20160630 Ver 2_Shoreline Stabilization_20161104

DUKE ENERGY EXCAVATION PERNIIT APPLICATION FORM �T O
FOR DUKE ENERGY USE ONLY
Duke File No. 0
Application Fee$ Security Deposit$ Check# Date Recv'd
Date of Duke Energy Lake Services,applicant and/or contractor on-site inspections Date 1° v �/1J�yl�jal 1201
Date Final Protection/Avoidance Area Markings Field-Verified Initials 2016
Approved to Start Work By*: 4 ' B A F R RF �R
(Print) (Sign) 1 N
Date Completion Required Date of Any Approved Extension Initials
Date Passed Closeout Inspection* Initials
Any Stop Work Orders or SMG Violations*?(check ane) 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.
PART L-APPLIICANT INFORMATION(Please Print) (,
Name I�A/CW/ CXAV-1 S Telephone7C 7 Z
Lake Address f�'7 /'//4I/�A '"""L Mailing Address
(If different)
�6C�ee-sv-llelIVC z11i17
Contractor Company C 6 C jMffe— '/��C. t , i
Contractor Contact Person ��//� r/1 les Telephone
LAKE LOT INFORMATION
Lake County(lie City 14100 f 5 � State t� Tax Map No.
// M+ � Y C P'nl:nI SG(r g Acres
Subdivisionl.-i��) �i�% c I�.I.ot/Section No. �C�� ' Lot Size L��
Are there any Co-Applicants*9(check one) OYes [:[No ff Yes,include names,addresses,phone nos.,lot nor.,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.Initiating this portion of the
application by a DELSR in no way constitutes approval or eadnent approval of the excavation or any other take use
P07WOW activity.
Date of on-site inspection L! Initials(Dake Energy) v'"t'«� (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 ❑Water Intake Channel
Wastewater Discharge Channel ❑Other(specify):
3. Lake user category:(check one) Wvate ❑Residential Marina ❑Commercial Marina
bPublic ❑Other(spec):
4. Max.Excavation Area Dimensions(ft): Length LO 0 Width V-0 Depth Jr
(Note:include 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): 1-79 Cubic yards
6. Type of material removed(applicant detennines byfield sample rrfpractical): /nub Sf!
7. Excavation Site area: O.b� Acre(s) Disposal Site area: [3. D 5 Acre(s)
8. Total Disturbed Area(including equipment staging area): 0-10 Acre(s)
9. Does the project meet the requirements of the applicable General Permit?(check one)kes ❑No
10. Do you claim title to the disposal area?(check one) 1 Yes [No
11. Do you claim title to the equipment staging area?(check one) Yes ❑No
12 Are there any water ent facilities within 50 feet of the proposed excavation area?(check one) [Nes *o
(If Yes.specify)-
13. How will the excavated material be entrapRedpnd they erosion gontro�ed?( .g.see attached erosion control plan and
disposal area design): LtJn rK W rl L7c Qienr� fj &P-J
if
14. Type(s)of excavation equipment to be used C ' IU�tf hC A c. WAW -y'e r
15. Will waters or wetlands be crossed in transporting equipment to or from the site?(check one) ❑Yes ado
(I.Tyr:s,explain)
16.Will return water re-enter the reservoir(Check one) ❑Yes �QVo pN/A (If Yes.specify poiru(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? es ❑No
(If Yes.specify the existing permit number. If No, include a scaled drawing of the proposed facility). Permi #
18. Total planned duration of a work(Ifrst equipment mobil' on,ethrough fnal mitigation measures
complete): START FINSH ©\( f�b
(Month) (Year) (Month) (Year)
Duke Energy Page 2 of 14 rev 9/19/14
Excavation Program
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
PART IL(Continued)
B. PROTECTION/AVOIDANCE AREA DESCRIPTION
Complete the following table including all land areas within and immediately adjoining the disturbed area:
Identification �1Iethod(*1
Protection/Avo}dance Areas Approx.
(check all that apply) cr Field ID Work Area Dwe.]ID
Avoid(A)o*Mitigate(Ml
a. Marshland,swamp,ponds,beneficial r
aquatic vegetation or other potential wetlands(circle all ,,///1
that apply) 4`/ (/"t
b. Buffer Zones(speck width&source of
requirement)
A4 /lam-/eW 04
c. Environmental Areas as identified by Duke , r /A
Energy �J r/
d. Natural Areas as identified by Duke Energy �,r
e. Historic properties(spew) /V
L Rare or threatened species(specify) I
Duke Energy Page 4 of 14 rev 9/19/14
Excavation Program
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
Identification Meth "
Protection/Avoidance Arms Approx.
(check all that apply) A—Creage Field jR Work Area Dwe.ID Avoid(A)or Mitigate(Ml
¢. Buried gas,water,sewer,communications I�
or electric lines(circle) nJ
h. Impact Minimization Zones as identified by ,(j
Duke Energy ,U(/
L Other areas requiring specific avoidance,
protection or mitigation(spec 6) 1 Q
* 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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DUE E ENERGY EXCAVATION PERMIT APPLICATION FORM
C. APPLICANT'S SIGNATURES
Comments: v rV1 i4 s .-va)n/f Vu
/� i Nf� fit/• �d'� f
Applicant Name(prim} Q l c f Lot#
Applicant Signature* Date z
Co,Applicant Name(print) Lot#
Co-Applic:aut Signature* Date
Co-Applicant Name(print) Lot#
Co-Applicant Signature* Date
Co-Applicant Name(print) Lot#
Co-Applicaut Signature* Date
Co-Applicant Name(prim) Lot#
Co-Appbmnt Signature* Date
Co-AppReant Name(prim) Lot#
Co-Applicant Signature* 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 Wlwatzon package)
* INCLUDED A SINGLE CHECK TO DUKE ENERGY FOR THE APPLICATION FILING FEE AND SECURITY
DEPOSIT
• INCLUDED ALL AGENCY PERMITS OR COMMENT 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 Enemy Page 6 of 14 rev 9119/14
Excavation Progam
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application 113 10.docx

State of North Carolina
Department of Environment and Natural Resources
F €
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
Raleigh, NC 27699-1650
(. Applicant Information [15A NCAC 02H .0502(2)]
1. Owner Information
Name: �. �l,�ti� C�►A �'s'
Mailing Address:
ZnPoreSV7/Ie , C .24117
Telephone Number: Fax Number:
E-mail Address: /SCCii-5C_(0 6'�t • co rh
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 ttached if the Agent has signed this application form.
Name: C i ri e _S
Company Affiliation: Ne
Mailing Address: 439OA i 2 m t
, J oo ire-5 Leel NC -2-el ZSR
/17
Telephone Number: Q Fax Number:! D ,-6 160 o S w
E-mail Address: ncC54A� /'s ��w,AfOf /1(e
Person to receive the Certification Approval: C-,'OQ /3r-i4
11. 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.
I 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 conducted)) j
County: Nearest Town: D©may jl r /
Subdivision name or site address (include phase/lot number): r��`✓►m'04erC eA1 >v�til0.
&- ' '9-6
Directions to si e-please include road names and numbers, landmarks, etc.: =77/V
• 33 f,Jc�J CtJ:/C%A>Mso�l
/
L�on� l�'
k-1- d --t'G�4}-C R/�1 c+N ` A L.A/
Latitude(in decimal degrees5 .), 5 )
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Y'C5-id etJ' i A-
6. Property size (acres): ©. y
7. Lake/river/ocean adjacent to property: �4-fl c /�c r/►1/�^�
8. Describe proposed work(include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Y
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:
•o I x '-+ I X
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:
12. Please describe the vegetation above the normal pool lake level/Normal Water Level and 5//0
feet landward to be impacted (number of trees,for instance): �'�5 5 f ! � �e 7-rt e>
�Se e p
s 6 �
Own /Agent's Signature* Printed ame Date
MA NCAC 02H .0502M]
`Agent's signature is valid only if an authorization letter from the owner is provided.
Page 2 of 3
FORM:SSGP 10-2013

Lake
(At Full Pond/Normal water Level)
60
/
Full Pond/
Normal Water Level -
r ,
�_a M :. �.�� r=�._ - � � � �.,�- ��:. � .gip-: �
Shoreline Yd.3
AA
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

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