20161179 Ver 1_Shoreline Stabilization_20161130

DUKE ENERGY EXCAVATION PERNUT APPLICATION FORM
79
FOR DUKE ENERGY USE ONLY
Duke File No.
Application Fee $ Security Deposit $ Check # 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 Initials
Approved to Start Work By * : Date
(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) 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-AAPPLICANT WFORMA ON (Please Print)
Namej"�� ��0#)e
7;ddress-/mo Telephond 0,0/ e-1✓ 4/Mailing Address a
(If different) I
r�c4'cc S. l �C ��� 3 /
pit o /Yl A -t' .flS Nt
J� 2016
1401 D
Contractor Company 57-DAle- s e Nj
-R, R E M T7
Contractor Contact Person !� r(C�7 C 5 Telephone (! 0 )
LAKE LOT INFORMATION L - I,
Lake r County ''-- rr ;mrCity a`f'wlU.S State N C- Tax Map No.
Subdivision#- 'Pe0� 1A) -5"f&- Lot / Section No. Lot SizetfJ�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: In"zing this portion of the
application by a DELSR in no way constitutes approval or eminent approval of the excavadon or any other lake use
Date of on-site inspection l ZZ k4 Initials (Duke Energy) l ` U (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 PERMrr APPLICATION FORM
PART II. - DESCRIPTION OF PROJEC r
A. BASIC INFO
1. Type of excavation: (check one) XNew excavation ❑ Maintenance excavation
2. Purpose of excavation: (check one)Boat Access Channel O Water Intake Channel
Wastewater Discharge Channel ❑ Other (specify):
3. Lake user category: (check one)tublic
vate OResidential Marina OCommercial Marina
00ther (specify):
4. Max. Excavation Area Dimensions (ft): Length Width 36 Depth
(Note: include additional area &mensions if necessary so response to #5 below equals in= area dimensions in #4)
5. Volume of Excavated Material (TOTAL for the project): -30(. Cubic yards
6. Type of material removed (applicant determines by field sample ##practical): 1AXA T S1 W
7. Excavation Site area: Q 4 Acre (s)
Disposal Site area 0. 0 Acre (s)
8. Total Disturbed Area (including equipment staging area): 0. Ov Acre (s)
9. Does the project meet the requirements of the applicable General Permit? (check one) XI'es 13No
10. Do you claim title to the disposal area? (check one) tomes ONo ''
11. Do you claim title to the equipment staging area? (check one) Yes ElNo
12. Are there any water -fit facilities within 50 feet of the proposed excavation area? (check one) OYes #o
(If Yes, spec#y):
13. How will the excavated material !gen=d end the on coptrolied? (e g. sed attac d erZ cgntrol Pign and
disposal ww design): O r' K -Fn h Z dere(G y 17/�'1'�(C . � /I � Di'1" Yl t1 IV nt' l
14. Type(s) of excavation equipment to be used:
15. Will waters or wetlands be crossed in transporting equipment to or from the site? (check one) 13Yes *Io
(If es � )
V_
16. Will return water re-enter the reservoir? (Check one) ElYes �No ON/A (If Yes, specs y 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 ONo
(If Yes, sped the existing permit number. If No, include a scaled drawing of the proposed facility), Perini #
18. Total planned duration of the work (Include first equipment mobilization, excavation through final mitigation measures
complete): START beC, l JO J(p FIMSH 'Dec— / �dJ to
(Month) (Yea) (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 / AVOIDANCE AREA DESCRIPTION
Complete the following table including all land areas within and immediately adjoining the disturbed area:
Protectton/Avoid&act Areas
(check all that apply)
Approx.
Identification Method (*1
Avoid (A) or Mitigate (Ml
Field ID
Work Area Dwg. ID
Acreage
a. Marshland, swamp, ponds, beneficial
aquatic vegetation or other potential wetlands (circle all
that apply)
/ `/A
!'
b. Buffer Zones (sped width & source of
requirement)
e bAfG �orK ' 111
.bAJ c. r Hn-u f cd o
G Environmental Areas as identified by Duke
Energy
d. Natural Areas as identified by Duke Energy
- r
,Y
e. Historic properties (specify)
/ v /4
E Rare or threatened species (specify)
. r
Duke Energy Page 4 of 14 rev 9/19/14
Excavation Program
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
Protection/Avoidance Areas
(check all that apply)
Aporox.
Acreage
Identification ethod (*1
Avoid (A) or Mitigate (Ml
Reld IDWork
Area Dwg. ID
g. Buried gas, water, sewer, communications
or electric lines (circle)
N
h. Impact Minimization Zones as identified by
Duke Energy
/
4/
I. Other areas requiring specific avoidance,
protection or mitigation (spec6)
!�
* 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 S of 14 rev 9/19/14
Excavation Program
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
C. APPLICANT'S SIGNATURES b iN a w LL
Comments: 5-re,/Gw1 %
%� �' i Gt- S � � rtG� �4-r►t 5 0� ($ 8 fl y � �4-1 IMp rt, � �f'G s
Applicant Name (print) Ta ►-. J r w, CS o`
Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Co-Applicaut Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Lot # 11S
Date 11t ► l
Lot #
Date
Lot #
Date
Lot #
Date
Lot #
Date
Lot #
-Date
*Per my signature, the information provided in this application is cornea 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 COA84ENT LETTERS AND RESOLVED ALL ISSUES RAISED
• INCLUDED ALL REQUIRED DRAWINGS (INCLUDING PROPOSED FACU mES), 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 10.docx

State of North Carolina
Department of Environment and Natural Resources
DWR. Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
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
I. Applicant Information [15A NCAC 02H .0502(a)j
1. Owner Information
Name: 0 U_ C ikir IM 4—
Mailing Address:oq-aPvS 6_N C t c
C)rNC_1•i.c5RIC ::?-Ab31
Telephone Number: 704- 4b8. �% Fax Number:
E-mail Address: r IIAe 47 Q/Nq: •Co
m
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: 5et Aoiet-5
Company Affiliation: Cee Smow_ f Read4ja
Mailing Address: (0,58 A-Iari d c F_"
M6ov'e5ri llf. C 98/Imo''
Telephone Number: 7d'F- &60. S/I ( Fax Number: D 4642-51(-9
E-mail Address: Ck ct41t) s ; M . AI e
Person to receive the Certification Approval: C k- p ?Jr'«i9Le 3
II. Project Information [15A NCAC 02H .0502(a) & (b)l
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.)
4. Location of the property (where work is to be conducted)
County: Mc[ O_Nearest Town: 're-I.K5.
Subdivision name or site address (include phase/lot number):
Dire: ions to si e - please include road names and numbers, landmarks etc.: :T-777 N
Arskf * c4c b Or.
Or.
SAS /./ IV -1 -Ad
Latitude (in decimal
" , L4_e 4 B& it" vC_
5t7w (7T C eN Vi(
Longitude (decimal degrees) 90.9 r 1 t a--1-7
5. Describe the existing land use or condition of theite at the time of this application
(residential, undeveloped, etc.): Ye 5 c d -eoJ4;t4
6. Property size (acres): 0.537
7. Lake/ river/ ocean adjacent to property:
C t(ormptpJ
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): �Y'C dqc Y o r} -i' 1�GGc 3S
9. Will work be conducted from land? ❑ From water? M
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:
11. Total amount of disturbance (including all clearing, backfill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake
square feet or acres: to Iytnp0r,
Water Level and 50 feet land -ward in
L
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): il r/*55
J7
01�v.11T' e0.rmird°N, II�il�li
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

Full Pond/
Normal WatteLevel
Shoreline
Lake
(At Full Pond/Normal Water Level)
�,e(eAJRW
/�aD K �Im- RC- Ion \5
Please approximately sketch the following information on this plan (provide dimensions for each
item, such os 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

LAKE
NORMAN
TE
.. NORMAAt`
r,—w, LIAn
FC L. LONG P S.
406 N. EET
MOORESVILLE, N.C. 28115
[phone]
17000
i
'
LAKE
NORMAN
�ZSo
S22'40'14"E
5k��gFi
90.19'
Ll
�, REeeAfl
2.88
t
t CROSSES AND
CONNECTS
iPIER`
17.2'
I
CURVE TABLE
!
CURVE LENGTH RADIUS
CHORD CHORD 8RG
28.11 '17"W
Cl 28.13 278.00
N40'1
/^`rT�i?
C2 71.35 278.00
71.15 NSVO7 'm'w
�i F
C3 19.73 25.00
19.22 N '52' "W
C4 9.96 25.00
9.90 S02'2YSD'E
93 47 TW
�/
C5 94.69 NO6'I6 4
L 0 T 15 A•
'SUB.1Ecr5 FENCE
INGROUND \ •.�. CROSSES AND
10 - POOL / BRICK CONMECIS14 PATIO
UNE TABLE
LINE I LENGTH I BEARING
Lt 0.77 S22'45'26"E
L21 21,80 539'26'52"W
NOTES:
1. NO NCGS MONUMENT FOUND
WITHIN 2000'
2. PROPERTY MAY BE SUBJECT
TO OTHER COVENANTS,
RESTRICTIONS, EASEMENTS OR
RIGHTS-OF-WAY THAT MAY BE
OF RECORD.
3. THE TOTAL AREA OF LOT 115
1S 23,032 SO. FT. OR 0.529
ACRES.
ODI -61t-24
MICE G ADAMSON
MJE R ADAMSON
DB 18642 PG 585
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PH Y,S"I CA L S UR V— Y OF
LOT 115 of THE PENINSULA, PHASE V, MAP 4
PROPERTY OF JOHN J. CARMOLA
O
O
imld
SCALE: 1"=40' CORNELIUS, MECKLENBURG COUNTY, N.C. DATE: 10/11/2010
AS RECORDED IN: MAP BOOK 24, PAGE 115 PID: 001-611-25
18201 CAPSTAN GREENS ROAD EOC > =1:10,000

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