20161040 Ver 1_401 Application_20161016

DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
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 Date Initials
Date Final Protection/Avoidance Area Markings Field-Verified In' als
Approved to Start Work By* : ate OC
(Print) (Sign) � D
Date Completion Required Date of Any Approved Extension Initi 6'
Date Passed Closeout Inspection* Initials R
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 L-APPLICANT INFOTION(Please Print)
Name tar R W—5114 ire 5 C4:�_ Telephone (QED ) 7-2-
Lake
Lake Address `7 9 e��/� Mailing Address 13 r 16( t o yr T_05 �C.
o r�e.5✓E r /V C (Ifdiferent) /q b o re S V c -�tt v
`' 7
Contractor Company C S TVA(e RE4 ye-//tf
Contractor Contact Person Telephone 4 )
LAKE LOT INFORMATION / /�J�
Lake D Y M�� County ell City /r u D rt SY` f State Tax Map No.
Subdivision f Lot/Section No. Lot S(4)D•bffDAcres
Are there any Co-Applicants*?(check one) ❑Yes ❑No (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 cmavadon or any other lake use
permitting activity.
Date of on-site inspection U 4 1f.1 Initials(Duke Energy) (applicant/contractor)
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 ❑Maintenance excavation
2. Purpose of excavation:(check one) (Boat Access Channel E3 Water Intake Channel
Wastewater Discharge Channel ❑Other(specify):
3. Lake user category:(check one) private ❑Residential Marina ❑Commercial Marina
❑Publ i�-� �ElOther(spec):
D
4. Max.Excavation Area Dimensions(ft): L4iffIL �Q( _ Width O t Depth. ,�t
(Note:include additional area dimensions if neces TMo response to#5 below equals max.area dimensions in#4)
u
5. Volume of Excavated Material(TOTAL for the project): o�� 55 Cubic yards
6. Type of material removed fapp lic nt termines by field sample if practical): A
Io4'3 O.
7. Excavation Site area:I o+-4)a plAcre(s) Disposal Site area: 1 o Ft{ o,07 Acre(s)
tAC3) 6.16
8. Total Disturbed Area(including equipment staging area):1e{-E ) 0.1 f- 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) txyes ❑No
11. Do you claim title to the equipment staging area?(check one) 1 kYes ❑No
12. Are there any water-treatment facilities within 50 feet of the proposed excavation area?(check one) Oyes XNo
(If Yes,specify):
13. How will the excavated material be en and a erosion pontro ?(e.g.see att f ched oswn coif Sol plan pnd
disposal area design): WOrK itil ►J G cION L Ill 4I 2A"R-- f 4A<4 eA
e.
14. Type(s)of excavation equipment to be used: �� ��� 16N r�CA
15. Will waters or wetlands be crossed in transporting equipment to or from the site?(check one) ❑Yes *0
(If yes,explain)
16.Will return water re-enter the reservoir?(Check one) ❑Yesio ❑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? NYes ❑No
(If Yes,sped the existing permit number. If No, include a scaled drawing of the proposed facility). Permit#
18. Total planned duration of thp work(I�first equipment mobi�excavation through final mitigation measures
complete): START / FINISH D l
(Month) (Year) (Month) (Year)
Duke Energy Page 2 of 14 rev 9/19114
Excavation Program
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application 113 10.docx

DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
PART EL(Continued)
B. PROTECTION/AVOIDANCE AREA DESCRIPTION
Complete the following table including all land areas within and immediately adjoining the disturbed area:
Identification M thod U*
Protection/Avoidance Areas Approx.
(check all that apply) Acrea¢e Field ID Work Area Dwe.ID Avoid(A)or Mitigate(M)
a. Marshland,swamp,ponds,beneficial n/A
aquatic vegetation or other potential wetlands(circle all
that apply)
b. Buffer Zones(specify width&source of ���� ��hA,t,
requirement) /�l/lY �D
hAticl� b� � h�
Energy
c. Environmental Areas as identified by Duke Afl
�
d. Natural Areas as identified by Duke Energy A//,+
e. Historic properties(specify) A//,4 f I
//'f
L Rare or threatened species(spec) tiht
Duke Energy Page 4 of 14 rev 9/19/14
Excavation Program
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
Identification Method(*)
Protection/Avoidance Areas Aoorox•
(check all that apply) Acreage Field ID Work Area Dwe.ID Avoid(A)or Mitigate(Ml
on
¢. Buried gas,water,sewer,communications
or electric lines(circle) A
h. Impact Minimization Zones as identified by /*
Duke Energy 4A
i. Other areas requiring specific avoidance,
protection or mitigation(specify) �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)/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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113 IO BOCK

State of North Carolina
Department of Environment and Natural Resources
DWR 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
1650 Mail Service Center 2 0 1 6 1 0 4 0
Raleigh, NC 27699-1650
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Infor ation /r /
Name: r 4Af - tleZ4r"4
Mailing Address:
Telephone Number. Fax Number:
E-mail Address: �j�5 Nc5 c� � �.�� •C�
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: C, u 13 r�d4c
Company Affiliation: _LZ( 5?-rlye � hOe" -Wo
Mailing Address: V-;elf C
orestri,I1r / rc X1111
Telephone NumberZd 0, 5/ Fax Number: 70 V, d 0, S 1
E-mail Address: 5G,9-W'4//3
Person to receive the Certification Approval: I'll ip 23'+"dg_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 4

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.)
A. Location of the property(where(where work is to be conducted) �
County: 7—r e oll// Nearest Town: AOOre5,fi#41, A1
Subdivision name or site address(include phase/lot nurn ): C <<
-3 �� A�
t
Directions to -please iqciude road name and nurn rs,ian rks 7c.: Av
i — ONI v� ter✓ ��i�
Latitude tmidepves).,3c5'5,;LO(o Longitude WmW Owen) G•�s?/
S. Describe the exlsting land use or condition of theJ at the time of Otis apPlWaWn
residential,undeveloped,et .):
� Q.�qO
6. Property site(acres): A7 3 �•��-//
7. take/riser/ocean adjacent to property: ,gym /J
9. Describe proposed work(includeasp how.herdening of horeline has been
avoided,or why it is necessary): ��1
9. Will work be conducted from land? E, from water?
1o.Total amount of disturbance(irOuding all excavation,backfill,rip rap,ratewing WAS,etc-)
normal pool lake level/Normal Wa in squaje feet oj ate:f
_ 0< O/ i 410 SCS X .
11.Total amount of disturbance(including aN clearing,backfill,wwristion,rip rap,mbdnft
waits,etc.)gen the normal pool lake level/Normal Water level and So feet lard-ward in
squara feet or acres:
12. Please describe the vegetation abase the normal pod We 1ev V Normal Water Level and t
feet landward to be impacted(number of trees,for instance): CI r#-s3Date
Sit'
Owner/Agents SW~e' Printed Name
flu f&K W.tkWM
'Agent's SignOWN is vu ld only tf an authorization kftrfnxn the owner is Wovkia+d.
FORM: 20-2M3 Nage 2 of 3

i
f
R
Ft!!!Par►dJ
NormINAMWd
Shoreline
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

4C.
Al
\V
Full Pond/
Shoreffne
147 �� 5
f Y,t
v r :
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

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L30 S 0013'50'E 79.99'
v UNE TABLE L31 S 16'40'50"E 1.50'
UNE BEARING LENGTH L32 S 16'40'50"E 24.78' STATE OF NORTH CAROLINA
0119wots coeTiFlcaT>: AND NOTARIZATION
L1 N 0114'02'W -12.7- LM S 1910'50'E 25.82' COUNTY OF PEDELL I HEREBY CERTIFY THAT I AM THE OWNER OF THE
L2 N Oi E 64.74'
L34 S 11'49'50"E 30.12' SURVEYORS CERTIFICATION PROPERTY SHOWN AND DESCRIBED HEREON, WHICH
- LANGTREE RD L3 N 1314'02'W 17.11' L35 N 4917'52'W 23.39' I,WILLIAM M.ALLEN CERTIFY THAT THIS MAP WAS ORA IS LOCATED IN THE SUBDIVISION JURISDICTION OF THE
�11 UNDER MY SUPERVISION FROM AN ACTUAL SURVEY MADE COUNTY OF IREDELL AND THAT I HEREBY ADOPT THIS
r o L4 N 1 4 L36 N 36'43'50' W 41.37' I,O N TY,C IA•aNA THE
REVIEW OFFICER OF IREDELL UNDER MY SUPERWSKIN DEED DESCRIPTION RECORDED PLAN OF SUBDIVISION WITH MY FREE CONSENT AND
L37 N 69'08'50'W 32.72' COUNTY,CERTIFY THAT THE MAP OR PUT TO M BOOK__PAGE � THAT THE RATIO OF ESTABLISH MIMMUM BUILDING SETBACKS AS NOTED.
L5 N 2723'58"E 15. WHICH THIS CERTIFICATION IS AFFIXED MEETS PRE SO4 AS CALCULATED BY LATITUDES AND AND DEDICATE ALL ROADS, ALLEYS,WALKS,PARKS, AND
1 }� 1-6 N 015 '02" W 7.4 ' L38 N 4427'50'W 22.33' ALL STATUTORY REQUIREMENTS FOR RECORDING, DEPARTURES IS 1:10000, (THAT THE BOUNDARIES NOT OTHER SITES AND EASEMENTS TO PUBLIC OR PRIVATE
i L7 N 7' 14,25' L39 N 0421'50" W 77.11' U SURVEYED ARE SHOWN AS BROKEN LINES PLOTTED FROM USE AS NOTED.
L40 S 6128'10 W 34.04' /, h/// INFORMATION FOUND IN BOOK_�PAGE_);
L8 N 17'00'0 ' W S0. 3/��r (CRL5 LCLL.{L�==� THAT TNS MAP WAS PREPARED 1N ACCORDANCE MITI I FURTHER CERTIFY THAT:
vT L9 N 17'00'0 W 19.07' L41 S 1737'10" W 58.82' DATE REVIEW OFFICER D.S.47-]0,AS AMENDED. A: THERE ARE NO DEED RESTRICTIONS
L10 N 30'3 b "W 17. L42 S 09'47'10'W 72.38' WHICH WILL BE VIOLATED BY THE
VICINITY MAP•••NO SCALE ■A�S�MYyANp AND SEAL THIS S Zr-DAY OF REQUESTED SUBDIVISION; AND
L71 S 80'44'58'W 26. 143 S 3431'10' W 3.66' �Arfd A.D.2016.
L12 N 5642'09*E 19.69' L44 N 0128'10'W 76.05' 8: THERE ARE NO GOVERNMENTAL REGULATIONS OF ANY
LEGEND L13 N 1' W 88. L45 N 01'28'40" W 80.39' ,.il•Lr.r•r�• KIND,
IN ,BOTHER THAN THOSE PUED OR UNDER(RICH COUNTY
VARIANCE
L14 N 4TJ ' 2"W 78. L46 N 5630'54"E 61.69' Ai AL LAND SURVEYOR
- EEN
P.P. 'POWER POLE Q� �Si1LL' i� SUBDIVISION ORDINANCE REGULATIONS.WHICH WILL
LiS N 61'37' " W 4.77' L47 N 5630'54'E 8.81' ' BE VIOLATED BY THE REQUESTED SUBDIVISION; AND
= POWER TRANS. 1-16 N 1'37 W 93 L48 N 0128'40"W 19.58' >_' A710N NUMBER C: I UNDERSTAND THAT ENFORCEMENT OF DEED RESTRICTIONS
E.I.P. . EXISTING IRON FOUND L17 S 62'5'4" W 60.22' L49 N 0128'40'W 31.65' / :4 AND ANY OTHER CONTRACTUAL AGREEMENTS IS NOT
I.P.S. = /4 REBAR SET L78 N '36'10"E 41.73' I / / Li:w j
L50 N 0128'40'W 158.84' - THE RESPONSIBILITY OF IREDELL COUNTY, WILL NOT BE
Lig 7'47'4"W 7. 1' L51 N 0128'40'W 2Q30' = UNDERTAKEN BY IREDELL COUNTY, AND 15 THE SOLE
R/W- RIGHT-OF-WAV RESPONS189UTY OF THE PARTIES AFFECTED BY VIOLATIONS
CP- COMPUTED POINT �O 7753'10" W 36.51' L52 CHAN LING \'T OF SUCH DEED RESTRICTIONS AND CONTRACTUAL
L21 7753'1 W 8.63' L53 It ,/ CE "i 4 AGREEMENTS.
L22 " w 65.72' I IAN U. I\ ,
L23 e'1o:w 36.32' AQUA NC INC. rRHa 1 CASTAWAY SNORES DAD OWNER/ME-/ /M
L24 1.44'1 W 8.06'
L25 2007\327 I PB.18 PC. 25
1'44'9 W 1 w �?'t( 6 THIS SURVEY CREATES A SUBDIVISION OF LAND WITHIN THE AREA
L26S 33*24*10'W '.Z, OF A COUNTY OR WAIOPI1 M THAT HAS AN OR04NANCE THAT DATE OWNER/MEMBM/MANAGER
L27 1 1 "W 75,12- I LOT .9 / REGULATES PARCELS IF LAND. NORTH CAROLINA
L28 S 1010'50'E 66.24' AQUA NC INC. t W NORTHIREDELCOUNTY
L29 S 756'39'E 13.21' ' I 2007\327 / I M
PROFESSIONAL LAND SURVEYOR
720\446 GOT 10 o PROF�
CURVE TABLE _ LSZ S8757'47"E f / JEFF SHOOK 1V111 A NOTARY PUBLIC FOR SAID COUNTY AND STATE
CURVE RADIUS LENGTH BEARING CHORD ' 79.74 w / 720\446 1 y.*1 Do HEREBY CERTIFY THAT
N 0'04'31" W 1' m 1 to
MICHAEL SHALVOY(OWNER/MEMBER/MANAGER)
m m OW*R(S)PERSONALLY APPEARED BEFORE ME THIS DAY,
m F9 / ,F ID AND ACKNOWLEDGED 1HE EXECUTION OF THE FOREGOING
' Z 174.61 . 1 INSTRUMENT. WITNESS MY HAND AND OFFICIAL SEAL,
CHRISTINA P. WEATHERFORD ( S89'42'27'E ---'42'27'E THIS 17 DAY OF 1362\500 8 j 90Eg <
201 6.
lu/ ` _d
NOTARY IC
a. N o MY COMMISSION EXPIRES: 6/17/17
I
143. 90 TOTAL %%SSE N I !ll
^ ��
S88'OS'32'E - 1A�► 0 0 u �1 / I�w _ NOTES:
i;.
- -�e I LOT 6 1)This property may be subject to any aosementa and/or
1s-w u +os' I 1.30 AC. r� $ Rights-ot-way of record. _
.• C,...�AJ ?r
C U I �m �ffCa�e ` 2)Tax Parcel No.'s(4644298751)DB. �PG.�
r� w I ca'` EIPer6.41'l •h'S��'.� C
I< f o o ` i (4644390927)DB. Alfjo PG. /8SS
II �$ V`< + I� �3• 1 1 J n'b (4644297886)DB. PC. /Bte9 _ .. (.!•
1 LOT 1 m S� `� 3) This property is zoned: RA
3 ` `b
LAKE NORMAN �I I 0.689 AC. I v v Nag~ ZZ 03g. 4)Minimum Building Setback Pa County Zoning: 35'FRONT
15'SIDE
u 50' from 760 contour or 35'from
/I� \cN•� \ r, �.� \ f rear property Ilse which ever is greater.
c� (I \\ tio� S)The property is located in DAVIDSON TwsP.,IREDELL W.,N.C.
LOT 5 1 I \\ off/ 6)This property is located in WS-IV Critical Area of the LAKE NORMAN/CATAWBA
Sr I 0.689 AC. ^
C: 1 m \ r WATERSHED BASIN.
Vy J 7)All lots as subject to a 10'Utility and Drainage Eoserrent.
// J,pJ J�� I o .y� 10 feet on each aide of the property line.
4y LOT 2 �C1/� IB e) TOTAL AREA SUBOIVIDED 4.746 AC.
0.689 AC. I by% \ ,\ ) �`m �'41°°0 w>x 9)TOTAL LOTS CREATED 6
10)No geodetic monument found within 2000'of said property.
11)AS OF THE DATE OF THIS RECORDING, THE LOTS
REPRESENTED ON THIS PLAT HAVE NOT BEEN INSPECTED
OR APPROVED BY THE IREDELL COUNTY HEALTH DEPT.
rm 'tT' + m• I y 4`/ rJ UNTIL INSPECTED THERE IS NO ASSURANCE THAT A
\ \
4D. '1 �'= I \ I alf 1 Ca LAKE NORMAN BUILDING PERMIT WILL BE ISSUED.
R N Lor 3 I( � 1 I 12) The subdivision will be served by Aqua INC Inc. for water and sewer.
0.691 AC. \o. C` LOT 4 j 1 13) Existing home sites to be removed within 60 days of the recordirg of this plot.
77SOM CONTOLM 0690 AC
N�1 '•\\ � n \ I g\ 1 4 I
MINOR SUBDIVISION
a u OF
LAKE NORMAN \ \ �_ �Or / - r fp/
\ <s v SC SETBACK k VEGETe-D//YE � LAKESIDE AT LANGTREE
IREDELL COUNTY, NORM CAROLINA \ R' �� I µ Ra
\ \ Q}4� BUFFER rRpl 760 CONTf1Xr�lWa /
OETHETSHOWN BESTT OF MY KNOWLEDGE UES WITHIN THE WS-17' \\ '76 THIS PLAT `� Re ao M / SCALE: t' =O 0' T P,� IDA�RVEYED JAN 15. 2016
CRITICAL AREA OF THE LAKE NORMAN/CATAWBA RIVER WATERSHED L2.0 DATE PLAITED: MARCH 17, 2016
AS DESIGNATED BY THE NORTH CAROLINA DIVISION OF ENVIRONMENTAL _-
MANAGEMENT AND AS APPEARS ON THE _J �" OWNER LAKESIDE AT LANGTREE LLC.
WATERSHED PROTECTION MAP OF IREDELL COUNTY. -_..i Ut9 L25
104 BRIDGEPORT DR.
/�l LAKE NORMAN MOORESVILLE N.C. 28117
DA r re ?l b ALU �1L 1®0'1N11111111'
SUBDIVISION ADMINISTRATOR
Doc ID: 016877310001 Tvoe: CRP
Roearded: 03/21/2016 at 02:16:47 PM GRAPHIC SCALE
Fee Ant: 921.00 Page 1 of 1
I HEREBY CERTIFY THAT THE SUBDIVISION PLAT SHOWN HEREON HAS BEEN Iredell county. NO
FOUND TO COMPLY LATH THE SUBDIVISION REGULATIONS OF THE COUNTY OF nstthw S. ecw11 Replacer of weds eo o m A ISO :a
D 0 N ALLEN k A S S O C I A T E S P. A. IREDELL, NORTH CAROLINA AND THAT THIS PLAT HAS BEEN APPROVED BY THE BK64 -95
'Since 1971' SUVDIM90N ADMINISTRATOR FOR RECORDING IN THE OFFICE OF REGISTER OF
Commercial •Residential a Mortgage SurVwys•Multi-Fanily DEEDS IREDELL COUNTY. ( IN F'EP.T )
Construction Staking• Subdivision Design a Topographical s !L I inch- 60 R
131 CroeMake Park Drive(suite 102)• Mooresville.N.C.28117
[phone] (7w)664-8041 Fa. SUBDIVISION ADMINISTRATORDATE!
IREDELL CO., NORTH CAROLINA
DASSURVEYOIINDSTREAM.NET file gUdger rd - 13404.dwg