20160039 Ver 1_Shoreline Stabilization_20160111

DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
Duke File No.
Application Fee $ Security Deposit $ Check S Date Recv'd Initials
Date of Duke Energy Lake Services, applicant and/or contractor on-site inspections Date 01 c,1 14 Initials iZ
Date Final Protection/Avoidance Area Markings Field - Verified Initit4l
� V
Approved to Start Work By • : 7 t
(Print) (Sign) 1 L Z 016
Date Completion Required Date of Any Approved Extension Initials
R RE -SOUR,
Date Passed Closeout Inspection' initials R PERMIT
Any Stop Work Orders or SMG Violations*? (check one) OYes ONo (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.
PARTQeL - /APPLICCAfr11NT INFORMATION
�(Pleeaase Print) _ �� C
Name S0jAer.VG#A %—„``Clir;t5-t-Fartn,%Irl Telephone (�5'��10 .52055.' r_
Lake Address i �1 � C)g �, &A Ric s E; ren F-9 . Mailing Address 11830 �AI"y t �c k! • c4e 2Z 5
Cprh(L�rNs,NC 2803j (If different) Cow—we-1445 x8031
Contractor Company
3$
Contractor Contact Person CA !fie 5 v Telephone
ModreSW #rWca2tV
LAKE LOT INFORMATION /
Lake Y►yl�� County fr kd dltr City CbrNtlr14.5 state NC Tax Map No.
Subdivision Lot / Section No. L0+ 38 Lot Siz�• +t8 Acres
Are there any Co -Applicants*? (check one) OYes ONo (If Yes, 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 fling 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. In"zing this portion ofthe
application by a DELSR in no way constitutes approval or eminent approval of the excavation or any other lake use
permitting activity.
Date of on-site inspection of O” 1 u' Initials (Duke Energy) Q K (( (applicant/contractor)
Duke Energy Page 1 of 14 rev 9/19/14
Excavation Program
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application 113 l0.docx

DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
PART M - DESCRIPTION OF PROJECT
A. BASIC INFO
L Type of excavation: (check one) New excavation ❑ Maintenance excavation
2. Purpose of excavation: (check one)gWastewater
Boat Access Channel ❑ Water Intake Channel
Discharge Channel ❑ Other (specify):
3. Lake user category: (check one) Private ❑Residential Marina ❑Commercial Marina
Public ❑Other (specify):
4. Max. Excavation Area Dimensions (ft): Length Width 150 Depth �3
(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): dL� Cubic yards
6. Type of material removed (applicant determines by field sample ifpractical): C
7. Excavation Site area: 0, Q& Acre (s) Disposal Site area: d p� Acre (s)
8. Total Disturbed Area (including equipment staging area): Q,/9-7 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) dyes ❑No
11. Do you claim title to the equipment staging area? (check one) RYes ❑No
12. Are there any water -treatment facilities within 50 feet of the proposed excavation area? (check one) [Nes XNo
(If Yes, specify):
13. How will the excavated material be entrapped and the erosion controlled? (e.g. see attached erosion control plan and
disposal area design): 121 birA
14. Type(s) of excavation equipment to be used: 6 4rAC W * I v N Q 'Ce Ad
15. Will waters or wetlands be crossed in transporting equipment to or from the site? (check one) ❑Yes 960
(If yes, explain)
16. Will return water re-enter the reservoir? (Check one) ❑Yes o ❑N/A (If Yes, sped 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 ❑No
(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 (Includg first equipment mobilization, excavation through final mitigation measures
complete): START Z l VX FINISH off- / 9z /(-
(Month) (Year) (Month) (Year)
Duke Energy Page 2 of 14 rev 9/19/14
Excavation Program
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application 113 l0.docx

DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
PART H. (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.
Identification Method
Avoid (A) or Mitieate (MI
**
Field ID
Work Area Dwe. ID
Acreaee
a. Marshland, swamp, ponds, beneficial
aquatic vegetation or other potential wetlands (circle all
that apply)
b. Buffer Zones (specify width & source of
requirement)
t o ov-K t )I IQC' ��"IG�
c. Environmental Areas as identified by Duke
Energy
f n
In
d. Natural Areas as identified by Duke Energy
, f
/J147
e. Historic properties (specify)
AV14
L Rare or threatened species (specify)
Duke Energy Page 4 of 14 rev 9/19/14
Excavation Program
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
Protection/Avoidance Areas
(check all that apply)
Approx.
Identification Method
Avoid (Al or Nllitinate (M)
Field ID
Work Area Dwg. ID
Acreage
**
e. Buried gas, water, sewer, communications
or electric lines (circle)
I
h. Impact Minimization Zones as identified by
Duke Energy
r
N
i. Other areas requiring specific avoidance,
protection or mitigation (specify)
1 "
* 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 mitigation plans
Duke Energy Page 5 of 14 rev 9/19/14
Excavation Program
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C. APPLICANT'S SiGNAIINES
Canunents:
3q )q I1& 14
i cs C::� rd Ia
j ty,jLLfA Pro c�rf�rrs 0WAIev-9
�
IA)A-+Z.V-
Applicant :mWFtj
Signature*Applicant
Co-Appiicant Name (prim )
Co -Applicant Signature*
Lot4 38
Date
Lot #
Date
Co -Applicant Name (print) Lot #
Co-ApplicantSignature* Dale
Co-Appli ut Name (print) _ Lot 4
Ce -Applicant Signature* --- Date
Co -Applicant Name (print) Lot #
Co -Applicant Signataare'� - - _ _ _ _ Date
Co -Applicant Name (print) Lot 9
Co -Applicant Signature* _ Date
*Per my signature, the information provided in this application is correct to the best ofmy knowledge.
BEFORE YOU MAAIL THE APPLICATION TO DUKE ENERGY LAKE SERVICES ENSURE YOU RAVE:
oCHEECKED TBE INFO TgOROUMILY
a MET ALL REQUiREMEWS FOR A COMPI FTE APPLICA fi0iti (see ever letter of aWleation package)
a INCLUDED A SINGLE CHECK TO DUKE ENERGY FOR THE APPLICATION FILING FEE AND SECURN Y
DEPOSIT
® INCLUDED ALL AGENCY PERNM OR CONaviENT LETTERS AND RESOLVED ALL ISSUES RAISED
B INCLUDED ALL REQUIRED DRAWINGS (INCLUDING PROPOSED FACILITIES), PMATO FOR EXISTING
FACILITIES, SURVEYS AND PLANS
0 INCLUDED COPIES OF DEEDS AND AUTHORIZATION LETTERS
Dake Energy Page 6 of 14 rev 9119114
,l xcavaVonPrflgfaill
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application 113 10.docx

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
Three copies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information n
Name:
Mailing Address:
Telephone Number: 104- MY! Number:
E-mail Address: v r^S (f)
2. Agent/ Contact Person Information
20160038
.— dr/'5 /7 p74;rM q J
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http://www.saw.usace.armv.miI/Portals/59/docs/reRulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: 3 v- a P 5
CompanyAffiliaton: C6 5�^r�
Mailing Address: (039 04Kridge M f4vvq
ftlooce5v� Ile. C: :) g/I T
Telephone Number: A�6(60, 51// Fax Number: 70,16. 6 G 0
E-mail Address: ChC,Se,4 w-4 _c xt , /✓4/Ye q m. mef
Person to receive the Certification Approval: 64"'P /3V -/At --S
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 Page 1 of 3

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 conductIpvnd('U_S )
A
County: I Q V�.(EA UUP Nearest Town:
Subdivision name or site add r s (include phase/lot number): AV 113l
lot IN N, 1_:�>eAios Voyd- Fbcd, Utotlih,<n.
Dir ctions to ite -please includ road names and numbers, landmarks, tc.: 71V
hand
®1cl e. s
Latitude (in decimal degrees) 35-4-72-7 Longitude (decimal degrees) Cl 0. 5 3
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): �q.5 i �- .1LWAgve [-UVQ d ; pn _
6. Property size (acres): + 4ft CIVV ,
7. Lake/ river/ ocean adjacent to property: LAVe- 9000 Y
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Awedq-_' 4Crr pr3-f J� Cc eSS
IJ
9. Will work be conducted from land? ❑ From water?
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool lake level/ Normal Water Level in square feet or acres:
50'y' " So' X 3 Cu. d s
11. Total amount of distu ante (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: 0
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): d .5
/--7-/(P
Owne�//Age 's Signature* [15A NCAC 02H .0502(f)] Date
Agent's si nature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

Q1fBF-Mr. 7J
Normi
S
La ke
(At Full Pond/ Normal Water Level)
Please approximately sketch the following information on this plan (provide dimensions for each
item, such os 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

;gid\'lsHyCARO %
SITL
DARYL W.LONG. .S.
y 18335 OLD STATESVILLE ROAD
SUITEA • ;s L�Ma
CORNE=
+� LIUS, N.C. 28031 = 7
1704) 765-5134 S o7'8tmv .•�
b .m INI41111HN\
LEGEND
4
Gk \ c� i4 REBAR FOUND O
\ /4 REBAR SET
\ UTILITY POLE 0
FENCE
Q\a OVERHEAD UTILITY — OU
F`\ \ LIGHT POLE10 V
p
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oo
LA NORMAN
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R!-04
BILLYHAGER
b•
BILLY RAY DUANE S. UN04A n
OB 1118 PG 75 1!�.
0 J•
sjr > 4q C�? 001-753-06
>y . 4'4 PENINSULA PROPERTY
Al
��• \ OWNERS 801ASSOCIATION
61 i2 T� INC.
LOT 3 - �. NB.26 PG.402
/ 19,528 S0. ". % "WATER ACCESS LOT'
S?y tk- 014 t ` 0.448 ACRES
7 ly E' ' 15°•. \ \,\\I 42.uta
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aq� N 's'B.\81\ \ 44.y0.
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NOTES 'C OJ !'r J� OU, OU
CCC jJ v
1. NO NCGS //p MONUMENT TD
FOUND WITHIN 2OW Fp
2 PROPERTY MAYBE SUBJECT
TOOTHER COVENANTS.
RESTRICTIONS, EASEMENTS
OR RIGHTS-OF-WAY THAT'
MAY BE OF RECORD.
3. SETBACKS TAKEN FROM
TOWN OF CORNELIUS
CURRENT'GR' ZONING.
Con\uk wkA Nm«rnata aaenry br
Premalgns RM tlemebpmerrt antl
ronin, reyuiremena prbr to tlesign
or mnstruction of any
Improvements.
UNE TABLE
UNE
LENGTH
BEARING
Lt
24.00
S 514.50"W
1_2
3.08
S72'59 •15'E
L3
4.79
58 '10.34"W
L4
43.12
S3615'36'W
L5
45.44
S365V50'W
APPMENi GIP B[lagEN
su9,[cT LOt lw.t2 PG.tJ)
LW (W -M .AA cI) ACCESS
lox (NB.Ia POR 1)
o.aos Acnlss aR 14a sa IT
PaCPFRTY 6 pSSQlII LANA
ANO 111BFR CCpPC1iAx10N
,,,a PC.677
'd
Graphic SCeb
40 zo 0 40
sale or Deming 1 Inch = 40 Fla
Physical Survey of L07 M Ur MUUN 3 AIIN v Lr - W
Site Address:
Professional
PropertyProperty
of
As Recorded in
19104 N. BEATTIES FORD
J Surveyors. Inc.
PLAT BOOK 12 PG. 13
ROAD
18335 Old Sutesvillc Road
Ste. A. Cornelius. N.C. 28031
CHRIS HOFFMAN
DB. 3917 PG.771
CORNELIUS NC 28031
704-765-5134 Phonc/Faz
MECKLENBURG COUNTY
Fum I.tu<ree C -W4
1014.�I
JEC
z1l00W 1'=40'
EDnmin Scal<
001-753-05 119104NEFATTr
azP�NumbereNavte
f'10116013
ShM— N�uma
B

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:—Southern cottage /Chris Hoffman_
Street Address (at Lake) _19104 North Beatties Ford Rd
Subdivision Name:
Tax Parcel ID (if known): -00175305
City:–Cornelius,
State:
Latitude: 35.4730
Telephone: [phone]
(s) 38
County_Mecklenburg
Longitude
Zi p:_28031
: 80.9275
Directions from major road or highway):
1-77 North to exit 25 – West on Catawba Ave Right on Jetton Rd –Right on North Beatties Ford
Rd
Descriptive Structures- (s) ( i.e. brick garage, white fence, mobile home, etc)
19104 North Beatties Ford Rd

Google Maps
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MapCard - Print your custom map
N O R M A N
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