20160338 Ver 1_Shoreline Stabilization_20160407

20160338
State of North Carolina
Department of Environment and Natural Resources
------ Division of Water Resources
DWR
Division of water Resources 15A NCAC 02H .050D — Water Quality Certification, Shoreline Stabilization
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 ���
OR 0 �, • �
1. Applicant Information [15A NCAC 02H .0502(a)]
�r•�t;�o�� „ �`,h
1. Owner Information
Name: C
Mailing Address: _ a �-j 0 C'(\e s -�w o 0 Ji f70 OL
Char I�s-4-an w V 0- S 3 0 Q
Telephone Number:-q*1(0[ 5e001 Fax Number:
E-mail Address: �ri ��Q. • u Yvon✓ C54 i,/V. CDM
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http:Hwww.saw.usace armv 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'll ib �5ri,
Company Affiliation: Me s e GG'nr
Mailing Address: ridgc- m
Telephone Number. Fax Number: 7.04- {60,57637
E-mail Address: �'1jC ` ,�q /5 & uJ; ed_.5 IrreAAf, Me
Person to receive the Certification Approval: 13r d ycS
II. Project Information [15A NCAC 02H .0502(a) & (bll
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 the property (where work is to be conducted) l
County: D;taiel% Nearest Town:
Subdivision name or site address (include phase/lot number): Z ?7_ .1-73
Vire ions to site - please include road names and numbers, landmarks, etc.: /y
r 4
�A
�ifDir"CS Lead,
5. Describe the existing land use or condition of the/site at the time of this application
(residential, undeveloped, etc.): rets i d enl `F�"A I
6. Property size (acres):
7. Lake/ river/ ocean adjacent to property:
M F+d
8. Describe proposed work (include disc ssion//as to ho hardenin of shorelinJ� ha's been
avoided, or why it is necessary): A /i ze � �� r eVC,J7ero s i a AJ
9. Will work be conducted from land? [Vr 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:
� J o'X 3
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pgol lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres: ') d6 X /
12. Please describe the vegetation above the normal pool lake level/ Normal Wa r e e5
lio0s�Level and
50 feet landward to be impaff e n tuber of trees, for instance): 561he r
Owner/Agent's Sig tures [15A NCAC 02H .0502(f� Date
Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013
Page 2 of 3

C
Full Pond/
Normal Water Level
Shoreline
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 "MRNAL USE ONLY:
Construction ����
Date Received: FAF Paid Application ` +=:-
❑ Application Complete +sam,, , d. ENERGY.
.
HEP Fund Permit No Water Strategy, Hydro Licensing and Lake Services
Duke Energy
Site ID Close -Out Date PO Box 1006/ EC12Q
Charlotte, NC 28201
I. DATE OF APPLICATION* _- — aQ/b0 PermW -g
N.APPUCANTINFORMATiON(appficantmailing address and contact infprntati0n)
Name" c + - ----- -•- • - --- •-._ •.. ............ . __ _. . --- -- --, -
�v 6 Primary Phone C 6-6 • J
Address* EaQp c'f e'5 I WOQ 0
Gi, Secondary Phone
City" o f I{rh State¢ Iryy l Zip Code aS30 Fax Number
Email* ua.rYp�
-
Ill. PROPERTY INFORMATION (location of toennit)� �_ _ _�
Address*
City" Mbti �I State* i 4 Zip Code: a 8117
Lake*:
Subdivision CL s j Lot(s) 02 7
To enter the Latitude and Longitude of the property, please use a~
service/software to easily acquire the location information. Values
should be provided in Decimal Degrees format (35.1245),
exampleservice- http-ritoucbmaP.com/ladong.htmi
IVo PROPOSED ACTIViTYW���-'"�'"""'--•`•__._ _
oGificatfon of Existing Structure r Maintenance of Existing Structure — Is Dock
ew/Modification of Existing Shoreline Stabilization r Maintenance of Existing Shoreline 5tabil'r2ation Covered?
r New/Modification of Existing Structure &Stabilization r Maintenance of Existing structure & Stabilization # of Slips
C Transfer of Ownership r Other (please describe below)o❑
# f Jetports
Area over land (sq f4) Area over water faq fa) 1 —� T
oral Square Feet
County" 7! e je `/
County Parcel ID number
(e.g. Pin, Tax ID, TMS ,2 7/ bA3 8 7
Number._)
Plat Book/Page 1pZ-2—wo
3 f3
Latitude (e g. 35.12345)* -
Longitude (e g. -80.12345)' 6. 9 9
Shoreline Stilbitization (feet)
s.eno of
�80
Stabghation
Brief Descripti
of the Activity
Distance From ShorelineyVI II ��rvqri s /,KVI
Materials
Describe Briefly the Existing I
Structures Over Land and it t 5 cl e%��l A-( e- /
Water (include N ft) W

V. Dock Builder or Engineer
Name/Company
Address [6 33 ©,.,k r;dgz At-„ % T � Phone Number 7,4 f�. � �o • S /1 �
city0TCIr r / State Zip Code / �s Email
- - -. f •�•-I _ CSe4w1¢ll3Litloq/c�g�i-�..AHr,�tf
VI. Cheddist of Required Docs ments (to include with Application Submission)
,,:?.Iecent 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)
[9 Y otos 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)
ilii. 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 retumed 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.
VIil,Directionstryitoad •_._.._. ____-- _,_,. ------,______.-_.<...>-_._.....__,__.,_..._,.�..___�_,..._..-._______.__ �..�.._...-_._
Directions by
Road'
% 7 3 3 f Di1�
�A/<e IfY ,S rC s
Lon
lX.APlslicationSubmissioh
Wi /l; A-615oA1 )t�, 1—ToA/
cP/L"O'T' / o iv
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.
iNater Strategy. Hydro Licensing and Lake Services
Duke Energy Print Form
PO Box 1006/ EC12Q
Charlotte, NC 28201 / i\
I agree that the information contained within is accurate.

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