20161085 Ver 1_Shoreline Stabilization_20161107

DUKE ENERGY EXCAVATION_ PERMIT APPLICATION FORM
FOR DUKE ENERGY USE ONLY
Duke File No.
Application Fee $ Security Deposit $ Check # Date Recv'd_
Date of Duke Energy Lake Services, applicant and/or contractor on-site inspections Date
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
(Sign)
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 aonlication.
PART I. - APPLICANT INFORMATION (Please Print)
Name DA v ( c) J 1 S r—O Telephone 7o � j5dy- II/P 12-4
Lake Address / �5 k7-5 �C.S P%f'I < Dr • Mailing Address /I-?-- FD v e- 5 Ta �1 t knT
+ (If different) S V 1
�Q-OY`GS✓i%I/ t�I`G/ � ���7 �DO re 11r �IqC e'wl7
Contractor Company
rwe- i �eGNGIN
Contractor Contact Person Vi ' i� !✓ r'``t 1 c-5, l Telephone %D 660.5-111
LAKE LOT INFORMATION
Lake o rrNknl County City & r e' Vi t�j State _ Tax Map No.
Subdivision Lot / Section No. O Lot Size Acres
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 excavation or any other lake use
permitting activity.
Date of on-site inspection 1 UZ ! Ul Initials (Duke Energy) �ll (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 U. - DESCRIPTION OF PROJECT
A. BASIC INFO
1. Type of excavation: (check one) KNew excavation ❑ Maintenance excavation
2. Purpose of excavation: (check one) *Boat Access Channel ❑ Water Intake Channel
Wastewater Discharge Channel ❑ Other (spec fy):
3. Lake user category: (check one)9nvate ❑Residential Marina ❑Commercial Marina
Public ❑Other (spec):
5-0 60
4. Max. Excavation Area Dimensions (ft): Length _.2.0 - Width ,-l� Depth Z
(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): *?/ Cubic yards �%
6. Type of material removed (applicant determines by field sample if practical): .A U..,,( 4 5 �1/
7. Excavation Site area: Acre (s)
Disposal Site area: 0. D 19 Acre (s)
8. Total Disturbed Area (including equipment staging area): Ob I& Acre (s)
9. Does the project meet the requirements of the applicable General Permit? (check one) 'Ayes [No
10. Do you claim title to the disposal area? (check one) Yes ❑No
11. Do you claim title to the equipment staging area? (check one) �es [No
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
disposal area des
be enUwped qnd the erosion controlled? (e.g. see attached erosion control plan and
14. Type(s) of excavation equipment to be used: wi T N /W j r'e
15. Will waters or wetlands be crossed in transporting equipment to or from the site? (check one) ❑Yes
(If yes, explain)
16. Will return water re-enter the reservoir? (Check one)
show on Excavation Area Drawing)
❑Yes *0 ❑N/A (If Yes, specify points) of re-entry and
17. Is there an existing facility (e.g. pier) that access is being maintained to by conducting the excavation? iYes ❑No
(If Yes, specify the existing permit number. If No, include a scaled drawing of the proposed facility). Permit #
18. Total planned duration of workQ lode first equipment mobil' tion excavation through final mitigation measures
complete): START f l _�{p FENISH / 2!Q(�p
(Month) (Year) (Month) (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 IL (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.,
Acreaae
Identification Method
Avoid (Al or Mitieste (Ml
Field ID
Work Area Dw¢. IID
a. Marshland, swamp, ponds, beneficial
aquatic vegetation or other potential wetlands (circle all
that apply)
l
b. Buffer Zones (specify width & source of
requirement)
1, ,� �K ��pNL
W
PI hlf-C7;
0 y 6l�AL.-
c. Environmental Areas as identified by Duke
Energy
d. Natural Areas as identified by Duke Energy
r 1
e. Historic properties (spec)
A IIA -
f. Rare or threatened species (specify)
r
N /4
Duke Energy Page 4 of 14
Excavation Program
rev 9/19/14
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
Proteetion/Avoidance Areas
(check all that apply)
Auoroa.
Identification Method (*)
Avoid (A) or Mitigate (M)
Field ID
Work Area Dwg. ID
Acreaee
**
¢. Buried gas, water, sewer, communications
or electric lines (circle)
, f
h. Impact Minimization Zones as identified by
Duke Energy
1. Other areas requiring specific avoidance,
protection or mitigation (specify)
���
* 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
c:\users\ann\appdata\local\microsoft\windows\temporary internet files\content.outlook\mp7eolj9\c-w excavation application 113 l0.docx

C.
Co
DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
APPLICANT'S SIGNATURES
mments:7:�e4
/,/jp�IL L C �s s 38-3
S'Tu�✓ t QRi 5 ;Ne W—.+ &N—t y Est-�s f'larre,r. l-07'
Applicant Name (print) ✓ S� $ SCG
Applicant Signature*
Co-Applicaut Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Lot it
Date
Lot #
Date
Lot #
Date
Co -Applicant Name (print) Lot #
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Co-Appiicant Name (print)
Co -Applicant Signature*
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 PPI.1(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 COMMENT• LETTERS AND RESOLVED ALL ISSUES RAISED
INCLUDED ALL REQUIRED DRAWINGS (INCLUDING PROPOSED FACILITIES), PERMIT # FOR EXISTING
FACIIITIES, SURVEYS AND PLANS
• INCLUDED COPIES OF DEEDS AND AUTHORIZATION LETTERS
6 f14
rov 9119114
Duke End, Page o
Excavation Program
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application 113 10.docx
3 rs

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
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 ] 6 ] o 8 Jc
Applicant Information [15A NCAC 02H .0502(a
1. Owner Information
Name: T)AVI O 5; 5 KO
Mailing Address: 1 12
resV �
c Lo
Telephone Number: 'P 501). 4P/24 Fax Number:
E-mail Address: ID&VI& . t. i 5Ka C.? RVJC- • Corm
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 AUTHO
RIZATION FORNI.pdfmust be attached if the Agent has signed this application form.
Name: C�lp �ric�q�s
Company Affiliation:
Mailing Address:
38 idef-c F� ► h�y,
Telephone Number: 70 f. 6& 0. 5/11 Fax Number: X . & SPD • 5 G
E-mail Address: P he se -A -a4 t s EJ W -
Person to receive the Certification Approval: Ck F3r;49!t 5
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. Location of the property (where work is to be conducted) ,,�/
County:
rtct-c��j Nearest Town: (o60y-eS4�<
Subdivision name or site address (include phase/lot number): %o g
ns
site - please include road names anA numbers landmarks, etc.:
-75 3 I.J o N (� 11i Ig -h9 So�//rit • , �e •V %� rlFw�t
ty
4W.1
Latitude (in decimol degrees
�5 X08591 Longitude (decimal degrees) O _qll gS 9
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): 1rt Sic�eiJ 'q•
6. Property size (acres): O.6 S
7. Lake/ river/ ocean adjacent to property: �.Q-X C /�iorn�t 441.1
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): G� r�g IOGp'� l�4CL t S -g
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 normarre
l pool lak level/ Normal Water Level in square feet oL res:
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 50
feet landward to be impacted (number of trees, for instance):
rr455
See s
nerJAgent's Signature
Printed Name Date
115A NCAC 02H .0502(fil
'Agent's signature is valid only if an authorization letter from the owner is provided.
Page 2of3
FORM: SSGP 10-2013

Full Pond/
NormaILW&r.P=l
Shoreline
Lake
u I Pond/Norm) Water Leve!)
uh �Al
103 S -
D r
STc 5 r K-
ir' '
dV►�vres V l
it,
be- v-cwv-'r-t
/"44 n* pip
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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AND ESTES PARK DRIVE S AWES
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FILED FOR TNA PLAT USED ONLY 1HE JN-
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D® SK 3920 PO WI LOTS 384 J8A AND 2.8E FWAV ON
16507 Mst 882{ n ESIES PARK ORJbf MP 17 PAGE 611
►el.. OOSi - 882E
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Lllliltfff fi)f Y IRON PERI, 9 PLAT SUPERGEDIES iw PLAT PREVIOUSLY
faER9A o. FELL REMPMED IN AV 17 ON PAGE Q?a
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Cm+v Rodkw Chwd Bar
aing and Claim" Arc Length I ` IRON REBAR L♦ S 05' 07' 15' IN 63.61'
lo4,8p.• \ LS S 29.34' 95' W 11.10,
MIT
I 90' + L6 S 64' SY 20' E 16.15'
Cl 771,84' N 06. 25' 06' E 2e.eo' 28.84' L7 S M' 07' 40' W 27.24'
C2 171.48' N 89' 47' 45' E 70.20' 70.69' I 386 L6 9 31,32* 45' W +O.J2'
C3 111.84' S 27' 25' 25' W 8.00' 8.00' L9 S 69' 12' 10' W 43.78'
�' w LID N 78. 2Y 35• E 62.69' 1 RbDr1 t RrAM! arMy Met A e+.f w sown
CI 171.05' 4 {2' 22' 20' W 62.70' 82..92' I Zen4.2 s.r. L11 966. 51' S0' E 60.79' ar "'•'+"' w ..eer 'tee s.+• '*ea' u mr ~
C4 171.45' 1 Sr 09' 20' W 5.00• 5.00' 1 0.65 Ao. .or hran.• Met M. sawa,w..we.. a. a.e M. ,«
Cb 771.64' N 11' 24' 10' E 08, B 1' 09.64' I L12 H 77' 59. 60' E 90.04• ears MMmeeM ..w anon: Mar M. eetw nae .r
a VICTOR KK*IL L73 N se, of 15' E 35.09' y.ewan ..r..0 r:/40m Met Mn yen we y
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DEED 8K 4701 PO 709 L15 N 06' Sr 25' W 45.52' e -t Mee Mb Aw np.,wh . w,.. er w s.ke-
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sns "A. oat ar 04 rem br -4 rdr
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0 - NEW IRON SET 'Y 1 �� % REVISION OF WO 17 PAGE 523 FOR-
��N LAKE NORMAN RECREA770M LOTS VICTOR H. HARRELL, JR.
X - SURVEY POINT - NO MONUMENT SET , v SECTION 8 KA THLEEN ALLEY HARRELL
- - - LINE DRAWN FROM PLAT PSD: HARRELL
T 17 PG 623 16525 PARK DRIVE
• 2s o 90 C'1oD MOORESVVILLE ILLE,_N. C. 28115
. A.ts7 a47g Irir_n� rS�(RwyN fun; r71w}7 ^,� fflaSV uern er•.i r ne na.wluc IS t lural • 90 LEFT DWG. HARRELL LEMLEY T011M5H7P MECKLENBURG COUNTY, N, C.

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