20161064 Ver 1_Shoreline Stabilization_20161104

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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
FOR DUKE ENERGY USE ONLY
Duke File No.
Application Fee$ Security Deposit$ Check it Date Recv'd Initials
Date of Duke Energy Lake Services,applicant and/or contractor on-site inspections Date-'d-2C-0 IU Initials agg K
Date Final Protection/Avoidance Area Markings Field-Verified Initials
Date
Approved to Start Work By*:
(Print) (Sign)
Date Completion Required Date of Any Approved Extension Initials
Date Passed Closeout Inspection* Initials
Any Stop Work Orders or SMG Violations*?(check one) ❑Yes ONo (If Yes,explain in PART V)
Daze Deposit Refunded Initials Date Permit Database Updated
*Forward copy of approved application(all pages,plus any attachments that Do rgy changed)back to a nt
with Approval Letter and highlight any changes.File copies of Approval and Clo ork
Orders with application.
PART L-APPLICANT INFORMATION(Please Print) 401BUF RESUU—PERM R NG
Name�t NA .'4y1i,AV- &*clue.. Telephone
Lake Address i 2 3 6`'xetf_O V�1'W "f - Ming Address
(Ifdifferent)
�'rnrnie��kS NC -q14031
Contractor Company C Jo tJe t )2\e - C.h K
Contractor Contact Person C / Y"44 e 5 Telephone (7 ) p I
LAKE LOT INFORMATION i
Lake/Y�r��� County C dui6n City (f tY'AfC g State L Tax Map No.
Subdivision P el" i J 51'� Lot/Section No. b 2 Lot Size6 815 Acres
Are there any Co-Applicants*?(check one) ElYes [JNo (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(DEISR)and the applicant and/or the excavation contractor. NOTE.Ini &Uzing this portion of the
application by a DELSR in no way constitutes approval or eminent approval of the excavation or any other lake use
pmvduh g activity.
Date of on-site inspection 16 ZV I LP Initials(Duke Energy) JQ111 (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 O 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) *Mate ❑Residential Marina ❑Commercial Marina
❑Public 00ther(specify):
4. Max.Excavation Area Dimensions(ft): Length
D Width 54) Depth
(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): J 70 —Pubic yards
6. Type of material removed(applicant determines byfield sample if practical): tM(A t �)dff
7. Excavation Site area: O.O 7 Acre(s) Disposal Site area: 0.D 7 Acre(s)
8. Total Disturbed Area(including equipment staging area): ¢ Acre(s)
9. Does the project meet the requirements of the applicable General Permit?(check one) E es ONo
10. Do you claim title to the disposal area?(check one) OKes ON�o
11. Do you claim title to the equipment staging area?(check one) DYes Mo
12. Are there any water-treatment facilities within 50 feet of the proposed excavation area?(check one) ❑Yes 0�
(If Yes.specify):
13. How will the excavated material be entrapped the on ?( &see attached erosion control plan and
disposal area design): v
14. Type(s)of excavation equipment to be used: Ptr 4 Z ic) 1 DNq re PO P_dN/l9
J
15. Will waters or wetlands be crossed in transporting equipment to or from the site?(check one) OYes 0<o
(Ifyes,expo)
16.Will return water re-eater the reservoir?(Check one) ❑Yes 00vo ONIA (If Yes,spcc�,fy poim(s).f, .ntry w,d
show on Excavation Area Drawing)
17. Is there an existing facility(e.g.pier)that access is being maintained to by conducting the excavation? a (es ❑No
(If Yes specify the existing permit number. If No,include a scaled drawing of the proposed facility). Permit#
18. Total planned duration of wprk(Include first equipment mobil' 'on,excavation through final mitigation measures
complete): START J /_ f" FINISH O� /—,&&
(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 II.(Continued)
B. PROTECTION 1 AVOIDANCE AREA DESCRIPTION
Complete the following table including all land areas within and immediately adjoining the disturbed area:
Identification Method(*)
Proteetion/Avoidence Areas ADDMY.
(check all that apply) c a Field ID Work Area Dwe.ID Avoid(A)or Mitl¢ate(Ml
a. Marshland,swamp,ponds,beneficial
aquatic vegetation or other potential wetlands(circle all l
that apply) l
b. Buffer Zones(sped width&source of Dr�q c �` /I /e o(o e fe
requirement) ✓✓y f !�
c. Environmental Areas as identified by Duke �/
Energy !r
d. Natural Areas as identified by Duke Energy N f A
e. Historic properties(sped)
L Rare or threatened species(specify) A111+
]
Duke Energy Page 4 of 14 rev 9/19/14
Excavation Program
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
Identiticaton Method
Protection/Avoidance Areas Apnrox•
(check all that apply) AcresField ID Work Area Dwe.ID Avoid(A1 or Mitigate(M1
Buried gas,water,sewer,communications J
or electric lines(circle) A114
h. Impact Minimization Zones as identified by ���
Duke Energy
i. Other areas requiring specific avoidance,
protection or mitigation(spec(&) A1)A
* 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 PERMT APPLICATION FORM
C. APPLICANT'S 9QN&U=
comments:
u5 s as ��� �,�tA/ /0'7L/
Applicant Name(prbrt) At, Lot# l o`L
Appiicam Signature* Date tO
Co-Applicant Name(print) Lot#
Co-Applicant Signature* Date
Co-Applicant Name 6v*d) ll t, t �rgttcr?,O, Lot# l
Co-Applicant Signature* Date /
Co-Applicant Name(print) Lot#
Co-Applicant Signature* Date
Co-Applicaut Name(print) 110t#
Co-App icaat Signature* Date
Co-Applicant Name(print) Lot#
Co-Applicant SIVature"' Date
*Per my signatme,the information provided in this application is omTed to the best of my lmowledr.
BEFORE YOU MAM THE APPLICATION TO DUKE ENERGY LAKE SERVICES ENSURE YOU HAVE:
• CHECKED THE INFO THOROUGAi Y
• MET ALL REQU EMENTS FOR A MMPLME APPLICATION(see caw letter Of q0c ation Package)
• INCLUDED A SINGLE CHECK TO DUKE ENERGY FOR THE APPLICA110N FILING FEE AND SECUM Y
DEPOSIT
• INCLUDED ALL AGENCY PERMITS OR COMMENT LElTFRS AND RESOLVED ALL ISSUES RAISED
• INCLUDED ALL REQUIRED DRAWINGS(DICLUDING PROPOSED FAC XrES),PE,RMT#FOR EXISTING
FACILITIES,SURVEYS AND PLANS
• INCLUDED COPIES OF DEEDS AND AUTHORIZATION LETTERS
Duke FMCy Page 6 of 14 wv 9/19/14
Excavation Program
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application 113 10.docx

State of North Carolina
Department of Environment and Natural Resources
I Division of Water Resources
15A NCAC 02H.0500—Water Quality Certification,Shoreline Stabilization
Division of"later 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 2 0 1 6 1 0 6 4
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner lnf/o�nation
Name: l_ �t� r u v 0 f oNC,
Mailing Address: /7,q 3 6 Cry-t-eiV I I' ' tv'
C6 r,vc 1 u.s, /VC �-94231
Telephone Number: 70q- L,0S 7/39 Fax Number:
E-mail Address: (-A&01/C_ e- . c-i yv\
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 FOR��,M//.pdf) must be attached if the Agent has signed this application form.
Name: (� r4LS
Company Affiliation: rAC
Mailing Address: 639 G> Kf�dot �' m ` J y
M©
Telephone Number: 70 ,-/I/ Fax Numb r: 70
E-mail Address: Ch S AGfs J 6 /L&A M • �n,
Person to receive the Certification Approval: /3 r- �C5
if. Project Information f15A NCAC 02H .0502(x) & (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)/��
County: Nearest Town: ( ����'�5
Subdivision name or site address(include phase/lot number):' $NiAI5u 0. �b�IDZ
Directions to site-please nclude road names and numbers,landmarks,etc.:
/V`e, 'CAI Je- ►
4- CAIo N 6AIME✓ /� �� 011/ �' cC rJ f>[ A;"/
Latitude(in decimal degrees 4 Longitude(decimal degrees) �a ' /2 c9©2/7
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped,etc.): 1r C Jid CsJ�
6. Property size(acres): 0. 815
7. Lake/river/ocean adjacent to property: Z-4'Ke- Wm I+V
8. Describe proposed work(include discussion as to how hardening of shoreline has been
avoided,or why it is necessary): 1r c 0 7 fl-GCcsS
9. Will work be conducted from land? 9-h
From water?
10.Total amount of disturbance(including all excavation, backfill, rip rap, retaining walls,etc.)
below the normal pool lake level/Nor Tal Water Level in square feet or acres:
50 ` x 5oX 4
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 Wat r Level and 50
feet landward to be impacted (number of trees,for instance):
y�J C,�iS
� T
Date
Owner/Agent's Sl§nature Printed Name
115A NCAC 02H .0502(fll
'Agent's signature is valid only if an authorization letter from the owner is provided.
Page 2 of 3
FORM:SSGP 10-2013

i
Lake S6
{At Full Pond Normal water Level
r
Full Pond/
Normal Water Level -
r�' =-- !z_..
Shoreline I
i
D
f/� t
Y
I
37 CkP�5
-
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

NOTES: CAR �.
y
NTE FOUNDw �
mf1N� E1T I ��OQ`OFESS/'4�
?Q y;y9
2.PROPERTY MAY BE SUBJECT DA L W.LONG
ff TO OTHER COVENANTS. 18335 OLD :
RESTRICTIONS.EASEMENTS ;f9 Okr
OR RIGHTS-OF-WAY THAT SUITE A
1weun MAY BE OF RECORD. CORNELIUS.N.C. 28031 'y O'y�S(/(ZV�t•'' ��
3.CONSULT WITH GOVERNING [phone] �i ,a!N",�
VT1Y,w AGENCY FOR PREVAILING LAND
DEVELOPMENT AND ZONING
REQUIREMENTS PRIOR TO
DESIGN OR CONSTRUCTION OF
ANY IMPROVEMENTS.
C' p IN p
SOL vP �% '
LINE TABLEPvB�"`G
UNE LENGTH BEARING 6Q CF P
L1 .7.00 N20-4C06-
L2
3400'L2 19.24 NO 0' 'W
L3 35.02 Nt
14. 16.40 NS 00-E )S r
LS 17.46
L6 16.00 N69`25'00'W
L7 21.43 N 'W
La 7.81 NO3.56'00
L9 5.83 SS5W'00'W Ile
LIO 30.00 N35 roV"W 30r FRONT
L11 13.60 N18.4G'00'W /
L12 23.86 N88.53'00'W
L13 11.59 N1SMS 'E
N
alb/• N ?S2 n / ocur
.� \ /
001-071-33
Stuart D. Ross m
DB 16356 PG 25 yScgyc s` �" A
c'
WALL -Z
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is.E^o 1,2,
LO p
i L12 !� \'�os7 9 So- F 'UCt olO,
LAKE NORMAN ?0
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L6
h �y ✓e� 001-841-40 b
Gjh Stehpen J. Neal
i`, ,�, Judith K. Neal
v DB 14999 PG 312
o
o CURVE TABLE
4 CURVE LENGTHI RADIUS I CHORD CHORD BRG
LEGEND 1 ^`' �,' C11 134.371 163.171 130.60 S89'05'42'E
#4 REBAR FOUND O f
#4 REBAR SET O• s i'
COMPUTED POINT • 1
FENCE--- --- Graphic Scale
STORM PIPE-----`----- / \ 50 25 0 50
UTILITY BOX [7 MIN
/®T Scale ofDrawirtp,lInch=SOFeetysical Survey of Lot 102 of Crescent Land& Timber Corp., Section 2
F/APProrofessional Site Address:
Surveyors.Inc. Property of As Recorded in 17236 Green Dolphin Lane
18335 Old Statesville Road Chip Bottone Deed Book 28538.P8 327 Cornelius,NC 28031
Ste.A.Cornelius.N.C.28031 Gina Bottone Map Book 17.Pg 542
704-765-5134 PhoncfFax Mecklenburg County
Firm Lisc eme:C-3666
06-131441 1 JW >I:10.0W 1"-50' 001-071-33 1r_i6 GREEN L of l 6/Y+A14
Job No. Prepared By Error o Iosure Drawing Scale Tax Parcel Number Drawing,File Name Shcel Number Date

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