'ey-, tVC iso 37
Telephone Number: U d01. 310— — Fax Number:
E-mail Address: VA -11g, A41.5 cv- 0 b cl/5tik • MG �-
2. Agent/ Contact Person
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
httD://www.saw.usace.armv.mil/Portals/59/docs/reeulatorv/reizdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FO df must be attached if the Agent has signed this application form.
Name:COV- e 9
Company Affiliation: C& 57-onre- i 1ee_c iW
Mailing Address: �► 3 g OA -K- r� c AN
Telephone Number:
E-mail Address:
Fax Num0er:
Person to receive the Certification Approval: Ch,i �2 C3.-�d qts
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: 1 iAreo/4/ Nearest Town: 7)CAI Uw /
Subdivision name or site address (include phase/lot number): s P}w� ��`I le T 34
Dir ctions to site - please include road names and numbors, landmarks,,etc.: A. N
tl't r ydq( (,/9-t�'1 V_"4 _14_ A �o�I IK�G �C�i r.
Latitude (in decimal degrees)612j. 55 % A Longitude (decimal degrees) R�- � U �
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): h-vs'foto*► tti� I
6. Property size (acres): (.13
7. Lake/ river/ ocean adjacent to property: "Ke- l )&'f MAA
8. Describe proposed work (include %sqission as to how hardening f shoreline has been
avoided, or why it is necessary):S b� �1'Z-�
9. Will work be conducted from land? 0 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:
-;5 Io'X 2'-63'
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 SO feet land -ward in
square feet or acres: 3 I a/ 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): a
(o .
Owner/Agent's Signature* Printed Name Date
115A NCAC 02H .0502(f))
'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
Q .ire r.a ■7
Shoreline
11 �`- 6�r&-
Lake
(At Full Pond/ Normal Water Level)
5/0-
77-5a lJrP4� �N� C-,va1c
T)e tj Vt.%' I a..0'0 3'7
Aae5-5 3�os
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
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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