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HomeMy WebLinkAboutNCG520126_Application_20211028 2,,, .„ . .,.. ROY COOPER Governor ELIZABETH S.RISER . _6 Secretary •�°""�`-�' S.DANIEL SMITH NORTH CAROLINA Director Environmental Quality October 28, 2021 Randy Austin Randy H Austin 239 Quiet Water Rd Belmont, NC 28012 Subject: Permit Renewal Application No. NCG520126 239 Quiet Water Road Gaston County 1 Dear Applicant: The Water Quality Permitting Section acknowledges receipt of your application for a new NPDES WW permit, including supporting documentation and your check number 5428 in the amount of$100.00 as payment of the application fee. These items were received in our offices on October 28, 2021. Your application will be assigned to a permit writer within the Section's NPDES WW permitting branch. The permit writer will contact you if additional information is required to complete evaluation of your application. Your timely and direct response to any such request will help to expedite the review process. Please note that acceptance of the application does not guarantee a NPDES permit will be issued for the proposed activity. A permit will only be issued following a complete review of the application, concluding the proposed discharge is allowable per applicable statutes and rules. Information regarding the status of your renewal application can be found online using the Department of Environmental Quality's Environmental Application Tracker at: https://deq.nc.gov/permits-regulations/permit-guidance/environmental-application-tracker If you have any additional questions about the permit, please contact the primary reviewer of the application using the links available within the Application Tracker. Sinc ly, ''II 11 ItoI--1 Wren The. ord Administrative Assistant Water Quality Permitting Section ec: WQPS Laserfiche File w/application DE Q.�� North Carolina Department of Environmental Quality I Division of Water Resources �pp�w •��'� Mooresville Regional Office 610 Last Center Avenue.Suite 301 Mooresvilk.North Carolina 28115 Eri=f=.+o.+b� 704.663.1699 FOR AGENCY USE ONLY re " , i ,'=lr Date Received Year Month Day ire Certificate of Coverage NORTH CAROLINA N C G 5 2 b 1 �! Environmental Quality Check# Amount NCDEQ / Division of Water Resources �ya 100 National Pollutant Discharge Elimination System Assigned To: Chap e5pgreL Application for Coverage Under General Permit `� NCG520000 RECEIVED Sand Dredging operations and similar point source discharges OCT282021 NOTICE OF INTENT NCDEQ/DWR/NPDES [Required by 15A NCAC 02H .0127(d); Term definition see 15A NCAC 02H .0103(19)] (Please print or type) 1) Mailing address of owner/operator: (address to which all correspondence should be mailed) Company Name: Randy H. Austin Owner Name: Randy H. Austin Street Address: 239 Quiet Waters Rd. City: Belmont State: NC ZIP Code: 28012 Telephone No.: 704-609-8801 Fax: Location of facility producing discharge: Facility Name: Austin/Nichols Cove Facility Contact: Randy H. Austin Street Address: 239 Quiet Waters Rd. City: Belmont State: NC ZIP Code: 28012 County: Gaston Telephone No.: 704+609-8801 Fax: 2) Physical location information: Please provide a narrative description of how to get to the facility(use street names, state road numbers, and distance and direction from a roadway intersection). Head south on South Point Road to Lower Armstrong Road and turn left. Travel approximately 1 mile to the Forrest Bay subdivision on the right and turn into Forrest Bay which is Quiet Waters Road. The address is 249 Quiet Waters Road. (A copy of a county map or USGS quad sheet with facility clearly located on the map is required to be submitted with this application) Page 1 of 4 NCG520000 New Application 3) This NPDES permit application applies to which of the following: X New[term definition see 15A NCAC 02H .0103(16)] or Proposed o Modification Please describe the modification: o Renewal Please specify existing permit number and original issue date: 4) Does this facility have any other NPDES permits [term defmition see 15A NCAC 02H .0103(15)]? X No o Yes-If yes, list the permit numbers for all current NPDES permits for this facility: 5) Description of Discharge: [Required by 15A NCAC 02H .0105(c)(1)] a) Is the discharge directly to the receiving water? ❑Yes X No-If no, submit a site map with the pathway to the potential receiving waters clearly marked.This includes tracing the pathway of the storm sewer to the discharge point, if the storm sewer is the only viable means of discharge. b) Number of discharge points(ditches,pipes,channels,etc.that convey wastewater from the property): None c) Volume of discharge per each discharge point(in GPD): #1: #2: #3: #4: d) Please describe the type of process the sand dredging wastewater is being discharged from,be specific: The sediment will be hauled from Lot 27 on the lake to Lot 19/20 which is across the street to a hole that will be dug to contain the sediment more than 500 feet from the lake. e) Is there any treatment being applied to the wastewater before discharge(check the type of treatment in use)?: ❑ Settling pond o Lagoon X None o Other: f) How much of the volume discharged is treated(state in percent)? 0% g) If any box in item(e)above,other than none,was checked, please include design specifics(i.e., design volume,retention time,surface area,etc.)with submittal package. Existing treatment facilities should be described in detail. Design criteria and/operational data(including calculations)should be provided to ensure that the facility can comply with the requirements of the General Permit,as required by 15A NCAC 02H .0127. The treatment shall be sufficient to meet with the limits set by the general permits. The trapping efficiency should be greater than 75%. The surface area should be as large as possible to insure sedimentation occurs. To secure optimum efficiency the flow length of the basin to the basin width should have a ratio of 2:1 Note: Construction of any wastewater treatment facilities requires submission of three(3)sets of plans and specifications along with the application. Design of treatment facilities must comply with requirements of 15A NCAC 02H .0138. If construction applies to this discharge, include the three sets of plans and specifications with this application. 2 NCG520000 New Application 6) Discharge Frequency: [Required by 15A NCAC 02H .0105(c)(1)] a) The discharge is: ❑ Continuous X Intermittent ❑ Seasonal i) If the discharge is intermittent, describe when the discharge will occur: This will be a one time occurrence during dredging of the cove. There should be no direct discharge into Lake Wylie. ii) If seasonal check the month(s)the discharge occurs: ❑ Jan. ❑ Feb. ❑ Mar. ❑ Apr. ❑ May ❑Jun. ❑ Jul. ❑ Aug. ❑ Sept. ❑ Oct. ❑ Nov. ❑ Dec. b) How many days per week is there a discharge? Should be less than 10 days c) Please check the days discharge occurs: ❑ Sat. ❑ Sun. X Mon. X❑ Tue. X❑ Wed. X Thu. X Fri. 7) Receiving waters: [Required by 15A NCAC 02H .0105(c)(1)] a) What is the name of the body or bodies of water(creek, stream, river, lake,etc.)that the facility wastewater discharges end up in? If the site wastewater discharges to a separate storm sewer system(4S), name the operator of the 4S (e.g. City of Raleigh). Lake Wylie b) Stream Classification: 8) Alternatives to Direct Discharge: [Evaluation required by G.S. § 143-215.1(b)(5)(a) and 15A NCAC 02H .0105(c)(2)] Address the feasibility of implementing each of the following non-discharge alternatives a) Connection to a Municipal or Regional Sewer Collection System b) Subsurface disposal(including nitrification field,infiltration gallery,injection wells, etc.) c) Spray irrigation The alternatives to discharge analysis should include boring logs and/or other information indicating that a subsurface system is neither feasible nor practical as well as written confirmation indicating that connection to a POTW is not an option. It should also include a present value of costs analysis as outlined in the Division's "Engineering Alternatives Analysis (EAA) Guidance Document". Additional Application Requirements: For new or proposed discharges,the following information must be included in triplicate with this application or it will be returned as incomplete. Per I5A NCAC 02H .0105(c) a) 7.5 minute series USGS topographic map(or a photocopied portion thereof)with discharge location clearly indicated. b) Site map, if the discharge is not directly to a stream,the pathway to the receiving stream must be clearly indicated. This includes tracing the pathway of a storm sewer to its discharge point. c) If this application is being submitted by a consulting engineer(or engineering firm), include documentation from the applicant showing that the engineer(Or firm) submitting the application has been designated an authorized Representative of the applicant; per 15A NCAC 02H .0138(b)(1). 3 1 NCG520000 New Application d) Final plans for the treatment system(if applicable). The plans must be signed and sealed by a North Carolina registered Professional Engineer and stamped-"Final Design-Not released for construction;"per 15A NCAC 02H.0139. e) Final specifications for all major treatment components(if applicable). The specifications must be signed and sealed by a North Carolina registered Professional Engineer and shall include a narrative description of the treatment system to be constructed;per 15A NCAC 02H.0139. CERTIFICATION I certify that I am familiar with the information contained in this application and that to the best of my knowledge and belief such information is true,complete,and accurate. Printed Name of Person Signing: Randy H.Austin Title: Owner (Please review 15A NCAC 02H .0106(e) for authorized signing officials) ,j-----e____ /G -- 26 Zv 2 / (Sign ure of Applicant) (Date Signed) North Carolina General Statute 4 143-215.6B provides that: Any person who knowingly makes any false statement representation, or certification in any application, record, report, plan, or other document filed or required to be maintained under this Article or a rule implementing this Article; or who knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the Commission implementing this Article, shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars($10,000). 18 U.S.C. Section 1001 provides a punishment by a fine or imprisonment not more than 5 years,or both, for a similar offense. Notice of Intent must be accompanied by a check or money order for$100.00 [per G.S. $ 143- 215.3(a)(1b)]made payable to: NCDENR Mail three(3)copies of the entire package to: Division of Water Resources NPDES Permitting Section 1617 Mail Service Center Raleigh,North Carolina 27699-1617 Final Checklist This application will be returned as incomplete,as allowed by 15A NCAC 02H.0107(b),unless all of the following items have been included: o Check for$100.00 made payable to NCDENR o 3 copies of county map or USGS quad sheet with location of facility clearly marked on map o 3 copies of this completed application and all supporting documents o 3 sets of plans and specifications signed and sealed by a North Carolina P.E. o Thorough responses to items 1-10 on this application 4 NCG520000 New Application ❑ Alternatives analysis including present value of costs for all alternatives Note: The submission of this document does not guarantee the issuance of an NPDES permit 5 assign 81 r x e[a.0 O.r/OMmr• GaaY .0¢i 0 " Randy H.k Mary P.Austin ECEA 1 Z P AS T SI MO CASE LESS Know wham below. 0 ",C 2J9 Quiet MOAT Rd. 6T5 Huntsman Court aces Caii before you dig Belmont.N.C.28012 Gastonia.NC Teosa (216 0 Site"aa Ras CC a sm.wT CONTROL M H ea HUNTSMAN COURT NIP ITeEm.0 1 D9 mT ors. 0 .LLR OP RECORD a APIN .RE �4A En o %M NO vas. 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U 0. •ROPOSED 12'X16' C, e"�'•en1'""'"u ORMAL POOL ELEVATION 570' (MSL) FLOATING DOCK (TYP.) `ta CC �m N RANDY & MARY AUSTIN 249 QUIET WATERS RD o � � BELMONT, N.C. 28012 VICINITY SKETCH v LC PROJECT 1 202108B XISTING GRADE OF HE PROPOSED O DRAWN BY: BJPJ DREDGE AREA TO BE EXCAVATED APPROXIMATELY 3'-5' ,_CHECKED BY: ACl 12.0 • r O DATE:10/05/2021 MIIIII SCALE: 1"=30' I_____I ,iiiiiiiimii. iiimirr, } z Cr) o "°1=IIIIII=IIIII g-IIIIII=IIIIII=IIIIII=IIIIII==IIIIII=IIIIII=IIIIII=IIIIII=IIIIII=IMF; w g 4 "'-7-r pill1=IIIIII—IIIIII-IIIIII—IIIIII—IIIIII—IIIIII—IIIIII—IIIIII—IIIII S� R°-I11111=111111=111III=IIIIII=I1111=11IIII—IIIIII=111,,,,, 1/q S`p-e wmglIIIIII=IIIIII= dimIIIIII=IIIIII= '"" c, Ih O Lr_ 72.0 1ml 32.0 SECTION B'—B' r9 ...". H g I FGEND ROPOSED 12'X18' — — ORMAL POOL ELEVATION 570' (MSL) FLOATING DOCK (TYP.) • D RANDY & MARY AUSTIN == 249 QUIET WATERS RD _._ Oft ,. BELMONT, N.C. 28012 XISTING GRADE OF THE PROPOSED "_u+q, •�'""w DREDGE AREA TO BE EXCAVATED e... +/,g' `� .`i[ss26t`k'"l APPROXIMATELY 3'-5' (Ti,, K1b • i3`: '1Q I ` 18.0 1y _ `i ynar� "W[C 10.22.2021 3'_5. = -: $ Cl 1011. 41jII' -= III-'I1= II11®11=IIIIII= I =III=III=I =I I °I°9� •w= =III �' -.. " ,» II M I I =I—IIIII IIIU=IIIIII-1 IIIII O 3 a TMwnOAn 'Spp1lr111111-111I1E11111M11111—IIIII 1III •III—IIIIII=IIIIII-11111EI11117. 5 o (Dzw a1,, .•,,, a =IIIIII-IIIIIIE1111E-111111=1111:1-111111=IIIIII=1111IIPIr o •---.-� • u b O ;) 'ALL "• 0 '., 18.0 \ € il 't U cwin ra ; d A'A..m a..r,n.,aa,7,N1ERED DURING GRADING.Au.BE MOORED AS SECTION A'—A' ,o In Owen-7 o...as• Crw D.agn Dy: 811b�e�lye.�� [NORMAL POOL ELEVATION 570' (MSL) Randy N R Mary P.Austin ECEA239 IL' Z g Y�IYAe Belmont tN..C.ters Rd. 625 28012 Gastonia,smon NC 2B051Court O �r � OATING DOCK (TYP.) Site"D•p1 U oecea e.►•se.uve.aM•w �4�, � Wa nunrewu.mtArr BOATHOUSE (TYP.) vi ONC MIME NO./20129 .DOM..o P FM D.Leal. VICINITY SKETCH (� WEIEP""�"E,Om RANDY & MARY AUSTIN - PROeECT�. 20210BB 239 QUIET WATERS RD .DRAWN BY: BJPJ BELMONT, N.C. 28012 XISTING GRADE OF THE PROPOSED i_ CHECKED BY: ACL 25.0 DREDGE AREA TO BE EXCAVATED ° DAlE:10/OS/2021 APPROXIMATELY 3'-5' SCALE 1"=30' u II IJ I� I U I I / I g 4 I 4 L.I 25 b T . SECTION B'—B w NORMAL POOL ELEVATION 570' (MSL) COATING DOCK (TYP.) ).EGEND II RANDY & MARY AUSTIN - _•_ 239 QUIET WATERS RD BELMONT, N.C. 28012 _ XISTING GRADE OF THE PROPOSED BOATHOUSE (TYP.)� DREDGE AREA TO BE EXCAVATED a..n 01 H ••..,,t �-"^•., 30.0 APPROXIMATELY 3'-5' �'. -:°,.. /R�0Va.'+:\ 10.22.2021 ICI-1N I I� =O {Min = = = - el _- = - ,, e D N. 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L� i_CHECKED BY: ACL 37.0 e r Z DAiE:10/05/2021 1-1 I 11 11 IL I I J 4 _ 1 SCALE:1••- Mq-itii 111=11111I=11111®IIII®IIII III_Illmllll®IIII®IIIIonifflIIII-111t®IIIIEIilll®llll�llllElllll.11l_II=111_II,„,,lll °PE w PTA 3 clllill-111111 1111®IIII®imff_IIIII�IIII-IIII®IIII®IIII®IIIILIIIII®II IHIIIII IIII®IIIIIwIIIII=IIIIII "5:�S W hyi S70.6 III=II111 I I- II- III I- 1-II-III-III a - II-I `=II - -III-IIII=III' M"" x H e 37.0 57.0 - FI SECTION B'-B' ORMAL POOL ELEVATION 570' (MSL) 41 LOATING DOCK (TYP.) LEGEND 11 FRANK NICHOLS -•— 243 QUIET WATERS RD EXISTING GRADE OF THE PROPOSED --- BELMONT, N.C. 28012 DREDGE AREA TO BE EXCAVATED APPROXIMATELY 3'-5'. 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Belmont N.C.28012 Gaetano,.NC 28051 Site a U �. 0 ecea /"' ORMAL POOL ELEVATION 570' (MSL) •ROPOSED 12'X18' D FLOATING DOCK (TYP.) `tea Ce w�• -may RANDY & MARY AUSTIN 4,i°a t~itp 249 QUIET WATERS RD z ROME:(AN o BELMONT, N.C. 28012 VICINITY SKETCH c.) PROJECT it 2021088 XISTING GRADE OF THE PROPOSED p DREDGE AREA TO BE EXCAVATED L.DRAWN BY: BJPJ APPROXIMATELY 3-5' CHECKED BY: ACL 12.0 • Z DATE:10/05/2021 I irimil. 1.1 .11 inv. I , : Z Z Cin ttl_ _ _ .... o Mq7IIIIIIIItIIIUIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII-1111IIIIIIIIIIIIIIIIIIIilllllllllllliillllll1111llllllllllllllllllll„S�IoQ' 3 f 4.1 1iRIIIIR1111II=IIIIII=IIIIII IIIIIII=111111=111111=III:0-3'' 5 -Y. _ _ ui S4Ope -null=IIIIII=IIIIII=116J=IIIIII=IIIIII- ' ix E., , 0 L� 12.0 4 32.0 SECTION B'-B' 4 •ROPOSED 12'X18. LEGEND11 ORMAL POOL ELEVATION 570' (MSL) FLOATING DOCK (TYP.) —•— d" f " RANDY & MARY AUSTIN ---- 249 QUIET WATERS RD CY BELMONT, N.C. 28012 — u. XISTING GRADE OF THE PROPOSED � DREDGE AREA TO BE EXCAVATED =_ a� `.k C�i't,H APPROXIMATELY 3'-5' �,g 18.0 -' 9 fr µ�1 m F a.AUt o -- 1 10.22.2021 ON el 11210, DO,C1.1 MUST OE �,ACCORDANCE_TM 'tIIaI__IIIIII=IIIIII=IIIIII=IIIIII=IIIIII=IIIIII=IIIIII==IIIIII=IIIIII=IIIIII=IIIIII=IIIIII=IIIIII=IIIIII- 0 fro, '—IIIIII=IIIIII=IIIIII=IIIIII=IIIIII=IIIIII—IIIIII=IIIIII=IIIIII=IIIIII=IIIIII=IIIIII=IIRS\-6' „. CONS 3'S<ppIIII_IIIIII—IIIIII—IIIIII—IIIIFiIIIIII-IIIIII—IIIIII—IIIIII—IIIIIIIUIII 0. ;- o a -,>o ,..4 F IIIIII=IIIIII=IIIIII=IIIIII1111JIIIIII=IIIIII=IIIIII-III' '" 0 = (0 Z p H: € SECTION 18.0 .. . Q ' .��,.�.. IT.. , SECTION A'-A' W 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 Initials Date Final Protection/Avoidance Area Markings Field-Verified Initials Approved to Start Work By*: Date (Print) (Sign) Date Completion Required Date of Any Approved Extension Initials Date Passed Closeout Inspection* Initials Any Stop Work Orders or SMG Violations*?(check one) ❑Yes ❑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. Part I. Applicant Information (Please Print) Name Randy H. Austin Telephone 704-609-8801 Email address: randy@visionmetering.com Lake Address Mailing Address (if different) 239 Quiet Waters Rd Belmont, NC 28012 Contractor Company Randy H. Austin (will bid dredging once permits received) Contractor Contact Person Randy H. Austin Telephone 704-609-8801 Contractor Email Address: randy@visionmetering.com LAKE LOT INFORMATION Lake Wylie County Gaston City Belmont State NC Tax Map No. Subdivision Forrest Bay Lot/Section No. 27, 28 & 29 Lot Size 2•6 Acres Duke Energy Page 4 of 13 rev 10/1/2019 Excavation Program Duke Energy Excavation Permit Application Form Are there any Co-Applicants*? (check one) EYes ❑No (If Yes, include names, street addresses or lot numbers,pier numbers,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 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. 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. NOTE: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 activity. 2/2/2021 Date of on-site inspection Initials (Duke Energy)_ (applicant/contractor) Duke Energy Page 5 of 13 rev 10/1/2019 Excavation Program Duke Energy Excavation Permit Application Form Part II. Description of Project • A. Basic Information 1. Type of excavation: (check one) D New excavation 0 Maintenance excavation 2. Purpose of excavation: (check one) 0 Boat Access Channel ❑ Water Intake Channel 0 Wastewater Discharge Channel ❑ Other(specify): 3. Lake user category: (check one) DPrivate ❑Residential Marina ❑Commercial Marina ❑Public ❑Other(spec): 4. Max. Excavation Area Dimensions (ft): Length 150' Width 30' Depth 3'to 5'from 97' (Note: include additional area dimensions if necessary so response to #5 below equals max. area dimensions in #4) 5. Volume of Excavated Material (TOTAL for the project): 500 to aoo Cubic yards 6. Type of material removed (applicant determines by field sample if practical): Sediment, Silt, Sand 7. Excavation Site area: .5 to.75 Acre (s) Disposal Site area: 1.25 Acre(s) 8. Total Disturbed Area(including equipment staging area):-5 to.75 Acre (s) 9. Does the project meet the requirements of the applicable General Permit? (check one) ✓ {es Jo 10. Do you claim title to the disposal area? (check one) EYes No 11. Do you claim title to the equipment staging area? (check one) ❑Yes '10 12. Are there any water-treatment facilities within 50 feet of the proposed excavation area? (check one) Yes ✓ to (If Yes, spec): 13. How will the excavated material be entrapped and the erosion controlled? (e.g. see attached erosion control plan and disposal area design): A hole will be dug on lot 20 across the street from Lot 27(269 Quiet Waters Rd.) in the area designated on the attached map. Silt fencing will be installed around the hole and spoils and SCE to burial pit. Duke Energy Page 6 of 13 rev 10/1/2019 Excavation Program I � Duke Energy Excavation Permit Application Form 14. Type(s) of excavation equipment to be used: Track Hoe and/or pump 15. Will waters or wetlands be crossed in transporting equipment to or from the site? (check one) ❑Yes UNo (If yes, explain) 16. Will return water re-enter the reservoir? (Check one) ❑Yes I INo ON/A (If Yes, sped point(s) 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? r21Yes ❑No (If Yes,provide 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 11 / 2021 FINISH January / 2022 (Month) (Year) (Month) (Year) Duke Energy Page 7 of 13 rev 10/1/2019 Excavation Program Duke Energy Excavation Permit Application Form Part II. (Continued) B. Protection/Avoidance Area Description Complete the following table including all land areas within and immediately adjoining the disturbed area: Protection/Avoidance Areas Approx Identification Method(*) Avoid(A)or Mitigate(M) (check all that apply) Acre Field II) Work Area Dwg. ID None a. Marshland,swamp,ponds,beneficial aquatic vegetation or other potential wetlands (circle all that apply) None b. Buffer Zones(speck width&source of requirement) None c. Environmental Areas as identified by Duke Energy None d. Natural Areas as identified by Duke Energy None e. Historic properties(sped) None f. Rare or threatened species(sped) Duke Energy Page 8 of 13 rev 10/1/2019 Excavation Program Duke Energy Excavation Permit Application Form Protection/Avoidance Areas Approx Identification Method(*) Avoid(A)or Mitigate(M) (check all that apply) Acre Field ID Work Area Dwg. ID None g. Buried gas,water,sewer, communications or electric lines(circle) None h. Impact Minimization Zones as identified by Duke Energy None i. Other areas requiring specific avoidance,protection or mitigation(spec) * 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)/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 on miti ati plans g Duke Energy Page 9 of 13 rev 1 of 1/2019 Excavation Program Duke Energy Excavation Permit Application Form C. Applicant's Signatures Comments: I am a General Contractor in North Carolina with an unlimited license and my license number is 60134. Applicant Name (print) Randy H. Austin Applicant Signature* Date Co-Applicant Name (print) Frank B. Nichols PP Co-Applicant Signature* Date Co-Applicant Name (print) Co-Applicant Signature* Date Co-Applicant Name (print) Co-Applicant Signature* Date Co-Applicant Name (print) Co-Applicant Signature* Date *Per my signature,the information provided in this application is correct to the best of my knowledge. Duke Energy Page 10 of 13 rev 10/1/2019 Excavation Program Duke Energv Excavation Permit Application Form Part III. Additional Information A. Deed and Survey Plat: A copy of the deed and registered survey plat or other instrument under which each applicant and co-applicant claims title to the affected property(the shoreline adjoiningthe excavation area, equipment stain area, area crossed by any spoil staging and return water lines, and the disposal area). If the applicant(s) is(are)not the owner(s)of said property,then forward a copy of the deed and registered survey plat or other instrument under which the owner(s)claim title plus written authorization from the owner(s)to carry out the project on their land. B. Excavation Area Drawing: An accurate drawing of the area to be excavated.The drawing must show at a minimum, a North arrow;the boundaries and acreage of the proposed excavation area and equipment staging areas; lake,county, city, cove,tributary, road and subdivision names and lot numbers(as applicable);property corners for project front lots; the full pond elevation contour and lines dividing the cove width into equal thirds(as applicable); approximate volume in cubic yards of the material to be excavated; point(s)of return water re-entry;the boundaries of any adjoining areas that are to be specifically avoided or protected during the work and the location(address)of the disposal area for the excavated material. [NOTE: A copy of this drawing must also be provided to the excavation contractor to ensure restricted areas are not impacted.] C. Disposal Area Drawing: An accurate drawing of the proposed design for the disposal area. The drawing must show at a minimum,a North arrow;the boundaries and acreage of the proposed disposal area; lake,county, city, cove,tributary,road and subdivision names and lot numbers(as applicable);the full pond elevation contour(unless disposal is well away from the lake);the boundaries of any adjoining areas that are to be specifically avoided or protected during the work;the location(address) of the excavation area from which the material came and a statement of the disposal area's capacity with all dimensions labeled that were used in the volume calculation. [NOTE: A copy of this drawing must also be provided to the excavation contractor to ensure restricted areas are not impacted.] Also note for projects larger than one (1) acre in North Carolina, including excavated, equipment staging, and disposal areas, you must submit an erosion control plan. For projects larger than two(2)acres in South Carolina, including excavated, equipment staging and disposal areas, you must submit an erosion control plan. For projects< two(2)acres in South Carolina,you must submit a completed standard reporting form for construction sites disturbing two(2)acres or less to the South Carolina Dept. of Health and Environmental Control (SCDHEC)- Stormwater Management D. Vicinity Map and Driving Directions:A vicinity map and directions by road showing directions to both the excavation area and disposal area. Include the latitude and longitude of both the excavation area and the disposal area. Part IV. Agency Reviews and Approvals Begin this section with a summary table of all agencies consulted and applicant response to agency comments as shown in the example table below. Agencies should be listed in the order Duke Energy Page 11 of 13 rev 10/1/2019 Excavation Program Duke Energy Excavation Permit Application Form shown in the Agency/Organization List. Consultation letters must be dated within the two years preceding Duke Energy's receipt of the application. Table IV-1. Sample Agency Comment and Res onse Table Agency Comment I Applicant Response Agency 1 The activity is approved as proposed. NA Agency 2 The on-site well provides drinking water to the Contacted Mr. Smith on 1/1/20xx. No public. Please contact Mr. Smith to discuss the further action needed. proposed changes and potential issues associated with your proposal. You must contact us immediately if Applicant will contact Agency 2 if endangered species are located during the endangered species are located during course of construction. construction Agency 3 Requested agency comments on 1/1/20xx and NA again on 2/1/20xx. No response as of 2/16/20xx. Agency 4 Section 401 Water Quality Certification Applicant will comply with the conditions of the 401 Water Quality Certification Following the table of agency comments and applicant responses, include a table of permits and certifications issued by the reviewing agencies. As with the table of agency comments and applicant responses, agencies should be listed in the same order as they are listed in the Agency/Organization List. Table IV-2. Sample Agency Permits and Certifications Table Agency Permit/Certification Name Date of Date of Issuance Expiration Agency 1 Surface Water Withdrawal Permit Agency 2 Section 401 Water Quality Certification Following the two summary tables, include a copy of all correspondence to and from any local, regional, state and federal agencies or other organizations with which you are required to consult, including any required permits(e.g., Section 401 water quality certifications, Section 404 dredge/fill permits,building permits, etc.)or other approvals or comments which have been obtained from these organizations regarding this activity. Include a copy of any local,regional, state or federal regulations or guidelines that will be followed. All permitting issues must be resolved and clearly documented. Correspondence should be organized in the order the agencies are listed on the Agency/Organization list with the applicant's request for comments followed by additional correspondence in chronological order. All permits must be valid at time of Duke Energy Page 12 of 13 rev 10/1/2019 Excavation Program Duke Energy Excavation Permit Application Form application and have a term longer than the projected schedule for completing the permitted project. Part V. Additional Information Provide relevant additional information. Reference previous parts as applicable. Include the FERC-required Environmental Assessment if you were directed to do so during the initial site visit. If there are co-applicants, this is where their information would be provided (see Part I). Frank B. Nichols at 243 Quiet Waters Road, Belmont, NC 28012 will be joining the dredging process so we do the entire cove at one time. His email address is fbnichols@yahoo.com. RandyH. Austin owns the propertyat 269 Quiet Waters Rd, Belmont, NC 28012. Duke Energy Page 13 of 13 rev 10/1/2019 Excavation Program ' s,. Y .m, n^ «_ E'�i-• k]aanex J 1 'A ,/erg '4.. \ fl,rwoW. - r `S• ' r. GASTONIA �_—__ /„+ ✓' \ rm.'r caa e :. it .0' r 1 F 1 . ." SITE,, x R \ j a,r. ,s 4 I \ .....^. , ( '4. N \\\,. .' ' - 11, i k-in cA�n LINA ~n9 ' V , A�ouNA — — a a t rs e t J' 's f. 1 EXCEL CIVIL&ENVIRONMENTAL TOPOGRAPHIC MAP it ASSOCIATES, PLLC 625 HUNTSMAN COURT Excel Project No. 2021088 GASTONIA, NC 28054 (704) 853-08000 N Source: USGS Belmont NC-SC, 2016