20170561 Ver 1_Shoreline Stabilization_20170508

PUKE ENERGY INTERNAL USE ONLY: Construction
DUKE
Date Received: FAf Paid
Application
'
PP "" ENER)f.
Application Complete version 13p
Permit No. Water Strategy, Hydro Licensing and Lake Services
HEP Fund Duke Energy
PO Box 1006/ EC12Q 2 x 1 7 0 5 6 1
Site ID Close -Out Date Charlotte, NC 28201
1. DATE OF APPLICATION* /E3, 5/% Permit/Tag #.:
If. APPLICANT INFORMATION (applicant mailing address and contact information)
Name* oAt W& N Z Primary Phone` 1 63 , 000 %
Address* 1 7!5s I �T' 1.�d i l4� I -0O F'
City" 40v'e5Ui1 State-' Zip Code*
Email*
�edYonr� n1F}►1,(:or\
III. PROPERTY INFORM TiOA� N location of permit)
Address* 1 7Y5 ; pif►nl pow
City" o-9ws ll� State* ® Zip Code*
Lake*: QvA'4.4/
Secondary Phone
Fax Number
ltd e,11
County Parcel ID number
(e.g. Pin, Tax ID, TMS
Number...)
X8367367
Subdivision Lot(s) 0671 PlatBook/Page
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 35 Z `
should be provided in Decimal Degrees format (351245). �� ��� ��
Longitude (e.g. -80.12345)*
examIn ple service: `>httpV- 'Th uchrnap corgi at!on :ll rn1
IV, PROPOSED ACTIVITY
C New/Modification of Existing Structure C Maintenance of Existing StructureIs Dock
� Covered?
Q�Iew/Modification of Existing Shoreline Stabilization C Maintenance of Existing Shoreline Stabilization ❑
�( `New/Modification of Existing Structure & Stabilization (' Maintenance of Existing Structure & Stabilization of Slips
C Transfer of Ownership C1 Other (please describe below) # of Jetports R
Area over land (sq ft)
Shoreline Stabilization (feet) Length of
Stabilization
Brief Description
of the Activity
Area over water (sq ft)
/9.5
Total Square Feet
Distance From Shoreline
Materials
L—X5JA II 4d (0 A�ANcC4 t -j e 14,571 ArC 4oJdtty" 0A -rt
Describe Briefly the Existing
Structures Over Land and
Water (include sq ft)
A- , P` ev-
I
iN

,V. Dock Builder or Engineer
Name/Company Y
Address
r;d
5eryi«s LLC j
Phone Number 70'/ (-/C�,/�J
City My C`C,$1(G State R Zip Code a 8 �� - Email CS 11'3
/g AXA14 ,
Vl. Checklist of Required Documents (to include with Application Submission)
ecent Survey (stamped/signed by a professional licensed surveyor showing the to
structure and/or survey of the existing or proposed stabilization)
GYPIhotos along property shoreline and photos of any existing structures and/or stabil
L plication fee (check only, payable to Duke Energy) [Signed user Agreement L
Applicable local, state, and federal permits ❑ Plan and profile drawing
❑ Habitat Enhancement pa
Al. Approval Process
• Application is reviewed and determined if complete. Fields with an
of the existing or proposed
in or near the water
ig all measurements and elevations
(if applicable)
are required.
• If application is not complete or does not include all items and inforation 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 Ipplication approval, posted and
must be viewable from water. The notice must remain posted until al representative inspects the
project and determines the project is complete and within the applic tion specifications.
Vlll. Directions by Road
77 aN �� ��1 u c 'e/��
14-4
Directions by f—O� � �� 40o f� q o 40 '-lel
Road J
11C. 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 Form
Duke Energy
PO Box 1006/ EC7 2Q
Charlotte, NC 28201-
I agree that the information contained within is accurat

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
DWIR
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 115A NCAC 02H .0502(aj
1. Owner Information
Name:
Mailing
Telephone Number:
E-mail Address:
764 66 3. 6607 Fax Number:
Y'n
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. df must be attached if the Agent has signed this application form.
Name: C -� n P)K'i Ate 5
Company Affiliation: pkY A
Mailing Address: (0 3 8
S ;Sery ice s, /_L._C
w
Telephone Number: 70�, (o(,a .3/1( Fax Number: 66
E-mail Address: A-45 60 A);PJ4 5 reA Of . Af
Person to receive the Certification Approval: �' r' p �ric�g.CS
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)
County: .L—� �t O Moor
NearestTown: CSV)
Subdivision name or site address (include phase/lot number): 755 �iAAl'Zor
M &),-e 5Vo U e. IqC_ /t.5'
n
9
Latitude (in decimal degrees)_ �� . <p2�0 Longitude (decimal degrees) OV • 0� 3 �� 9 7
5. Describe the existing land use or condition of the/site at the time of this application
(residential, undeveloped, etc.): V
6. Property size (acres):
7. Lake/ river/ ocean adjacent to property: 4A4(e- NO'S►
8. Describe proposed work (include discu ion a� to how haardenin� of sh reline has b n
avoided, or why it is necessary):�l/C ''�✓�%C� Std
9. Will work be conducted from land? X From water? El
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:
14-5 /X 4—'
11. Total amount of disturbance (including all clearing, backfill, excavation, rip rap, retaining
walls, etc.) above the normal pool lakelevel/ Normal Water Level and 50 feet land -ward in
square feet or acres: 4-5 IX
C
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):
Owner/Agent's Signature* Printed me Date
[15A NCAC 02H .0502(f))
'Agent's signature is valid only if on authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

Full Pond/
Normal Water Level
Shoreline
1 16-61,
Lake
(At Full Pond/ Normal Water Level)
lf5`
75 5�
fA flo f
b� IV cv--
0
4 . kj""i
C,
4M. w �.
X68'ru-f`J3"
Please approximately sketch the following information on this plan (provide dimensions foreach
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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