20171125 Ver 1_Shoreline Stabilization_20170906

State of North Carolina
DWRF'. Department of Environment and Natural Resources
0 1 7 1 1-2 5 Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources 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
I. Applicant Information
I. Owner Information
Name: L2
Mailing Address:
15A NCAC 02H .0502(a
(e�&
r07 1
S
>�,b ') 2017
DEQ -WATER RESOURCES
401 & BUFFER PERMITTING
r.- t mn cG�/ 3,9o,7�1
Telephone Number: (3oj) 77%"- Fax Number:
E-mail Address:
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.armV.miI/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name:
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Person to receive the Certification Approval:
Fax Number:
11. Project Information [15A NCAC 02H .0502(a) & (b)J
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 3

etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
and 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
4
of some sort- a yard stick, shovel handle, etc.)
Location of the property (where work is to be conducted)
County: 1�50-q Nearest Town: (A >'"UiL(e
Subdivision name or site address (include phase/lot number):
Directions to site - please include road names and numbers, landmarks, etc.:
Latitude (in decimal degrees) 3 / y� `lf Longitude (decimal degrees) — 15 . i 54 '74-y
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): lz251 e"11"
6. Property size (acres): 0- & y
7. Lake/ river/ ocean adjacent to property: "Ike-
8.
Ike
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): _ �dlV �►� �jvr S C4 /�'<`thIvIa—
r
9. Will work be conducted from land? ❑ 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:
2e"v S4t::
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 50 feet land -ward in
square feet or acres: O �, C? 19-
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): 4t-,e_S 1 -54,n, -kg
XC_+ A, el 5
Owner/Agent's Signature* [15A NCAC 02H .0502(f)]
Js2 z I_-�,
Date
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
5
Lake
(At Full Pond/ Normal Water Level)
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

DUKE ENERGY PRIVATE FACILITIES
"APPLICANT'S USER AGREEMENT"
(Fill in blanks with required information. Please Print)
Date
TO: Duke Energy
c/o Lake Services - ECl2Q
526 S. Church Street
Charlotte, NC 28202
RE: (Lake Name) GZ✓l /T''�l�-�
(Lake Address) l 1? 36 &doydJ
(Applicant's full name) w (V[ � hereby
agrees to comply with all requirements and conditions set forth by Duke Energy's Lake Services
(Duke Energy) office, and any federal, state or local agencies pertaining to our application to
construct and/or maintain a ,�p
M"dQi'.A y&lf ro o l/N" Mom on Li�
Lake /4WA, . In addition,
I/we have read and agree to comply with Duke Energy's Shoreline Management Guidelines
(SMG) and understand that written authorization must be obtained from Duke Energy prior to
beginning any activity/construction within the Federal Energy Regulatory Commission (FERC)
Project boundary. The construction will be completed as described in the approved application
and within twelve (12) months following the date of approval by Duke Energy. An extension
will be considered for legitimate extenuating circumstances (as determined by the sole discretion
of Duke Energy) provided a specific timeframe in which to complete the construction, not to
exceed an additional 12 months, is provided in writing to Duke Energy by the applicant. Failure
to complete construction within the 12 -month build -out period or any Duke Energy approved
extension will require the applicant to file a new application that complies with the then -current
SMG. The new application filing will include any applicable fees and security deposits.
I/we attest to be the owner or lease holder of the tract of land immediately adjoining the Project
boundary where the proposed private facility is to be constructed.
I/we agree to comply with all FERC orders (as modified or interpreted by FERC), with all other
applicable FERC Rules and Regulations implemented by Duke Energy, and with all rules or
regulations imposed on Duke Energy by any governmental agency.
Pagel of 5
Rev 11/9/2016

Uwe understand the physical location of my/our lot in relation to the common property line with
Duke Energy, if any, the FERC Project boundary, and any deeded flood easements or required
building setbacks.
I/we understand that this lake was constructed as a working hydropower reservoir for the primary
purpose of producing cost-effective electric energy and that this remains as the lake's primary
purpose. Vwe understand the lake and its associated hydroelectric facilities are operated by Duke
Energy under the terms of a license issued by the FERC and there will be no change in hydro
project operations as a result of the construction and/or use of any facilities that Uwe may be
allowed to place within the FERC Project boundary or on any Duke Energy -owned property.
Uwe understand during drought conditions Duke Energy may request reduced usage or
discontinued usage of any water withdrawal or related systems, until such drought conditions
improve. Failure to do so may cause possible removal of the system and/or any other permitted
facilities that Uwe may have, and any costs associated with removal of the facilities will be
assessed to the lot owner.
I/we understand lake levels will rise and fall over time in response to weather events and hydro
project operations and Duke Energy does not guarantee an approved facility will always have
sufficient water depth to be accessible by boat or for other water depth related recreation
activities.
Uwe acknowledge Duke Energy provides no guarantee of any specific quantities (except those
identified in the FERC license) or quality of water in the lake.
Uwe understand the facilities to be installed and/or maintained are my/our property and I/we
therefore agree to be fully responsible for the permitted reservoir use including maintaining
facilities in good repair. If the private facility is deemed unsafe by Duke Energy, Uwe agree to
repair or remove the private facility at my/our own expense and within the specified timeframe
set by Duke Energy.
I/we understand Duke Energy approval of the requested reservoir use in no way constitutes
assignment of any interest in real property Duke Energy may have (i.e. land rights). The approval
is granted and maintained solely at Duke Energy's discretion. Uwe also understand the permitted
use may be revoked at any time by Duke Energy or its successors for any reason whatsoever. If
the approval is revoked, I/we agree to remove the facility at my/our own expense within the
specified timeframe set by Duke Energy.
Uwe understand ownership/interest in a Common Use Facility or residential marina eliminates
the option of having a separate private facility on any other owned or leased lot within the
affected subdivision.
I/we understand this lake is open for use by the general public and that maintaining safe and
lawful public use is one of the primary lake management objectives of Duke Energy.
Page 2 of S
Rev 11/9/2016

Uwe understand the use for which we are applying is a private use and it should not interfere with
the general public's safe and lawful use of the lake.
1/we understand lake use permit holders have the authority to prevent others from trespassing on
the facilities Uwe have built. Uwe also understand Uwe, however, do not have any authority to
impede anyone from pursuit of the lawful public recreation enjoyment of FERC Project lands
and waters. Except as specified otherwise in the SMG, other Duke Energy documents (e.g.
Public Safety Plans), or a separate lease agreement, anyone may fish around/under facilities built
by others, may walk/wade/fish within the FERC Project boundary, boat in the lake's waters, etc.
without having to get anyone's permission to do so.
I/we agree to fully disclose all information regarding the approved private facility to any
prospective buyer/leaseholder of the property and any new owner/leaseholder. Uwe agree to
notify Duke Energy immediately of any sale/transfer of the property, including the name and
address of the new owner and to transfer the permit and/or Duke Energy lease to the new owner.
I/we agree the adjacent Duke Energy Project property, if any, shall be used exclusively for non-
commercial recreational purposes and that I/we shall not rent or otherwise allow third parties
(except for temporary use by guests, family members, and leaseholders of the residential
property) to use any facilities permitted to me/us by Duke Energy.
Uwe agree not to allow any use of the adjacent property, and will exercise due care and diligence
to prevent all other persons that are affiliated with my/our property (including invitees, family
members, guests, etc.), to violate an applicable federal, state or local law or regulation. Examples
include, but are not limited to nudity, illegal discharge of firearms or fireworks, controlled
substance abuse, public drunkenness, public urination or defecation, or other activities
determined to be a nuisance by law enforcement officials.
I/we agree to exercise all care and due diligence to preserve and maintain the character of the
Duke Energy's adjacent property, if any. I/we agree to comply with the Duke Energy vegetation
management requirements as stated in the SMG. Uwe agree further to not allow sewage,
including discharge from septic tanks (or similar facilities) or boat holding tanks, garbage, trash,
or other waste material to be discharged or dumped into the reservoir, tributaries or adjacent
property-
1/we understand that as an adjoining property owner Uwe can make no change in land form of
land within the FERC Project boundary or land owned by Duke Energy, if any, such as grading,
excavation or filling without prior written approval by Duke Energy.
Uwe agree for myself/ourselves, members of my/our family, guests and invitees that Uwe assume
all risks of personal injury or property damage incident to my/our occupancy and use of the
FERC Project boundary or land owned by Duke Energy, if any; including, but not limited to, any
personal injury or property damage which may be sustained as a result of flood waters or in
connection with the rise and fall of water in the reservoir as a result of floods or of the operation
of Duke Energy's hydroelectric facilities. Uwe as the adjoining property owner(s) further agree
Uwe will indemnify, protect, defend, and save harmless Duke Energy from any and all loss, cost,
Page 3 of 5
Rev 11/9/2016

claims damages, expenses, judgments and causes of action for all injuries and damages sustained
by the members of my/our family, guests, and invitees arising or claimed to have arisen in
connection with their occupancy or use of the Duke Energy permitted facility(s).
1/we agree if any action is taken by Duke Energy to enforce any provision, covenant or
agreement contained in this user agreement or Duke Energy SMG or if Duke Energy is required
to retain an attorney to enforce any provision, covenant or agreement contained in this user
agreement or SMG (including, without limitation, the payment of fees due hereunder or the
removal of an encroachment constructed in violation of this user agreement or SMG), then Duke
Energy shall be entitled to recover all of its reasonable costs associated with such an action,
including but not limited to, attorneys' fees and court costs incurred in such action and/or
enforcement.
1/we understand certain activities specified in the SMG are prohibited because of environmental
concerns, boating capacity limitations, safety considerations and other reasons.
I/we specifically waive any claim against Duke Energy for consequential damages arising out of
or relating to this application, Duke Energy's approval or denial of it, or subsequent revocation
of approval, and Uwe specifically understand and acknowledge that, because Duke Energy can
revoke the permitted use at any time, Uwe am/are not entitled to reliance damages.
Uwe understand the proposed facility will be used only for the purposes described in the
information submitted to Duke Energy and other appropriate governing bodies for approval.
I/we understand every reasonable effort must be made to minimize adverse impacts on fish,
wildlife, and other natural resources.
Uwe understand trees and vegetation growing within the Project boundary play an important role
in the overall environmental condition of the lake. The ecological benefit the vegetation has on
the fish and wildlife habitat supports a sound and healthy lake environment. Uwe also understand
unauthorized removal of shoreline vegetation and/or disturbance of the shoreline buffer may
result in suspension or denial of lake use permitting requests and require me/us to re-establish the
vegetation, if the disturbance is found to be in violation of the state or county watershed buffer
regulations or Duke Energy's vegetation management requirements as stated in the SMG.
I/we agree to maintain any prescribed mitigation activities that are required in order to gain
approval for facility construction, as long as the facility exists.
Uwe recognize Uwe have the continuing responsibility to ensure that the constructed facilities are
maintained in good repair, including, but not limited to maintenance of the facilities, and proper
erosion control within the permit area and along the shoreline, and agree to take all reasonable
steps necessary to meet this responsibility. I/we agree to maintain all facilities within the Project
boundary and on Duke Energy -owned property, if any, in a sound condition and in a neat
appearance and pay all costs for said maintenance.
Page 4 of 5
Rev 11/9@016

I/we understand Duke Energy representatives may issue Stop Work Directives for any
violation(s) of the SMG or engagement in prohibited acts or activities on Duke Energy property,
if any, as specifically identified in the SMG. I/we understand persons found to be in violation
will be subject to Duke Energy sanctions which can include, but are not necessarily limited to: 1)
restoration of the impacted area at the person's expense; 2) loss of consideration of any future
lake use permitting activities for up to five years for improper vegetation removal or until
vegetation is satisfactorily re-established (even if there is a change in property ownership); 3)
revocation of a previously issued permit and loss of consideration of any future lake use
permitting activities and/or reinstatement of the revoked permit; 4) increase in fees; 5)
modification or removal of non -complying facilities; and/or 6) further legal action being taken
by Duke Energy.
I/we agree that if any historic or archaeological resources are discovered during construction of
an approved activity the applicant must stop work immediately and contact Duke Energy. Uwe
understand that in the event that anyone discovers a potential site of archaeological or historic
significance including any gravesite within the Project, the individual must immediately notify
Duke Energy.
I/we acknowledge Duke Energy has the right to charge reasonable user's fees for private use of
its property, if any, and the Project and failure to pay any applicable user's fees in a timely
manner can result in the suspension or cancellation of any previously approved lake use permit.
1/we agree to notify Duke Energy when construction is completed and during the construction
period, I/we will post the Duke Energy approval (to be provided by Duke Energy) at the job site
visible from the water's edge.
iQ a y, K. J UgTrtc,t
Applicant Name
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Lake Street Address
City/State/Zip Code
Prejf�erred contact Phone Number
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Email Address
Page 5 of 5
Applicant Signature
ZIi7 S El -1 M P)_R g lA &iA'tII�
Home Mailing Address
1-��AI ih➢a�1Nn ZEACM FL 37—o t-}
City/State/Zip Code 1
(aiO4) 43 Z. -77-(01Z
Home Phone Number
IR) Z21)'--/-
Date
Rev 11/9/2016

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