20160775 Ver 1_Shoreline Stabilization_20160808

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State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
D
Dlvlslon of Wafer esources ISA NCAC 02H.0500— Water Quality Certification, Shoreline Stabilization
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
A(1G 0 8 20IS
I. Applicant Information lisle NCAC_02H OS(}2+a d
1. Owner Information4 -B FER RESOU S
Name: iec,i9a� . /�v�[ �' +i d'dp 4'V �• rC�iyG I N
Mailing Address: !f3YZ6 .2 c.
_ .�.Q ✓tFE � A/M� 20/Sz�
Telephone Number 'X &9/S960& Fax Number: 703 SYZ 75'52-
E -mail Address: h M 61 �V ✓Otfibw • Ne7-
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http1Lvrww.saw usace_arn�V miljPortals/59joocs/re�ulatory(redocs/Perr)jrts/SAMPLE AGENT A(1TNU
R(ZATION rORM pdf) must be attached if the Agent has signed this application form.
Name C#Ars ll'gyrD cL
Company Affiliation: dTG a" p., Amo 11A&4ew.✓,�'
Mailing Address: 77 7 / Aceloi to St
Telephone Number:01/ 0L /38.5 Fax Number:
E-mail Address: &fGIr �'�1I . "Al
Person to receive the Certification Approval: elfW4e:.5 f/.QN4 Y
II. 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, 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)
County. e*Ar A4 NearestTown, EAA-c4� _r /;,to
Subdivision name or site address (include phase/lot number).
LAKE Pioinr 410 t-rq <aT 53
Directions to site - please include road names and numbers, landmarks, etc.: Are- 77
r�rz wcsToC., Rr !Sv '4is( Sf1E�/t�%�-r moo,, AD 97- o.✓
A7/,Z;701 2e 44— CA/ &m&W i9 Rol , ­Xe Xe 23- 7�D
e�
Latitude (in declmol degrees) Longitude fdecimol degrees),
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.)- UW01pYBLo M
6. Property size (acres)- •70 41C U'S
7. Lake/ river/ ocean adjacent to property. .1-AAC A1Q,vnA)r
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): 3i��c�l�.�-� S'�4�ic�ZPr� C..,/ 'A Awl--Zck
All-fee-
9.
✓i/tG9. Will work be conducted from land? IX From water? ❑
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool laky level/ Normal Water Level in square feet or acres:
/f'�'x A/
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: l / ;L X / "
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): t e—>- S)
115A NCAC 02H .0502il( J
'Agent's signature is valid only if on authorization letterfrom the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

Full Pond/
NormalWater Level
.
C
Shoreline
Lake
(At Full Pond/Normal Water Level)
,r,)- b -7ck, rl�
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:
Date Received: I FAF Paid
L_
E] Application Complete
Construction
Application
ve Nt 13p
DUKE
ENERGY
HEP Fund Permit No. Water Strategy, Hydro Licensing and Lake Services
Duke Energy
Site ID —� Close Out Date C 120
Ch Box e, NC 8201
Charlotte, NC 28201
I. DATE OF APPLICATION` , I Permit/Tag #.
II. APPLICANT INFORMATION (applicant mailing address and contact information)
Name' f,(/ic�q,.. (� �%�riOyNal►! L /�•�vle Primary Phone' P (o '
Address' L y2( �4yLE I SecondaryPhone 767.rgL 75_S'Z
City' * !vA• State" i/0 -I Zip Code, Zfj��f L Fax Number -'?p 2✓ S 2 -rS,Si
Email' Lam`^ /�y � � dt�tlgOti• �1L7
"if.- PROPERTYINFORMATION (location of permit) –
Address' Cou ly'
City" 'iNB� P Code' • StateZi L O/
tia i� %3 County Parcel ID number
(e.g. Pin, Tax ID, TMS
Lake':
�p,c.�¢ y Number_)
Subdivision 1•'�KLot(5)g-?� PlatBook/Page
To enter the Latitude and Longitude of the property, please use a Latitude (e g. 35.12345)• 5• (p3 76
service/software to easily acquire the location information. Values
should be provided in Decimal Degrees format (35.1245). Q
Longitude (e.g.,80.12345)' _j 3
example service: http://itouchmap.com/lationg.htmi
1V. PROPOSED ACTIVITY--.�--
(' New/Modification of Existing Structure (' Maintenance of Existing Structure �
`~ Is Dock
Covered?
(– ew/Modification of Existing Shoreline Stabilization (' Maintenance of Existing Shoreline Stabilization
(' New/Modification of Existing Structure & Stabilization C Maintenance of Existing Structure & Stabilization # of Slips
( Transfer of Ownership (– Other (please describe below) # of Jetports
Area over land (sq ft) Area over water (sq ft) Total Square Feet
Shoreline Stabilization (feet) Length of Distance From Shoreline �� D u% 5 N ►� c/I"��
Stabilization
Materials
Brief Description
of the Activity
Describe Briefly the Existing /1°,/i
(,Jee
Structures Over Land and
Water (include sq ft)

V. Dock Builder or Engineer
Name/Company
Address 79 %1 A
City F.tRrN1'
AOADI
Phone Number F,7W910 2—
State
State Zip Code c 6l0 73 Email —J
VI. Checldist of Required Documents (to include with Application Submission)
Vecent 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)
�hotos along property shoreline and photos of any existin ructures and/or stabilization in or near the water
�)Applicable
pplication fee (check only, payable to Duke Energy) Signed User Agreement Letter
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.
Vill. Directions by Road - —�
Directions by
Road'
F40— ,27- 77 fcp W' -VT 2T /SDS ILTo�✓ ,s' jy�i/� ARD QD
779 47 Ary /S&tWJO D !liar 01 A.' CAAW&R Pa#ri'7c 4N.
cvi-de
IX. Application 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
PO Box 1006/ EC72Q
Charlotte, NC 28201 le -'N i
I agree that the information contained within is accurate.

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war ions w rs a ulocNn cu Rami. Lspm I chore 1 cnoro Beat FOR
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____NDRYAN'___ i\ .Istoeeurt 1 6 N �+• CHUCK POOVEY, PLS x3762
ROBERT DEDMON, PLS y899
4 3704 NC HIGHWAY n6 NORTH
W PA BOX494-D�NVER. NC 26037
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FAX. [phone]
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GRAPHIC SCALE — Fm— _ 4. 1p�"' CAMELIA POINTE DR \1
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