20190711 Ver 1_Shoreline Stabilization_20190528

State of North Carolina
DwR Department of Environment and Natural Resources
Division of Water Resources
Div
ision Water Resw�taes 15A NCAC 02H.0500—Water Quality Certification,Shoreline Stabilization
FORM: SSGP 10-2013
--$Shoreline Stabilization Application Form �A'D
Three copies of the application(including attachments)and the application fee should be sent to:
Division of Water Resources
401&Buffer Permitting Unit ��-.
1617 Mail Service Center �‘ G
Raleigh,NC 27699-1617 Q , v 1� 2 9 Q 7 r
�✓ ��a0 1
I. Applicant Information 115A NCAC 02H.0502(a)J
1. Owner Informa ion
Name: / ( 1�� f!6/4-i
Mailing Address: / 7 4_
A-Al, AT C S/L/
Telephone Number:47:-.i7G -G77I Fax Number:
E-mail Address: ,Xi . p 51 G/,V La q_trtieb�. CGwh
2. Agent/Contact Person Information �J
A signed and dated copy of the Agent Authorization letter(a form can be downloaded here:
hua(twww.saw.usace.army.miVortalc/59idocsrreRulatord!eRdocs/Permit5 SAMPLE AGENT AUTHO_
RIZATION FORM.pdf)must be atta1,hed if the Agent has signed this application form.
Name: BA 4 Dlt L4,u is Sc-A.rt .q,,c �L-
Company Affiliation:
Mailing Address: ( OS Vic- -p tY• - `
-cw
•5T-p,.a-e:3 v t 1\cf NC_ g$ 41.5
Telephone Number 7C4.402-_/11/5 Number:
E-mail Address: b ‘o-a
)/t i. . ��4- ,(-et-
Person to receive the Certiflca ion Approval: -i-- O .0_44 se e.,N-r- ^___
II. 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,etc.),
rip rap,excavation or dredging below Full Pond/Normal Water Level elevations,and
FORM:SSGP 10-2013 Page 1 of 3

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)
Countyccdell Nearest Town:
Subdivision name or site address(include phase/tot number): i . j
geoeke_ iee
Directions to site-ple include road names and numbers landmarks,etc.:
' 36 oiv go So f P vi4(
41.1 1-_-`0N B yr ri'SoN
410,E-d4- tee-
Latitude(lade:J=1degrees) 35.(v5.f
Longitude ldetimcl deyregi
5. Describe the existing land use or condition of the site at the time of this application
(residential,undeveloped,etc.): Ire.gi &*1
6. Property size(acres): p ,c
7. Lake/river/ocean adjacent to property: L4,re4. o ery11,M/
8. Describe proposed work(include discussion as to how hardening of shoreline has been
avoided,or why it is necessary): S
cernsjO11.)
9. Will work be conducted from/and?
Q� From water? 011
10.Total amount of disturbance(including all excavation,bad dill,rip rap,retaining walls,etc.)
below the normal pool lake level/Normal Water Level in 7c i square feet or acres:
11.Total amount of disturbance(including all Bearing,back excavation,rip rap,retaining
walls,etc.) bone the normal pool lake�level/Normal Water Level and 50 feet land-ward in
square feet or acres: 7 )(
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 IC.40 /-r L.t.
s
Owner/Agee s Signatures Printed Name `�
15A NCAC 02� 0502(fll Date / ✓
Agent's signature is valid only if an authorization iemei from the owner is provided
FORM:SSGP 10-2013
Page2of3

Lake
(At Fun PondMormd Winer Level)
r I a 5 '
2 h{
Full Pond/
obove ' 7s=7s 5. . R,,,�v € ° �
a
Norma!�1Ater Level
a . ��
Fho:aline . q coCr-Jc�-.•'.
1 i C.c4-5 5
197 o4 ,�A t. ��
V
i
7
L.o1F 2-A
Please approximately sketcn the following information on this plan(per dimensions for each
item,such as 10 ft x 100 ftja:
1. All proposed vegetation clearing
2 Location of rip rap or fill to be placed above the Full Pond/Normal Water level elevation
Vcat%on of rrp rap or rill to be placed belc4r the FuK Pond/Normal Water Level elevation
4. t..iaiton of any proposed suuLtures such es buildings,retaining walls,
5. Location of any excavation or dredging below the Full Pond/Normal Water Level elevation
6. Location of construction access corridors
FORM:SSGP 10-Z013
Page 3of3

CATAWRA RIPARIAN BUFFER NOTJEICATIQ1V QRtV[
Projecis Nomelad .calf i�i�._.P o itfGs J'C : r e - lI
Owner: jl1,/14e".jjk 7hc'ilteo . 6-pop
Prim Signature
Contractor/agent;13&Joy Law€1,54i-pcMitcfrmE..
Print Signature
The approval is :or rue purpose and design aescribeit m your a piicaaan. impacts not indicated in.The
application is a violation of the Buffer Rule. Site specific work should be provided in the application. [1SA
NCAC 02H.0506 and 15A NCAC 028.0243(8)1
•
Trees are not allowed to be removed from Zone 1 of the Buffer(within 30 ft of the full pond elevation),unless
approved.Exception,those trees that are severely undermined alongyon the}intnaediate shoreline�i can be removed.
MinkmA shaping S,i 1`1.f7 44�('1)1�'�,'..�.�=Tr tr.C.A` e.5.4.rtlit120 w k57 Li at.AC C . . .p)l.
Benching,
elhing,guiding in the buffer is not allowed.Excessive disturbance of ground covet[15A NCAC 02B.0243
Beaches, impervious patios, impervious 'walkway:. etc. are not allowed in the buffer unless specifically
approved by the Division. There are limitation on size for decks.115ANCAC 02B.0243(4)and(6))
Work to be conducted from land must indicate an access and indicate any trees that are to be removed. The
work corridor should be described.The approved access corridor shall be restored.Staging,spoil,construction
material must be outside the buffer.BSA NCAC 02H.0502 and 15ANCAC 023.0243(4),(6),(8)]
Stormwater cannot be piped or channeled for direct discharge to the take. All constructed stotmwater
discharges most be at the,=anal elevation and discharged prier 10 egg the buffer directed as diffuse or
sheet flow ar non-erosive velocities tv nit like.(ISA NOV:C .002430),t61:
Acknowledgement ofNot cation
I. .hereby state that t have been informed of the Catawba
Riparian Buffer Rule. Any work conducted in the buffer,not specifically stated in the application and approved
by the Division of Water Resources(DWR),is a violation and subject to enthreement.Due dilieenee will he
taken such that the construction will be built within s tbs;iin:i►a'cot>m anec and lams of the 40:Water Quality
Certiriantion.aid Buffer Wes,'te Fkin(s)anel sl It for vit andadmr supnoriinn/g�.materiels.
elf✓
Signature(owner): 1,/ Date: !t

DUKE ENERGY INTERNAL USE ONLY: Construction i
Date Received:L FAF Paid Application DU
KE
,� �, ENERGY
verison0 Application Complete —
Permit No. I Duke Energy Lake Services
HEP Fund Mail CodeEC12Q
526 S.Church St.
Site ID L Close-Out Date- i Charlotte,NC 28202
I.DATE OF APPLICATION ��l(----/9 J Permit/Tag#.:
II.APPLICANT INFORMATION(applicant mailing address and contact information)
Name* I Primary Phone* 7t7 574,:6 7*
Address* I /9 7 f)AeA _ Ri i
I Secondary Phone i
City" 147/101.&4 State* NCI Zip Code*gtf(o(o Fax Number ( J
Email* Kzepsi in/_C hlA•If. Com
Ill.PROPERTY INFORMATION(Iota on of permit)
Address* A /e . County"
y., ell
City" A0A/ State*kC1 Zip Code*I,g-�6` ,. County Parcel ID number I, q
, (e.g.Pin,Tax ID,TMS 1/G 3/.2 21 7Qo
Lake*: I No r/.A/ f Number_) - -
Subdivision — J Lot(s)( Plat Book/Page �! /OS
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)* 35.65 79
p
should be provided in Decimal Degrees format(35.1245).
Longitude(e.g.-80.123451'[So - y/ J
i example service: httpJ/ftouchmap.com/latIonghtml 1
IV.PROPOSED ACTIVITY
C New/Modification of Existing Structure C'Maintenance of Existing Structure Is Dock
Covered?
C New/Modification of Existing Shoreline Stabilization C Maintenance of Existing Shoreline Stabilization
C New/Modification of Existing Structure&Stabilization C Maintenance of Existing Structure&Stabilization #of Slips 11
Cransfer of Ownership C`Other(please describe below) #of Jetports 1
Area over land(sq ft) [_ Area over water(sq ft) I _Total Square Feet �_
Shoreline Stabilization(feet) Length Distance From Shoreline illAbed S/ r cf J't-
Stabilization 7 1 Materials 11/(r / OCK, J
Brief Description 54,4 Ye-- I'r!r A/L C.v pr e�/ C�,fos(OW
of the Activity
!' ----���IIIi����`""'"
Describe E [ im ,,rncx
-) ifnft) [ 4

V.Dock Builder or Engineer c
Name/Company Bilivoy hAW O S PLit
Address /05 V!G#r"4 J Phone Number lid i /4 5
City 1M-esti* State LvC Zip Code .2t6'7 5 Email
VI.Checklist of Required Documents(to include with Application Submission)
1ecent 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)
2/Photos along property shoreline and photos of any existing structures and/or stabilization in or near the water
[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)
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.
VIII.Directions by Road
77 ,! , 4:k oAi MAli Ise), & i A{‘c
Directions by er. v2 • JJ ova! /o l p r-ri 5o n/ / in
Road" �/� `7''/'r� '
1.4-0a /4�9kJ Ai,
IX.Application Submission
Please complete,print and sign this application.Then endose all items from the checklist above in an envelope and
submit all the information to the address below.
Duke Energy Lake Services I Print Form
Mail Code EC12Q
526 S.Church St.
Charlotte,NC 28202
I agree that the information contained within is accurate: R' •'
Sign • By :

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PROF E9°w.1ANo S211ETOR u2NSE No. ■ ■ ■ ■ ■
_ .! GRAPHIC SCALE—t't:ET
VICINITY MAP __.
DEDMON �(TRVEYS DATE 11-15-1e os: zz6o Pc:5e7 PHYSICAL SURVEY
WES: D8: PG:
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m ,) WW.CORDE9 MOWS OF WAYS cR MP/ESTS
A • j�tiTM.RTO Y ALL Wa'C1c5 TIN EC.Y�4
57q�P,�K 1tD'rar.ays P1aoR TD ANr PLINNi!x OR CHUCK POOVEY, PLS #3762 JEFFREY B. EPSTEIN
S o CONSIE"E"DN`s°oL,u IMPROVEMENTS SKIM on ROBERT DEDMON, PLS #3899 FALLSTOWN TOWNSHIP
Tres v4.6 SHOULD NOT SCALED DR ELIDD
g UPON NM D OR CONSTRUCTION 9601013 3704 NC HIGHWAY #16 NORTH IREDELL COUNTY, NC IIIVIBERLEE 7.AHARIAS—EPSTEIN
1 \ A SELO`E'"1AT1CN OF uL 5.40156165• P.O. BOX 494 — DENVER, NC 28037
mw7u cm Es OF Tns F4 ARE FOR REFERENCE
PHONE: [phone] 197 APACHE RD - TROUTMAN, NC
ONLY AM NAY NOT ES MED FOR=•201 WORK
•10'DR*NAOE 49 OOLINY FASENEN7 A2D43 LOT USES
•NO DECDEDC NONEM ON FOUND WREN ZOOS'a PROPERTY. FAX: [phone]
SM. BY:Vir DRAWN: RD doeg X15APACHE LOT #2A, PLAT BOOK 59, PAGE 115

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