20160745 Ver 1_Shoreline Stabilization_20160729

State of North Carolina
—`s �� }:' ` Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources 15A NCAC 02H •0'00 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the applicatio$eePh ent
to:
Division of Water Resources
401 & Buffer Permitting Unit �a
1617 Mail Service Center 20 ' s O o L5 @' R„
Raleigh, NC 27699-1617 7 Q 5
j
1. Applicant Information i15A NCAC 02H .0502 l 111L 2 9 zoos
1. Owner Information 40 E8 R _-Y F' REen_
Name:evu\ 491enn s-Cl\e
Mailing Address: Z13(6 Ck j Ap
CC-+a,WbLi, Mc- o' m
Telephone Number: 7Dy L 6 2ZO - I g a) Fax Number: 70 y - 8 7) - T) 0 /
E-mail Address: )5+% 1 le \d A a.0 46-c - Cr ,r wo,.sh C a M
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
ht*-p://wwv.,.Saw.usace.army mil/Portals/S9/docs/regulatory/reedocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM ndfl must be attached if the Agent has signed this application form.
Name: l-F,ce ri n0 SS
Company Affiliation: _Lor\q
Mailing Address: 7 `7 `1 � flu L o p C hcA VU
10 k, NJ r- 2 /, 1) C?
Telephone Number: 2/U y -L) 0 0 - 0 �1 G Fax Number: .S G. rr1 e
E-mail Address: onq isl Gin ci rn �r �, C 0 n Sir r v c-�-, 0 n ©Cj YY\ A'► , Go rr1
Person to receive the Certification Approval: la) ire d 0f\,)55
11. Project Information U1 A NCAC 02H 0502(al & (bil
I. 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

a
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)
County: etliawba Nearest Town: Cc 44&vi b
Subdivision name or site address (include phase/lot number):
2130 CIUcle Ra. e,,.kkwUG-. �1c 280001 - I -o -V
Directions to site - please include road names and numbers, landmarks, etc.:
i Vd soY\ Ch\C I Rc� -I-o Cl de fid. 2" hoose 0A ricah+
�e1��rcQ ry-\P- �0'r q\ CA i3,i�is �l�v✓Jncti- nU".�
d r\ Lack e)
Latitude (!n decimal degrees) 3s °6 963 7? Longitude (decimal degrees) d O . y6so tY T
S. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): re s; rlec-,41 c�.
6. Property size (acres): a I -Z ox -ye
7. Lake/ river/ ocean adjacent to property: Gke
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): \IeG -5 0 eco" o,�
9. Will work be conducted from land? Yr From water? n
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:
�D 3
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: % b01 x I
i
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and
d
50 feet landward to be impactedPUTber of trees, for instance): ru.5�
ces See- Aas
Agent's Signature
3—O
Printed Name
115A NCAC 02H 0502(f)j
Agent's signature is valid only (fan authorization letter from the owner is provided.
FORM: SSGP 10-2013
-7-1I-)�
Date
Page 2 of 3

Full Pond/
Normal Water Level _
Shoreline
i 1 a�rne-
Lake
(At full Pond/Normal Water Level)
3
D a o a
0� 0o dCD 6 00oo
-
��
Da
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as loft 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.
S. 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 WSW I USE onVc
Date Received; CoB� �9on
FAF Paid=Application
0 Auplteation Cnmpiete
HEP Fund Permit No. i Water Stmt
egy, Hydro Licensing and Lake Services
Duke Energy
Site ID Clot Date PO Box 1006/ EC12Q
- Charlotte, NC 28201
1• DATE
� p��p �AyIAeipIICgAp,?�IAIT+tO°!� 4 , �% Permit/Tag.:
I1..sY!—i�6�ee'a+�}ll I;WF i�vIVA tCViVF r
('M lhcaW tnsffrng addMa and can&= rnfermagan)
Name To e
• SL� 1.0, Primary Phone"
Address" 713 & C1 de, � " Secondary PhoneTZK�s' 7
GbA7.1 State - (d ��
� =ode � � Fax +1'+arrtber
Ernair
III. PRoPERTl woRmTm pocatron of permit)
Addmse 1. 13& C1
GVyo CAA -&W b C, States Zip Code�
'-meg Uke _i4orrnc.
Subdivision !�
To eater the Latitude and Longitude of the property,
servWsoftware to east please Use a
� aaluirethe location irrfomVation. Values
Should be
Provided In Decimal Degrees foff aW (35.1245).
example service htgrJ/rtouchmap corMatlong.hMI
IV. PROPOSED ACTS
CannWE,a..-�-rbk� c _.._J
County Parcel ID number
(e.g. Pin, Tax ID, TARS 70/of -74-83 Z
(dumber...)
Plat sook ge (_- 5 3Z D93�
Latitude (eg. 35.12345)" (p 3
Longitude (e.g. X80.12345)* a
New/Modification of Existing Structu
re Maintenance of Existing Structure ��s Dock
�idlodification of Existin oreline Stabilization Maintenance ofBasting Covered?
- New/Modification of Existing5 sting Shoreline Stabllaation
ftmJre & Stabilization AAafntenance of Existing Structure & Stabiihation # of Slips
Transfer of Ownership
Other (please describe below) i ofie
tpons
Area areerland {sg fgI Area rover •A11111111:e9 (st.9 ft)
Total 3speare F
shorefte subuhaden pm) Length
of q Q. R Z Distance From Shoreline f `-1 sWi S i n�
Stabilization 'i '1
Materials %--e h rpt p
MWD 5 -FA B 0, L 1 ZL S A0 � Ne— --- T
of the Activity 1-Vc7 - p VAof Y -0S 16 A
Describe Briefly the Existing [ (� -
Strucwres Over Land and TbYru 5 a e -e.S C S e e
dater fsndude sq ft)

V. Dock Builder or Engineer
Name/Company
Address 1*7T7 J n V dso A Phone Number 1709—(106- 0141a I
CityN&Wu k State D zip Code Email Io+,q;t 1a.n� MQri^e c0 in-'ryelui B
VI. Checklist of Required Documents (to include with Application Submission) qMa A .6 e en-
e- ,Recent Survey (stamped/signed by a professional licensed surveyor showing the location of the existing or proposed
LuJ structure and/or survey of the existing or proposed stabilization)
[rj Photos along property shoreline and photos of any existing structures and/or stabilization in or near the water
R Application fee (check only, payable to Duke Energy) 13'�Igned 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.
o If application is not complete or does not include all items and information listed in the checklist, the
application will be returned as incomplete.
e A Duke Energy representative will visit the site to conduct a visual Inspection.
Y 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.
VIR. Directions by Road
Directions by
Road*
C 1 Adt U. is 004 COSA 0^ r4ciwy.
P,es;beme is Z"O house o^ cti hr —2131.
IX. Application Submission
PIme 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
Duke Energy Print Form
PO Box 10061 EC12Q
Charlotte, MC 28201
I agree that the Information contained within is accurate:

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