20230829 Ver 1_duke a_20230726

Duke Fnerg-V FAcavniloll Permit Appliention Form
I'Olt hl'NV t'VFHG\' USE t►NI.Y
hlke 1 Ile N11. . --. _ --- -- --
kpi'll,nu,1n 1 n x �tti unh Ih 111sn 1 _ _- Check 0 Date 1(ccv'd Initials
11.11c PI 11AC 1 110 '% 1 Ake Nei%it C%. 111,111 it ant 1n1d or conimoot on -Site imr)CLtimis Date IniiialbJ
hate l nlel r11,tc, wt, :\1 anl•u,rc Ana Mnikinls hicld - Vcrilicd Initials
%plitv1 c\i to Stan \\ t11k 11'. • Datcf
U'1 irat (Sign)
Date l o,itrlctllnt 1 tNillre j — Date nl' Any Approved Extension Initials
11a10 Pakscsd t: Ios vul Imperuon' initials
Am "top \\ oti Onlers ur ti\i(i Violations'? (check ant-) ❑Yes []No (If Yes. explain in PART V)
Date Deposit Refunded Initials Date Permit Database Updated Initials
• Fon1 and copy of approved application (all pages, plus any attachments that Duke Energy changed) back to applicant
q ith Approval Letter and highlight any changes. File copies of Approval and Close-out Checklists and any Stop Work
Orders rith application.
Part 1. Applicant Information (Please Print)
Name Jeffery Keith Mullins II Telephone [phone]
Email address: [e-mail]
Lake Address
428 Lakeview Shores Loop
Mooresville, NC 28117
Mailing Address (if different)
3653 Melic Drive
Terrell NC 28682
Contractor Company CTC Grad
Contractor Contact Person
Contractor Email Address:
LAKE LOT INFORMATION
Tina Little
tinalittlel [e-mail]
Lake Norman County Iredell City Mooresville
Subdivision Crescent Land & Timber Lot / Section No.
Telephone [phone]
State NC Tax Map No. 4627
1618 Lot Size 1.46 Acres
Duke Energy Pnge 4 of 13 rev 1 t/2VZ1
Excavation Program

i)u{ce hnerCy i?xcnvntion Permit application Form
Security Deposit Refund Informntion
the scruriry deposit will be retinufed alley the excavation permit has expired if no violations of
the appro\al occurred. the applicant will receive the security depost refund at the mailing
address in Part I unless an :►Itcmative recipient is identified.
Send the se. u► its deposit to an alternative recipient? (check one) ❑Yes VNo (If Yeas,
in, hid" rr,rnt► ,m,l rr allln•t� address hclo►r.
Name:
Mailing Address:
I'ax ID:
Are there am C'o-Applicants' ' (check one) ❑Yes 2�4o Qf Yes, include names, street
,2,.' r'cccc•,c or lot nunrbcrs, pier nurnbe►•s, phone numbers, and email addresses in Part V —
Additional information)
" Co -Applicants exist when the proposed work is being done under a single application, will be
perfonned by a single contractor as one continuous project, and is done to benefit multiple
."hers lease holders of Project -front properties within a single development. There can be no
more than 4 co -applicants in addition to the lead applicant on any application.
Do not continue the application until an on -site inspection has been conducted between a
Duke Energy Lake Representative and the applicant and/or the excavation contractor.
.VOTE: Initialling this portion of the application by a Lake Representative in no way
constitutes approval or eminent approval of the excavation or any other lake use permitting
activitj,.
Date of on -site inspection U Q Z
Initials (Duke Energy)
(applicant/contractor) f .L.
Duke Energy Page 5 of 13 rev 11/22/21
Excavation Program

. .tn
l L
Doke E.nerev Fxcavnlion Permit AV211cation Form
Part III. Description of Project
A. Basic Inforrnalis2ii
1. Type of cxcaN ation: (, trr( 4 o►►r) ❑ New cxcnvntion ❑ Maintenance excavation
11rrl•e1w. tit'irn: Incc(k onr) ❑ Itoat Access Channel
O %Pater Intake ('hanncl ❑ Wastewater Discharge Channel
❑ tlthrr 1 �i+�'�'ilt l: ticcoss to existing Dock
1 ahc user categ0r\,: (ChCCA- rmc)
OCammcnial Marina
❑Other
Wrivate ❑Residential Marina
OPublic
4, Mait. Excavation Area Dimensions (fl): Length 50' Width 40' Depth 4'
O-Orc: inrhi,le additional area dimensions if necessarp so response to #5 below equals max. area
Jimensions in :4)
5. Volume of Excavated Material (TOTAL for the project):
o. Type of material removed (applicant determines hvfteld
Silt/ Clay
296.29
Cubic yards
7. Excavation Site area: .045 Acre (s) Disposal Site area: .057 Acre
(s)
S. Total Disturbed Area (including equipment staging area): .102 Acre (s)
9. Does the project meet the requirements of the applicable General Permit? (check one)
QYes ❑No
10. Do you claim title to the disposal area? (check one) KlYes ❑No
1. Do you claim title to the equipment staging area'? (check one) InYes ❑No
12. Are there any water -treatment facilities within 50 feet of the proposed excavation area?
(check one) ❑Yes ZNo
(If Yes, specs#):
13. 1low will the excavated material be entrapped and the erosion controlled? (e.g. see attached
erosion control plan and disposal area design):
Dredge by barge, haul out material through owner's property, material hauled by dump truck
to be area on owner's property. Material will be left on site
Duke Lnerpy Page 6 of 13 [ev 11122121
Excavation I'roglain

Duke mercy Excavation Permit Application Form
14. Tvpc(s) of excavation couirnunt to be used:
Barge, long Roach Excavator and Dump Truck
15. \Fill watcrs or Nvetlands be crossed in transporting equipment to or from the site?
whcck opic) QYCS ❑No
(tl ITS. C11+lain 1
By barge
1 h. Rill return water re-enter the reservoir? (Check one) ❑Yes ®No ❑N/A
1(1cs. spcIcifi- voint(s) ogre -entry and show on Excavation Area Drawing)
17. Is there an existing facility (e.g. pier) that access is being maintained to by conducting the
excavation? ®Yes ❑No
(If Yes, provide the existing permit number. If No, include a scaled drawing of the proposed
facility). Permit # 15914 Dock tag will need to be transfer to new owner
18. Total planned duration of the work (Include first equipment mobilization, excavation
through final mitigation measures complete):
START 8 / 2023 FINISH 8 / 2023
(Month) (Year) (Month) (Year)
Duke Lnergy t'uge 7 of 13 rry 11/22/21
Excavation Program

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Duke Fnero— F.ccayntion Permit %pplicRilon Form
C . Applica it's SIL"mitulrs
Crmmcnty
%pplicam Name (prowl Tj-�Ck M,U,l a:r
applicant Signature* Datc
Co -applicant Name (print)
Co-.-kpplicant Signature*
Co -applicant lame (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Date
Date
Date
Date
*Per my signature, the information provided in this application is correct to the best of my
knowledge.
Duke Energy Page 10 of 13 rry 11122CO21
t:xcavation Program