20160050 Ver 1_Shoreline Stabilization_20160113

DWR
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
Shoreline Stabilization Application Form ' 6 0 0 5 0
Four copies of the application (including attachments) and thea _q a sfigtiJd"fk- of to:
Division of Water Resources
401 & Buffer Permitting Unit 1NN 1 i 2016
1650 Mail Service Center
Raleigh, NC 27699-1650 gDot "� ePE=fes
I. Applicant Information 115A NCAC 02H .0502(a)]
1. Owner Information
Name: W01+e-4- Ctr,d
Mailing Address:
Telephone Number:
E-mail Address:
a IJ5
U nfi I'J"i , nc �&9
2. Agent/ Contact Person Information
Fax
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http://www.saw.usace.armv mil/Portals/S9/docs/regulatorylregdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORT . f) must be attached if the Agent has signed this application form.
Name: C -At p /0 r,
Company Affiliation: CAC '57DWt s
Mailing Address: 6 3 3 641,erit
Telephone Number: %�. �a�id , /(/ Fax Number: 0 0 �9
Email Address:
-ch C_�,CA "-)A45 co r f%s Afd i U4 m "?JC,
Person to receive the Certification Approval:
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

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
of some sort- a yard stick, shovel handle, etc.)
4. Location of a property (where work is to be conducted) /
County: A -T W f Nearest Town: L
Subdivision name or site address (include phase/lot number): A/ � - Av 7 3
Di ections jo site - please i crude road n es and numbers, landrn�arks, etc.: Z77 N
t' 310. filen/ f � l5D a� � t/�/� /f(ii✓iG(� , . OW
Z AAfd m ArK Dr
5. Describe the existing land use or condition of th sit at the time of this application
(residential, undeveloped, etc.): YYS ideAli A
6. Property size (acres):
7. Lake/ river/ ocean adjacent to property:
8. Describe proposed work (include discussion as to how har{dening yf shoreline,hasbeen
avoided, or why it is necessary):�7AOM/Ze s /�^� �rLr�/ c cr0 5 i0A)
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 normalpool lake level/ Normal Water Level in square feet or acres:
.ar)e90%r
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: /5(9<)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): 5fi1A41 -A—"S
Signature 115A NCAC 0 .05O2(f)) Date
signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

Lake
(At full Pond/Normal Water Level)
ci CJ V v' O Q i, 0
Full Pond/ U w e v �� E 6 %! & m c
Normal Water Level U t-✓ O oo � e
G4
� � � 0
ShorelineQ 0���'���Q$�o moo® G e o
W r
�3U CLXYds.
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 INTERNAL USE ONLY:
Construction
Date Received: FAF Paid �— Appiicaidan iDUKE
Application Complete reamnl3P Eh
HEP Fund Permit No. �� Water Strategy, Hydro Licensing and Lake Services
Duke Energy
Site ID Close -Out Date PO Box 10061 EC72Q
Charlotte, NC 28201
I. DATE OF APPLiGAT10N* PermiVTag
11. APPLICANT INFORMATION (applicant mailing address and contact infoatnati0r7)
Names d�r F �4ua�Ij Primary Phone
Address*� ,Box.
81--"rjSecondary Phone i —
Ci Lr
�Atei'I'Af #V _ itateJ Zip Code* C �� Fax Number —�
Email* +; S A4 e--sYJ BVI se r�... Nt 1
ill PROPERTY INFORMATION (location of permit)
Address* ?�� �/✓!� ®Vi/�1�1C iv.
City c5 (�� n State* & Zip Code�
Lake: /AD t -M 44
SubdivisionAr'O L.�i-i 1 Lot(s)
County
County Partes ID number
(e.g. Pin, Tax ID, TMS ���
Number...) Wo 70
Plat Book/Page
I o enter the Latitude and Longitude of theproperty,'
9 o a tion. use a 3 �' J 9 7 7
senrice/software to easily acquire the location information. Values Latitude (e.g. 35.12345r
should be provided in Decimal Degreesformat (35:7245).
exampleservice: httPt/fitouchniap.com/li�tiorig.iTtrhI Longitude (eg. -80.1 2345)*WI 0 1,5-7
IV. PROPOSED ACTIVITY
{' New/Moci fication of Existing Structure t' Maintenance of Existing Structure is Dock LL
New>Modification of Existing Shoreline Stabilization (' Maintenance of Existing Shoreline Stabilization Covered?
(' New/Modification of Existing Structure & Stabilization (' Maintenance of Existing Structure & stabilization # of Siips
(" Transfer of Ownership (' Other (please describe below) # of.let
Area overland (sq ¢$) Area overwater (sq ft) Total Square Feet 1 -
Shoreline Stabilization (feet)
Length of �7
Stabilization dam. d 7
Distance From Shoreline w /'% klo-4/ .e0 -3 m f1 3 O,4"'V ,
Materials
Brief Description '5 % 40pi, Sit kloe- r /'A 54A11K17-A' j f114 C4s-5 13
of the Activity < JJ
/)4t Afq re 4 w 1 41--1-e4- hxc1Wrs
Describe Briefly the Existing
Structures Over Land and ), O
Water (include sgft) w �� �` j r� I e.y"

V. Dock Builder or Engineer
Name/Company
Address 1. d { I -4 -nm Phone Number 70
City t�i'YSd� /�� State )V' Zip Code Email //���� ��/ M A.J
Vi. Checklist of Required Documents (to include with Application Submission)
ecent 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)
tos along property shoreline and photos of any existing structures and/or stabilization in or near the water
V
plication fee (check only, payable to Duke Energy) ❑Signed User Agreement tetter
plicable local, state, and federal permits ❑ Plan and profile drawing showing all measurements and elevations
❑ Habitat Enhancement payment (if applicable)
V11. Approval Process
0 Application is reviewed and determined if complete. Fields with an asterisk are required.
a 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.
o Applicant will be notified of approval or denial.
o 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.
Vitt. Directions by Road
Directions by
Road*
pit/ /—/WJ Oh'—k Dw .
1>t. Ap�iicatiori 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
Bax I Eli1
Ch
Charlotte,, M8�C 282009 �
I agree that the information contained within is accurate: ��� /K

NOTES:
• PROPERTY MAY BE SUBJECT TO RECORDED OR
UNRECORDED RIGHTS OF WAYS OR EASEMENTS
NOT OBSERVED
• OWNER TO VERIFY ALL SETBACKS AND ZONING
REGULATIONS PRIOR TO ANY PLANNING OR
CONSTRUCTION.
• DIMENSIONS OF ALL IMPROVEMENTS SHOWN ON
THIS PLAT SHOULD NOT BE SCALED OR RELIED
UPON FOR DESIGN OR CONSTRUCTION WITHOUT
A FIELD VERIFICATION OF ALL DIMENSIONS.
• DIGITAL COPIESOF THIS FILE ARE FOR REFERENCE
ONLY AND MAY NOT BE USEO FOR DESIGN WORK.
• A PORTION OF THIS PROPERTY IS LOCATED IN A
100 YEAR FLOOD PLAIN.
'q
1-0 - aw-- -1 � -
40 0 40 80 120
GRAPHIC SCALE - FEET
I
PAULINEJOHNSON
DB 2871-751
I
5 BT02'33"E 217.31' I
199,16' 14 REBAR
I 3.4g
1 16' SB ----------- 1
1 I I
1 I
I
I
/
/y o.504 AC+-
114 DB 2965-1658
I
1
IAPPROXIMATE 100
YEAR FLOOD LINE
L___________15_SB _ /
JOHN WESLEY LEWIS, JR
DB 3248-1366
S D710'00'E
99.81'
APPRDXIMATE 760'
CONTOUR UNE
'~ ANY DOLLS, PICAS OR OM r
::'NmT.M.xev�rtJ o US
PHYSICAL SURVEY
FOR
WALTER REYNOLDS
3826 LANDMARK DRIVE. SHERRILLS FORD, NO
DEED REF: 2965-1658
MOUNTAIN CRUX TOWNSHIP, CATAWBA COUNTY, NC
SCALE: 1' a 40'
DEDMON SURVEYS
CHUCK POOVEY, PLS #3762
ROBERT DEDNION, PLS #3899
3704 NC HIGHWAY #16 NORTH
P.O. BOX 494 - DENVER, NC 28037
PHONE: [phone]
FAX: [phone]
o L-.7899
viAQ9�G SUM,�•o`Q� ��
ill11 II�TTV`
1, ROBERT J. DEDMON, CERTIFY THAT THIS PLAT WAS
DRAWN FROM AN ACTUAL SURVEY MADE UNDER MY
SUPERVISION (DB 2965. PG 1658)(PB PG); THAT
THE RATIO OF PRECISION AS CALCULATED EXCEEDS
100,000' THAT THIS PLAT WAS PREPARED IN
ACCORDANCE WITH GS 47-30 AS AMENDED. WITNESS
MY ORIGINAL SIGNATURE, SEPTEMBER 21. 2015.
21 � p• al"1O 3899
PROFESSIONAL LAND SURVEYOR LICENSE NY
SURV. BY: JR DRAWN: RD JOB# JRLAND3
VICINITY MAP
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