Serigne_DukeDredge_SIGNED

Duke Energy Lake Services
Guidance for Completing an Excavation Permit Application
Note: If you are proposing excavation in association with the permitting of a new
or expanded facility under the Marina or Conveyance Programs, you do not need
to complete this application. Instead, you should incorporate the excavation
request into the permit application for the marina/conveyance using the
appropriate application.
Step 1: Contact Duke Energy Lake Services
Complete "Part I" of the application and develop a drawing of the proposed excavation area.
Contact Duke Energy Lake Services to schedule a site visit. Lake Services will conduct a site
visit to determine if Duke Energy will accept an excavation permit application for the proposed
work. If the Lake Services representative determines the application process may proceed,
he/she will initial Part I of the application.
Step 2: Draft Application Development
Complete Parts II-III.A-G and Part V of the Excavation Permit Application.
Step 3: Agency Consultation
Send the draft application developed during Step 2 to the agencies for review and comment on
the proposed activity. Refer to the Agency / Organization List available from Duke Energy to
determine which federal, state, regional, and local agencies and organizations require
consultation or review.
Note: Duke Energy reserves the right to require consultation with additional organizations
beyond those included in the Agency / Organization List.
Each agency / organization must be provided at least 30 days prior notification. Evidence must
be provided (e.g., response letter or Certified Mail receipt) in the complete application to show
each agency / organization was given the opportunity to review the proposal.
Consultation letters must be dated within the two years preceding Duke Energy's receipt of the
application. All permits must be valid at time of application and have a term longer than the
projected schedule for completing the permitted project.
What to Expect During Agency Review and Comment:
You will typically receive a letter from each agency / organization either documenting its
concurrence with your proposal, requiring additional information, recommending
modifications, or offering no comment. You must address each agency's / organization's
comments with a follow-up letter and in your final application as described in part IV.
• If you do not receive any documentation from an agency I organization within 30 days of its
receipt of your proposal, you must provide the agency / organization with a follow-up letter
requesting comment on your proposal within 15 days from the date of the follow-up letter. If
you still do not receive any response as a result of the second letter, type "NO RESPONSE"
Duke Energy Page I of 13 my t 1/22M
Excavation Program

at the top of the follow-up letter and include it in the application along with proof of the
agency's 1 organization's receipt of the letter (e.g., Certified Mail receipt). You may proceed
with the application process recognizing, however, that if its comments come later in the
application process, you will be required to address them.
From the United States Army Corps of Engineers (Corps): (** Note — The Corps may have
additional forms to submit for your proposal and an additional fee.) If the excavation can be
done under the requirements of the General Permit (GP) or a Nationwide Permit (NWP), you
will typically receive a copy of the Corps' tear sheet documenting authorization and
providing any additional instructions. If the excavation isn't covered under the GP or a
NWP, you'll be required to obtain an individual 404 Dredge and Fill permit from the Corps.
You must receive written documentation from the Corps that your application either (1)
meets the requirements of the GP or a NWP or (2) the proper 404 Dredge and Fill permit has
been received before Duke Energy can process your application.
From the North Carolina Department of Environmental Quality (NCDEQ), Division of
Water Resources: (Note NCDEQ may have additional forms to submit for your proposal
and an additional fee) If the proposal meets the requirements of the Clean Water Act Sect.
401 Water Quality Certification, you will typically receive a letter from the NCDEQ Division
of Water Resources documenting Sect. 401 Certification and providing any additional
instructions. You may also receive a letter requiring additional information or
recommending modifications. You must receive written documentation from NCDEQ
noting any required Sect. 401 Certification has been received before Duke Energy can
process your application.
From the North Carolina Wildlife Resources Commission (NCWRC): If you do not receive
any documentation from the NCWRC within 30 days of their receipt of your application, you
may proceed with the application process without submitting a follow-up request,
recognizing however if comments come in later in the application process, you will be
required to address them.
From the South Carolina Department of Health and Environmental Control (SCDHEC,):
(Note — SCDHEC may have additional forms to submit far your proposal and an additional
fee) The SCDHEC conducts a joint application process with the USACOE in S.C. If the
proposal meets any applicable requirements of the Clean Water Act Sect, 401 Water Quality
Certification, you will typically receive a letter from SCDHEC documenting Sect. 401
Certification and providing any additional instructions. You may also receive a letter from
USACOE requiring additional information for the agencies participating in the joint
application process. You must receive written documentation from SCDHEC noting Sect.
401 Certification has been received if required before Duke Energy can process your
application.
From the South Carolina Institute ofArchaeology and Anthropology (SCIAA): The applicant
must wait 30 days after receiving the signed postal returned receipt. If a response from
SCIAA has not been received by this time you may proceed with the application process
without submitting a follow-up request, recognizing however if comments come in later in
the application review process, you will also be required to address them.
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Excavation Program

Step 4: Final Application & Submittal to Duke Energy
Following the consultation process, finalize the application. The final application submitted to
Duke Energy should incorporate all comments and recommendations provided by agencies and
organizations during the agency consultation process as well as copies of all permits received. In
addition to the final application include the following:
• One check payable to Duke Energy for the application fee and security deposit
• If applicable, a separate check payable to the appropriate Habitat Enhancement Program fund
• Signed Excavation Program Applicant's Agreement
Note: Co -applicants must also submit the application fees and applicable HEP fees with the
application.
Duke Energy Page 3 of 13 rev 11/22121
Excavation Program

Duke Energy Excavation Permit Application Form
FOR DUKE ENERGY USE ONLY
Duke File No.
Application Fee $ Security Deposit $ Check # Date Reev'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 Completion Required _
Date Passed Closeout Inspection*
Date
(Print) (Sign)
Date of Any Approved Extension Initials
Initials
Any Stop Work Orders or SMG Violations*? (check one) []Yes ONO (If Yes. explain in PART V)
Date Deposit Refunded Initials Date Permit Database Updated Initials
* Forward copy or 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 Step Work
Orders with application.
Part I. Applicant Information (Please Print)
David Serigne
Email address: [e-mail]
Lake Address
20142 Walter Henderson Road
Cornelius, NC 28031
Telephone [phone]
Mailing Address {if different}
18801 Nautical Drive
Comelius, NC 28031
Contractor Company Waterside Docks & Piers
Contractor Contact Person Randy Keith
Contractor Email Address: [e-mail]
LAKE LOT INFORMATION
Lake Norman County Mecklenburg City Cornelius
Subdivision
Lot/ Section No. 7
Telephone [phone]
State NC Tax Map No.
Lot Size 2.07Acres
Duke Energy Page 4 or 13 rev 11t22P21
Excavation Program

Duke Ener , Excavation Permit A t tlication Forun
Security Deposit Refund Information
The security deposit will be refunded after the excavation permit has expired if no violations of
the approval occurred. The applicant will receive the security depost refund at the mailing
address in Part I unless an alternative recipient is identified.
Send the security deposit to an alternative recipient? (check one) Oyes ❑No (If Yes,
include name and mailing address below.
Name: Randy Keith
Tax ID: 200108946
Mailing Address: 164 Stutts Road, Mooresville NC 28117
Are there any Co -Applicants*? (check one) ❑Yes ONo (If Yes, Include names, sheet
addresses or lot numbers, pier numbers, phone members, 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.
Date of on -site inspection
Initials (Duke Energy)
(applicant/contractor)
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Excavation Program

Duke Fnergy Excavation Permit Application Forth
Part 11. Description of Project
A. Basic Information
1. Type of excavation: (check one) 19 New excavation ❑ Maintenance excavation
?. i'Ln-I)ose of excavation: (check one)
❑ Water Intake Channel
❑ Other (.specify):
® Boat Access Channel
❑ Wastewater Discharge Channel
3. Lake user category: (check one) OPrivate ❑Residential Marina
❑Commercial Marina ❑Public
❑Other (spec):
4. Max. Excavation Area Dimensions (ft): Length 40 Width 40 Depth 1.75
(Note: hichrde additional area dimensions if necessary so response to 45 below equals max. area
dimensions in #4)
5. Volume of Excavated Material (TOTAL for the project): 104 Cubic yards
6. Type of material removed (!ypplicani determines b reld sanr le ifpractica
Sand and Silt
7. Excavation Site area: 0.037 Acre (s) Disposal Site area:
(s)
0.034 Acre
8. Total Disturbed Area (including equipment staging area): 0.071 Acre (s)
9. Does the project meet the requirements of the applicable General Permit? (check one)
®Yes ❑No
10. Do you claim title to the disposal area? (check one) ❑Yes ONO
11. Do you claim title to the equipment staging area? (check one) 1tYes ❑No
12. Are there any water -treatment facilities within 50 feet of the proposed excavation area?
(check one) ❑Yes ONo
(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):
Silt fence and berm
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Duke Enemy Excavation Permit Application Form
14. Type(s) of excavation equipment to be used:
Long reach excavator on floating barge
15. Will waters or wetlands be crossed in transporting equipment to or from the: site?
(check acre) ❑Yes ❑No
mobilize equipment and cargo
rman
16. Will return water re-enter the reservoir? (Check one) ❑Yes ®No ❑NIA
I Yes, specify hints of re-err!ry 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 123No
(If Yes, provide the existing permit number. IfIIo, inchrde a scaled drawing of file proposed
facility). Permit # have approval letter attached to construct
dock after dredge is complete
18. Total planned duration of the work (Include first equipment mobilization, excavation
through foal mitigation measures complete):
START Aug 1 2023 FINISH Aug ! 2023
(Month) (Year) (Month) (Year)
DAe l:ner!y Page 7 of 13 tt% I 22'zs
Excavation llrogrun

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Duke Enerp_ry Excavation Permit Application Form
C. Applicant's Signatures
Comments:
Applicant Name (print] ri :Z:6 1IC
Applicant Signature* Z)MWDate 7 LZ L- h3
Co -Applicant Nance (prinl)
Co -Applicant Signature*
Co -Applicant Name (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 hest of my
knowledge.
Duke Energy page to or 13 rcv 11/=021
Excavation Program

Duke Ener Excavation Permit AUplication Form
Part II1. 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 adjoining the excavation area, equipment staging area, area crossed by any spoil
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.
13. 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 Iabeled
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 reportingform orm 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
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Excavation Program

Duke Energy Excavation Perini(Ap IA iration Form
shown in the Agency/Organization List. Consultation letters must be dated within the two years
preceding Duke Energy's receipt of the application.
'r,nhip iV-t _ fiamnle Agency Comment and Resnonse Table
Agency Comment A licant Response
A e►ag 1
The activity is approved as proposed.
NA
Agcncy 2
The on -site well provides drinking water to the
Contacted Mr. Smith on 111120xx. 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 111120xx and
NA
again on 211120xx. No response as of
2115120xx.
Agency 4
Section 401 Water Quality Certification
Applicant will comply with the conditions of
the 401 Water Quali 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.
•r-hip rV_,l C-m.,,■,to egp► " Permits and Certifications Table
Date of
Date of
Agency
Permit/Certification Name
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 my 1 1r2 021
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 1).
Duke Energy Page 13 of 13 rev 1112MO21
Excavation Program