20170206 Ver 1_Shoreline Stabilization_20170217

DUKE ENERGY INTERNAL USE ONLY:
Construction
Date Received:
fAF Paid
Application
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ENERGY
Application Complete
version 13p
Permit No.
Water Strategy, Hydro Licensing
and Lake Services
HEP Fund
Duke Energy
PO Box 1006/ EC12Q 2 0
1 7 0 2 0 6
Site ID
Close -Out Date
Charlotte, NC 28201
I. DATE OF APPLICATION* �,3 , alC/7 Permit/Tag #.:
11. APPLICANT INFORMATION (applicant mailing address and contact information)
Name*D Au Primary Phone` QV G3
i
Address*11-47 e Cv-e— -Y', Secondary Phone
City'° r p�.E WA,) I State* © Zip Code` Fax Number �—
Email*
111. PROPERTY INFORMATION (location of .permit)
Address* 0 y-C-ro SS G./ A1(— County F— "�-A-
City* OOre3VI t State ®. Zip Code* County Parcel ID number p
(e g. Pin, Tax ID, TMS
6 0 ip
Lake*: pr-�� Number...) 7 217
Subdivision L t Lot(s)
Plat Book/Page �ij Z. BAF RCE
To enter the Latitude and Longitude of the property, please use a Latitude (e.g. 35.12345)* , 5j 3 i'p ( 3
service/software to easily acquire the location information. Values
should be provided in Decimal Degrees format (35.1245). Longitude (e.g. -80.12345)* �� ��3 55 3�
example Service: httpVAtrruchrnap.comAatlon� fitmi
IV. PROPOSED ACTIVITY
New/Modification of Existing Structure C Maintenance of Existing StructureIs Dock
R Covered?
d'hew)Modification of Existing Shoreline Stabilization r Maintenance of Existing Shoreline Stabilization
( New/Modification of Existing Structure & Stabilization (' Maintenance of Existing Structure & Stabilization # of Slips
C Transfer of Ownership (' Other (please describe below) # of Jetports
Area over land (sq ft) Area over water (sq ft) Total Square Feet / ! I
Shoreline Stabilization (feet) Length of Distance From Shoreline �)1 4 f s
Stabilization a06
Materials ave- r p �t1q . �( L�s�t++�/�
Brief Description
of the Activity
Describe Briefly the Existing
Structures Over Land and
Water (include sq ft)
h0 k,l er- k-; r� Mrp r -v iC. / 2 5 v �' S ; w
`(a . �;,kds4Me- b. IA" 1,,)A-4 4o ►alp —y- -7s',, FsfV-e'
r-e5;0"-�-A-1 6vyw- W14- Vey-/ 44 "tc5c-
k'L

V. Dock Builder or fngineer��~��_�-�
Name/Company CA3c �7'D�(c 3 /L CGyC(•�.J q
Address (38 pr¢,►(r;� t ,rlPhone Number 701f.
City ......_oOt^Gsv'cl / t .. State ©. Zip Code Email
VI. Checklist of Required Documents (to include with Application Submission)
,Recent Survey (stamped/signed by a professional licensed surveyor showing the location of the existing or proposed
LL��II structure and/or survey of the existing or proposed stabilization)
f 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) Q 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.
IO. Directions by.-kond
7 36 a�1 �� �4-0�1 r".-tC iN l�s�� �-- ON
Directions by ew j �jAA'a,v / / o r'ev v ss
Road*
JX.Applf"t11Qn..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
Duke Energy #�r►nt Form
PO Box 1006/ ECII 2Q
Charlotte, NC 28201
I agree that the information contained within is accurate/(G!KGi ' 7 • "' L.

State of North Carolina
Department of Environment and Natural Resources
DW Division of Water Resources
R -
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources FORM: SSCP 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
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name:
Mailing
Telephone Number:
E-mail Address:
2. Agent/ Contact Person Information
Fax Number:
it .+r . C& M
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http•//www saw usace army 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: r - i b
Company Affiliation: `C. e f t 'N
Mailing Address: g Y -; t
�oor-t�sv�l�t �C �illlS�
Telephone Number: 70 C 660•5_711 Fax Number: -70 ¢. G I°a- �l
E-mail Address: /V_AJ %Nd,51' A- Wt . /V(!
Person to receive the Certification Approval: k * a 44Cs
II. Project Information [15A NCAC 02H .0502(a) & N
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

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: Nearest Town: 00re-5V1AC,
Subdivision name or site address (include phase/lot number): C L f T
p vCr055 W.
Directions to site - please includ road names and numbers, landmarks, etc.:
,4eA 3 c i 1A1 a
4-e At (-e-yy_ crrh APU . APAP Al VA re ro s 5
Latitude (in decimal degrees) 35. 3 Longitude (decimol degrees) O a -_q A ✓ 55 37
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Y esiA 'A-1
6. Pro erty size (acres): 0-44
7 Lok river/ ocean adjacent to property: D r M A"J
8. Describe proposed work (include disc ssion as to how hardening of shoreline ha been
_ _ avoided. urlwhy-itis necessary): S f i r G'�vc r�V tN C POSj• �✓
9. Will work be conducted from land? From water? ❑
10. Total amount of disturbance (inclu mg all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool lake level/ Normal Water Level in square feet or acres:
/X 3
11. Total amount of disturbance (including all clearing, backfill, 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: ;2_0d !X 1
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): SOMe- e-5
Owner%Agent's Signature*
t, I'►ilR Y
Printed Name
[15A NCAC 02H .0502(f))
Agent's signature is valid only if an authorization letter from the owner is provided.
Date
FORM: 55GP 10-2013 Page 2 of 3

La ke
(At Full Pond/ Normal Water Level)
VA Fi ��dKr Tje wwL
Full Pond/
Normal Water Leve!
� � n
Shoreline
a
/A,/o rC r•o 5 s
b,
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

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Google Maps
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Map data 02017 Google 200 ft
https://www.google.com/maps/@35.5939613,-80.9235537,17z 2/13/2017

MapCard - Print your custom map
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