20160038 Ver 1_Shoreline Stabilization_20160111

State of North Carolina
DWR
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H.0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources 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 2 0 1 6 0 0 3 8
1650 Mail Service Center
Raleigh, INC 27699-1650
I. Applicant Information [15A NCAC 02H .0502(a))
1. Owner Information L
Name: `li A,+t/ /2�+5riwuSSen! �Il
Mailing Address: /9�Ib RlrvtcyY, PIrve5 Ln/ I j 2016
,nVeG4-5 A(C X8-031 Deo•w
FF R PERMI�II
Telephone Number: -7i9'/- '?03- Fax Number:
E-mail Address:
2. Agent/ Contact Person Information
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: 1 r1d {S
Company Affiliation: C/5 5- ret t g
Mailing Address: 63,9 Kr' c- F n, vv
In eo res v <( , /V'c
Telephone Number:
E-mail Address:
Person to receive the
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,
FORM: SSGP 10-2013�n�� I Page 1 of 4
( !n� .

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: tcxlf-Al6tNearest Town: '9 ►-NL f' -a
Subdivision name or site address (include phase/lot number).77k 1D,'1VAW5't `t' /, ?L
Directions to sit - please include road ames and numbers, landmarks, a c.:
• �� ane Ci
-J /;P,* AT, /;? 6C 7j;ffv tj
PeivlArS wlA Ck4 ��. ;3*-lam°'-Xf`��
T
S. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.):
6. Property size (acres): 0 76
7. Lake/ river/ ocean adjacent to property: AA -14e- 0 (-/nOA/
S. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): dV e J9 -C
9. Will work be conducted from land? ❑ From water?LPJ
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the norma pool lake level/ Normal Water Level in square feet or acres:
ZZ^
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: /U®AlCs
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): Y'GSiG `W-J�4 �
home. w`'1 hlicy-
/�- 3 0 -15
Owner/Agent's Signature- (15A NCAC 02H .0502(f)l Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

4"o CO-,
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 EXCAVATION PERMIT APPLICATION FORM
FOR DUKE ENERGY USE ONLY
Duke File No.
Application Fee $ Security Deposit $ Check # Date Recv'd initials
Date of Duke Energy Lake Services, applicant and/or contractor on-site inspections Date_0 i O'1 I l.p Initials t
Date Final Protection/Avoidance Area Markings Field - Verified
Approved to Start Work By * :
Initials
(Print) Mtn)
Date Completion Required Date of Any Approved Extension Initials
Date Passed Closeout Inspection* Initials
Any Stop Work Orders or SMG Violations*? (check one) ❑Yes I]No (If Yes, explain in PART V)
Date Deposit Refunded Initials Date Permit Database Updated _ initials
* Forward copy of approved application (all pages, plus any attachments that Duke Energy changed) back to applicant
with Approval Letter and highlight any changes. File copies of Approval and Close-out Checklists and any Stop Work
Orders with application.
Date
PART I. - APPLICANT INFORMATION (Please Print)
NameM I cA,4 e Rks rq it � Telephone (7043
Lakedd�ress ��/ 7 �� b, hlAfOk� ��f' `i �' Mailing Address
( .0 V- Ow�t'.-piasf; AIC '290-3/ (If different)
Contractor Company
Contractor contact person CT r^ i d a esTelephone / (D In Q ,5-111
LAKE LOT INFORMATION
Lake County Q .N. LPa City. 60 F .N(t- State lJG Tax Map No.
Subdivision
Pe d t ,V S "L[&-, Lot / Section No. 13 3 Lot Size©, If78 Acres
Are there any Co -Applicants*? (check one) l7Yes ONo (Ifyes, include names, addresses, phone nos., lot nos., lot
sizes in PART V — ADDITIONAL INFORMATION) * Co -Applicants exist when the proposed work is being done under a
single application, will be performed by a single contractor as one continuous project and is done to benefit multiple owners /
lease holders of project -front properties within a single development. The check for the application filing fee and security
deposit should be from the party shown as Applicant and not several checks from the Applicant and Co Applicants.
Do not continue the application until an on-site inspection has been conducted between a Duke Energy Lake Services
Representative (DELSR) and the applicant and/or the excavation contractor. NOTE: Initializing this portion ofthe
applkwlion by a DELSR in no way constitutes approval or endnent approval of the awavadon or any other lake we
perndtting activity.
Date of on-site inspection bi Q I [ ca Initials (Duke Energy) J E?Kt ll (applicant/contractor)
Duke Energy
Excavation Program
Page 1 of 14
rev 9/19/14
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application 113 10.docx

DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
PART H. - DESCRIPTION OF PROJECT
A. BASIC INFO
1. Type of excavation: (check one) ?New excavation ❑ Maintenance excavation
2. Purpose of excavation: (check one) XBoat Access Channel ❑ Water Intake Channel
❑ Wastewater Discharge Channel ❑ Other (specify):
3. Lake user category: (check one)1 Private ❑Residential Marina OCommercial Marina
Public ❑Other (specify):
4. Max. Excavation Area Dimensions (ft): Length D Width 50. Depth._...,.�f.5
(Note: include additional area dimensions f necessary so response to #S below equals max. area dimensions in #4)
5. Volume of Excavated Material (TOTAL for the project): e2154 Cubic yards
6. Type of material removed (applicant determines by field sample # practical) r 1 A if
7. Excavation Site area: Acre (s) Disposal Site area: b • O Acre (s)
8. Total Disturbed Area (including equipment staging area):.. • f" O Acre (s)
9. Does the project meet the requirements of the applicable General Permit? (check one) Yes ONo
10. Do you claim title to the disposal area? (check one) 1 Yes ONo
11. Do you claim title to the equipment staging area? (check one) �Yes ONo
12. Are there any water -treatment facilities within 50 feet of the proposed excavation area? (check one) Dyes Wo
(If Yes, specify).
13. How will the excavated material be ped and the erosion cone g. see attached erosion control plan and
disposal area design); W 0Y K W � �G 4toG b �-
--- - f
14. Type(s) of excavation equipment to be used: h,A-�W,
15. Will waters or wetlands be crossed in transporting equipment to or from the site? (check one) 13Yes 1%10
(Ifyes. explain). .
16. Will return water re-enter the reservoir? (Check one) OYes #No ON/A (If Yes, specify points) of re-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 ONo
(If Yes, specify the existing permit number. If No, include a scaled drawing of the proposed facility). Permit #.
18. Total planned duration of the work (Include first equipment mobilization, excavation through final mitigation measures
complete): START Of l-20/6 FIMSH d I / 9-0 1 k
(Month) (Year) (Month) (Year)
Duke Energy Page 2 of 14 rev 9/19/14
Excavation Program
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application 113 10.docx

DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
,.
PART IL (Continued)
B. PROTECTION / AVOIDANCE AREA DESCRIPTION
Complete the following table including all land areas within and immediately adjoining the disturbed area:
Protection/Avoidance Areas
(check all that apply)
Approx.
Acreage
)(deatificatiop Method
Avoid (A) or Mitigate (M)
**
Field ID
Work Area Dwe. ID
a. Marshland, swamp, ponds, beneficial
aquatic vegetation or other potential wetlands (circle all
that apply)
%�14
b. Buffer Zones (spew width & source of
requirement)
C�.� Vf, tc We- CIOAl ,�
c. Environmental Areas as identified by Duke
Energy
P I A
d. Natural Areas as identified by Duke Energy
e. Historic properties (specify)
E Rare or threatened species (specify)
' r
Duke Energy Page 4 of 14 rev 9119114
Excavation Program
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM,
Protection/AvoWage .Areas.
(check all that apply)
Aaoros•
Identificatiga Method
Avoid (A) or Mitigate (Ml
#t
Field ID
Work AreaDwe. ID
Ac ea a
R. Buried gas, water, sewer, communications
or electric lines (circle)
h. Impact Minimization Zones as identified by
Duke Energy
)
i. Other areas requiring specific avoidance,
protection or mitigation (spec)
, ( j
lV I
* For "Field ID" column, specify entity or person that performed the identification and how it was physically marked (e.g. Duke Energy (John Doe)/Pink and purple -dotted tape,
Corps of Eng. (John Smith)t yellow flagging). For "Work Area Dwg ID" column, show the symbol that is used on the drawings to identify the protection/avoidance area
** List and attach mitigation plans
Duke Energy Page S of 14 rev 9/19/14
Excavation Program
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C. APPLICANT'S SIGNATURES DA
q�
Comments: : D AMG �S f� 1 ' �,�
! m, rf
Applies -at Name (Prin
Applicant Signature
Go -Applicant Name (print)
Co-Applicaut Signature*
;Co -Applicant Name (prim)
Co-Applicant Signature*
Co-Applicaut Name
Co -Applicant Signature*
Co -Applicant Name (prin
Co-Applienut Signature's
Co -Applicant Name (prin)--
Co-Applaeaut Signature* _
i-14 0/ C' -/ 3f -
Lot /3--,-
Date / - _J'�o 15
Lot'#
Date
Lot ##
Date
Lot ##
Date
Lot #
Date
Lot ##
Date
"Ter my signature, the information provided in it& application is correct to the best of my knowledge.
BEFORE YOU MAIL TUE APPLICATION TO DUKE ENERGY LAKE SERVICES ENSURE YOU HAVE:
CHECKED TETE INFO THOROUGHLY
MET ALL REQUIREMEN'T'S FOR A COMPLETE APPLICATION (see ever tetter oaf appi#cation package)
a INCLUDED A SINGLE CHECK TO DUKE ENERGY FOR THE APPLICATION FILING FEE AND SECURITY
DEPOSIT
INCLUDED ALL AGENCY PERT%M OR CONBAENT L& iERS AND RESOLVED ALL ISSUES RAISED
INCL13DED ALL REQUIRED DRAWINGS (INCLUDING PROPOSED FACILITIES), PERMIT4 FOR BXISTING
FACILITIES, SURVEYS AND PLANS
m MCLUDED COPIES OF REEDS AND AUTHORIZATION LINTERS
Duke Energy
Page $ of B4 rev 9119!14
Excavation Program
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application 113 MAO=

WATERSIDE DOCKS & PIERS
LAKE NORMAN
RASMUSSEN4 PROJECT
DEC 14 2015
TO BE REMOVED
existing dock
1/ 6 ►, ,/ 6 ►,
,25
12
CF) 156 156
5
,c.
g5
p� 144
1�5►,
- 161/2
67 4b.
7.5/ 70'
6.75/60
6.0150 300 O
O
5.5140
4.5 @ 20
i
1%y
approx 760 elev
I Y 1
NEW DOCK
105
proposed dock
1
---------------
'� 12
9.5
g 00�
04
7;5/ 70'
b
N
6.75160
6'0150
p)
--------------------
-------= -
64140
50
approx 760 elev
I Y 1

NORMM �
NORTH PER
MB 24 P6 543
74.
V, /
lq 0,
001{,62412
DMIELPARKS
KMTHUEN PARKS
DR 28400 K 531
-
X
ADTOINER'S
CONCRETE
Property
Surveyors, Inc.
DRIVE& WALL
LEGEND:
18335 Old Statesville Road
A4 REBAR FOUND
0
COMPL7EDPOBTT
e
UTJLTY PEDESTAL
Jd
FENCE L IE
-
LAKE
NORMAN
SUITE A
CORNEUUS,N.C. 28031
[phone]
..7..8�— 2 3�
BALMORE PINES LANE
SO' PUBLIC R/W ROAD WIDTH VARIES
l / ADIOINER'S FENCE
n
' EC.E14N
LAMESG JR.
�JJ,^ NUMG. .ENGEENGEL
5d D815996 PG 877
1Q N01E5:
' I. NO NCOS MONUMENTFOU
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S
2. PROPERTY MAY SURIR
OT
COVENANTS,
RFSTRICIONS.EASEMENIS
MGMT ()F -WAY TNAT MAY
Z OF RECORD.
co
3. PRWCIPAL STRUCTURE
N SETBACKS PER MR 24 M 543
P FRONT: N
SIDE: ON2 SIDE 6', TIDE OTI
ATLEAST8'
REAR: 45-
4. ACCESSORY SMACKS
THE TOWN OF CORNESIUS A
WATERSHED ORDMANCE
(PETITION N88 -31(Q:
SIDE: 5'
REAR30'FROM FF760
CONTOUR OR '
PROPERTY NE,.
WtDCNEVER IS GREAT
5. CONSULT WITH OOVE NIT
AGENCY FOR PREVAILING
DEVEIUPMENT AND ZOW4
REOUIREMETTSPWORTO
DESIGN OR CONSTRUCTION
P,_ ANY IMPROVEMENTS.
Physical Survey of Lot 133 of The Peninsula, Phase V, Map 6
Professional
Site Address:
Property
Surveyors, Inc.
As Recorded in:
Property of:18410
Baknore Pines Lane
18335 Old Statesville Road
Deed Book 6678 Page 678
Cornelius, NC 28031
Ste. A, Cornelius, N.C. 28031
Michael Rasmussen Map Book 24 Page 543
Mecklenburg County, NC
704765-5134 Phone/Fax
F.lj m C-3666
062915-03 1RW
21:10.000 1'70' 001622-03 RASMUSSEN
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DUKE ENERGY DIRECTIONS BY ROAD
Lake Use Permit Applicants and contractors: Ease of locating the proposed project site can
have a big impact on permit processing time. Please complete this form and return in along with your
completed permit application to:
Duke Energy
C/O Lake Services – EC12Q
P 0 Box 1006
Charlotte, NC 28201-1006
1-800-443-5193 and select Option 5
Applicant's Name:—Michael Rasmussen
Street Address (at Lake) _18410 Balmore Pines Ian
Subdivision Name: The Peninsula
Tax Parcel ID (if known): -00166203
City:–Cornelius
State: NC
Lot (s) 133_
County_Mecklenburg_
–Zip: -28031
Latitude: -35.4664 Longitude: -80.9125
Telephone: [phone]
Directions from major road or highway):
1-77 North to exit 25 – West on Catawba Ave Right on Jetton Rd – eft on Peninsula Club Dr.
To the end of Peninsula club Dr to Left on Balmore Pines Ln
Descriptive Structures- (s) ( i.e. brick garage, white fence, mobile home, etc)
18410 Balmore Pines Lane

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