20160869 Ver 1_Shoreline Stabilization_20160906

DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM 0
160868
FOR DUKE ENERGY USE ONLY
Duke File No.
Application Fee $ Security Deposit $ Check 4 Date Recv'd Initials
Date of Duke Energy Lake Services, applicant and/or contractor on-site inspections Dated w i t -P Initials _
Date Final Protection/Avoidance Area Markings Field - Verified
Approved to Start Work By * :
Date Completion Required
Date Passed Closeout Inspection*
(Print)
Date of Any Approved Extension
Initials
Initials
Date
(Sign)
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 of approved application (all pages, plus any attachments that Duke Energy changed)
with Approval Letter and highlight any changes. File copies of Approval and Close-out Checklists a
Orders with aoolication.
PART/L- APPLICANT INFORMATION (Please Print)
Name l '�/t 1 Kee- _Pf Z—od
Lake Address ,2 5 7 GYC Cr'c �oyp
MoOct_-_5V1)IPl6C 931/7
Contractor Company C 6C trm N_ t; P)e G jC ( i t
Telephone
Mailing Address
(If different)
Contractor Contact Person Y( /4i �{cj2 SJ / Telephone 7c b aJs1 I i
LAKE LOT INFORMATION , / y��
Lake D County--� r � t'U City 1 ' t 001-e5 I A t- State AJ C Tax Map No.
Subdivisio %�' , 4 e- Ot AIJ Lot / Section No. 45 Lot Size/ D S, 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 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 of the
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 04 Q 1 ! CO Initials (Duke Energy) _ (appticant/eontractor)
Duke Energy Page 1 of 14 rev 9/19/14
Excavation Program
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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 O Maintenance excavation
2. Purpose of excavation: (check one)Boat Access Channel O Water Intake Channel
Wastewater Discharge Channel O Other (sped):
3. Lake user category: (check one) ` nvate OResidential Marina OCommercial Marina
[Public [Other (spec):
4. Max Excavation Area Dimensions (ft): Length 0 Width 0th
(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): ---7—t-�13 _ Cubic yards /
6. Type of material removed (applicant determines by field sample if practical): / nU Gt
7. Excavation Site area _Q • de Acre (s) Disposal Site area: 6. 6 8 Acre (s)
8. Total Disturbed Area (including equipment staging area): C 0 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) Yes ONo
11. Do you claim title to the equipment staging area? (check one) C Yes ONo
12. Are there any water -treatment facilities within 50 feet of the proposed excavation area? (check one) [Yes *o
(If Yes, specify):
13. How will the excavatel material be cptrappe4 and the qr°si controlled? (e.g fee p d e olio ntrol plan and
disposal area design): Y K '� V 0 o K& YJ 4 C. 1 t o
14. Type(s) of excavation equipment to be used:�e--
15. Will waters or wetlands be crossed in transporting equipment to or from the site? (check one) [Yes *0
(Ifims � )
16. Will return water re-enter the reservoir? (Check one) [Yes *o [N/A (If Yes, specify 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? [Yes *0
(If Yes, specify the existing permit number. If No, include a scaled drawing of the proposed facility). Permit #
18. Total planned duration of the ork (Include first equipment mobilizati A excavation through final mitigation measures
complete): START �/ al& FINISH �-/
(M") (Year) (!u ) (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 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
(check all that apply)
Approx.
Aeresee
Identification Method (*1
Avoid (Al or Miti¢ate (Ml
Field ID
Work Area Dwe. ID
a. Marshland, swamp, ponds, beneficial
aquatic vegetation or other potential wetlands (circle all
that apply)
/�
4
b. Buffer Zones (spec6 width & source of
requirement)
c. Environmental Areas as identified by Duke
Energy
d. Natural Areas as identified by Duke Energy
I -
e. Historic properties (specify)
)VI
f. Rare or threatened species (specify)
f41-
A11
J
Duke Energy Page 4 of 14
Excavation Program
rev 9/19/14
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
Protection/Avoidance Areas
(check all that apply)
Aporox.
Acreaee
Identification Method (*1
Avoid (A) or Mitieate (M)
**
Field ID
Work Area Dwe. ID
e. Buried gas, water, sewer, communications
or electric lines (circle)
N�A
h. Impact Minimization Zones as identified by
Duke Energy
N r' A
I. Other areas requiring specific avoidance,
protection or mitigation (spec6)
^ f
* 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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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
C. APPLICANT'S SIGNATURES
Comments: C�ei�/A/Ad
e- CP cjo
Applicant Name (prim) G ,cel &001
L 001
Applicant Signature* &4z P
Co -Applicant Name (prim)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (prim)
Co -Applicant Signature*
Co -Applicant Name (prim)
Co -Applicant Signature*
Lo[ #
s
r.
Lot #
Date
Lot #
Date
Lot #
Date
Lot #
Date
Lot #
-Date
*Per my signature, the information provided in this application is correct to the best of my knowledge.
BEFORE YOU MAIL THE APPLICATION TO DUKE ENERGY LAKE SERVICES ENSURE YOU HAVE:
• CHECKED THE INFO THOROUGHLY
• MET ALL REQUIREMENTS FOR A COMPLETE APPLICATION (see cover letter of application package)
• INCLUDED A SINGLE CHECK TO DUKE ENERGY FOR THE APPLICATION FILING FEE AND SECURITY
DEPOSIT
• INCLUDED ALL AGENCY PERMITS OR COA04EENT LETTERS AND RESOLVED ALL ISSUES RAISED
• INCLUDED ALL REQUIRED DRAWINGS (INCLUDING PROPOSED FACILITIES), PERMIT # FOR EXISTING
FACILITIES, SURVEYS AND PLANS
• INCLUDED COPIES OF DEEDS AND AUTHORIZATION LETTERS
Duke Energy Page 6 of 14 rev 9/19/14
Excavation Program
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application 113 l0.docx

State of North Carolina
Department of Environment and Natural Resources
DW
Division of Water Resources
,-R
Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
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
1
V
Applicant Information [15A NCAC 02H .0502(a)]
Owner Information
Name: / ' ! i K.- Py Z-4Ai
Mailing Address: c;156'✓e- L
Telephone Number: %Yo JV04. • SJ P -5i Fax Number:
E-mail Address:
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 AUTHO
RIZATION FORM. f) must be attached if the Agent has signed this application form.
Name: C t S
Company Affiliation: ":�7vA/'e
Mailing Address:
Telephone Number: 70� Fax Number: 1K
E-mail Address: f hc6fluor�- 5c= oj%A/�S C
Person to receive the Certification Approval: CkL a
Il. 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, etc.),
rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations, and
FORM: SSGP 10-2013 Page 1 of 3

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. Locationofthe property (where work is to be conducted)
County: 7 Cd -e- it Nearest Town: Aoornsvillc_ %
Subdivision name or site address (include phase/lot number): 1'2he5 4 -KL Ai a/7"�
Direction to site - please include road names and numbers, landmarks, etc.:. N
3!? 14) o �! �� � soar �• `��a /jr11-u / 5-�i�+l.
l
Latitude (in decimal degrees) 3 5,5373 Longitude (decimal degrees)
5. Describe the existing land use or condition of theite at the time of this application
(residential, undeveloped, etc.): `-C 5J,,f?
6. Property size (acres): / , 0 SS
7. Lake/ river/ ocean adjacent to property: ZAKt, A1vrMA J
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): A-�
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 norma pool lake level/ Normal Water Level in square feet or acres:
,6-0x50 X 6 ' �Ierx-.Xo/x5- (703 cA,
11. Total amount of disturbance (including all clearing, backfill, 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: 911 rAir
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):
Owner/Agent's Signature* Printed Name Date
[15A NCAC 02H .0502(f)]
*Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

`LP
Full Pond/
Lake
(At FulltPond/Normal Water level)
Norma'tn��+a,
Sl
570
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.
S. 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

Ta 1, JIMMY N. FARES. CERTIFY THAT THIS PLAT WAS DRAWN LIDER MY SUPERVISION
SlatNSWTte FROM AN ACTUAL AInIEY MADE UNDER MY SUPERVISION: DEED DESCRIPTION
Eal AND/OR MAP BOOR . EE PAGE MYE 112 - THAT EHE BOUNDARIES HOT
35 SURVEYED ARE CLEARLY INDICATED AS DRAWN FROM INFORMATION FOUND N
BOOK N/A PAGE N/A THAT THE RA710 OF PRECISION AS CALCCAATED IS
1:10.000+; THAT THIS PLAT WAS PREPARED W ACCORDANCE WITH THE
STANDARDS OF PRACTICE FOR LAID SURVEYING IN NORTH CAROLINA (21 NCAC
56.I6eITHESS MY DRICINA4. SIGNATME. REGISTRATION NUMBER AND SEAL
THIS DAY OF iST
2014iE1RWy
Exit N,JAN K F 5, PLS
33 - L-43tI
MAL
To
O1mletb
*Site N
VICINITY MAP NOT TO SCALE
CURVE TABLE
CURVE LENGTH RADIUS CHORD BEARING CHORD DELTA
CE 85.00• 535.00' S49'31'tB�E 84.91' 9106'17'
LOT 42
Chesopeoke Pointe
Phase 111
Plot Bk: 51, Page: 15
I" at ; 1
w: faoon 03ood 2 Story
Lel
Da SWca
LOT 43 —
W / 1.055 Acres 0
G Fmd
\LOT 78 /
5�
foun
Q�
Ra v �0y
�Qr
! �S
iJ. 0
FwW Oro
N Raw
/ CaWait
/
law
- Supe . ter
�/� LOT 44
LOT 67
f2
Chesapeake Pointe
Phase III
Plot Bk: 51, Page: 15
/// /
LINE TABLE
LINE
LENGTH
BEARING
Ll
14.23'
S80'47*47'W
L2
23.06'
S431S56'W
L3
11-08'
S673943W
L4
14.72'
S47'29'26 -W
L5
12.93*
S24 '56'W
L6
19.76'
S89'47'2l'W
L7
14-4,V I
S6998'29'W
1-8
1 35.58'
N88"44'55 -W
1-9
19-57'
NBT46'05-W
1-10
25.78'
N69-40.25"111
UI
17.64
N2258'46'W
LOT 42
Chesopeoke Pointe
Phase 111
Plot Bk: 51, Page: 15
I" at ; 1
w: faoon 03ood 2 Story
Lel
Da SWca
LOT 43 —
W / 1.055 Acres 0
G Fmd
\LOT 78 /
5�
foun
Q�
Ra v �0y
�Qr
! �S
iJ. 0
FwW Oro
N Raw
/ CaWait
/
law
- Supe . ter
�/� LOT 44
LOT 67
f2
Chesapeake Pointe
Phase III
Plot Bk: 51, Page: 15
/// /
LEGEND
(T) - Tota
R /W = Righl-of-way
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Storm Drain Curb Inlet
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T1 WE I 10ft (=15 AS sOwl HW&T& NEbaa PRC 0 NswTL AK sNIID M THE MCAIba
d' M➢R[ A501E NMII[IIMIDQ CM aN01 x4116 YSa1 ONE am a� AND NOT Dom
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rpwOCDENT 6 MF Cab naCnan ma AIC cO cepm PUL cwm Asmw NL9o9R1TN rale
N401prNI lon at OMISM R tp4xlk noon eRMEi
8)N FJ154 or R6 STq[ PA11m an'A Or ­0AND DOES M, DEAR A N[W Saw an
$I 114 PROPptt m w nrOD omm! Y e -AE' AS Shaw W TEDom aa1RlK NW�OCNUIE AOEMCt
.OW RX100 MAMff NARNP Iff" U)"WiT PA1WIS 3N0l1MDA MM M UVWW 031E a
/ A = Water Motor
20' Reale Sh— Y = Collin Pedestal
Grain / PIL 331. PQ 1,k = ISght Pole
/ CP - Canputed Point
—FNM1d IPS - #5 Rebar Set
RNEor
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0twa)
GRAPHIC SCALE
eo o as so
( IN FEET )
1 inch = 50 tl
PHYSICAL SURVEY
LOT 43 — CHESAPEAKE POINTE
PLAT BOOK: 51, PAGE: 15
DAVIDSON TOWNSHIP. IREDELL COUNTY. NORTH CAROLINA
timer do Prepared For:
PEkCHTREE RESMENTW., LLC
7380 McMMS FERRY ROAD
SUWAML GA 30024
GEOMATIC CONCEPTS, PLLC
NC UCEIrss is P-1031
699 MIDWAY ROAD. STAT&4Y111L NC 28625 -BBDO
PHONE: [phone] EKAIU 7DOlY.FAIRBSOGEOMATI000NuErl COM
Drarn By. .NF Checked By JNF Seale Project No.
Tax PK- 4636-01-3742 1' 4. 50' 14008
Date: AUGUST 5. 2014 Sheet No.
Fil. 14008-0%eecpeake-Lot-43-R2dwg 1 0l 1

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