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Home My WebLink About20161229 Ver 1_Shoreline Stabilization_20161212DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM FOR DUKE ENERGY USE ONLY Duke File No. 2 229 Application Fee $ Security Deposit $ Check # Date Recv'd Initials. Date of Duke Energy Lake Services, applicant and/or contractor on-site inspections Date 12 t> _ JZ") Date Final Protection/Avoidance Area Markings Field - Verified Approved to Start Work By * : (prim) Date Completion Required Date of Any Approved Extension Date Passed Closeout Inspection* Initials Initials nEC 1 D 2 2016 i Any Stop Work Orders or SMG Violations*? (check one) OYes 13No (If Yes, explain in PAR 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 anolication. PART L - APPLICANT T INFORMATION (Please Print) 62-2-3567 NarY� • K� �ti 5'f e Y Telephone 70 Lake Address I I / A DAA C k e.__0T%.0 q� Mailing Address /0— 0 BOX 39 -I— (Ifdifferent) Cy'41c- f; a 5, ,A1C d2 kd 3 t Contractor Company � J Contractor Contact Person Telephone LAKE LOT INFORMATION Lake OY County) JL_ City 1 r0 VAA#J State N Tax Map No. Subdivision AD ftA G fU . Lot / Section No. 2A Lot Size` 6 Acres Are there any Co -Applicants*? (check one) ❑Yes 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. 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 . Z c-� t i t•t Initials (Duke Energy) -1 « (applicant/contractor) Duke Energy Page 1 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 10.docx DUKE ENERGY EXCAVATION PERAM APPLICATION FORM PART II. - DESCRIPTION OF PROJECT A. BASIC INFO 1. Type of excavation: (check one) (New excavation ❑ Maintenance excavation 2. Purpose of excavation: (check one) /Oat Access Channel 13Water Intake Channel ZWastewater Discharge Channel ❑ Other (specify): 3. Lake user category: (check one) Private OPublic OResidential Marina OCommencial Marina OOther (spec): 4. Max. Excavation Area Dimensions (ft): Length l7 width Dept (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): 370 Cubic yards 6. Type of material removed (applicant determines by field sample if practical): 7. Excavation Site area: p, o 5 Acre (s) Disposal Site area 0. 0!5 Acre (s) 8. Total Disturbed Area (including equipment staging area): 19.10 Acre (s) 9. Does the project meet the requirements of the applicable General Permit? (check one) XYes ONo 10. Do you claim title to the disposal area? (check one) Yes ONo 11. Do you claim title to the equipment staging area? (check one) *c's ONo 12. Are there any water -treatment facilities within 50 feet of the proposed excavation area? (check one) OYes *o (If Yes, specify): 14. Type(s) of excavation equipment to be used: M%% 15. Will waters or wetlands be crossed in transporting equipment to or from the site? (check one) Oyes XNo (I.fyes STP ) 16. Will return water re-crter the reservoir? (Check one) OYes *o EWA (If Yes, specify point(s) of re-entry and show on Excavation Area Drawing) 17. Is there an existing be ity (e.& pier) that access is being maintained to by conducting the excavation? es ONo (If Yes, specify the existing permit number If No, include a scaled drawing of theopated facility). Permit �Y, 18. Total planned duration of th work (Include rst equipment mobilizati°o�►� excavation through jural mitigation measures complete): START / FBQISH,7:3_,4/V /,O(.?r (Month) (Year) (Month) (Year) Duke Energy Page 2 of 14 rev 9/19/14 Excavation Progratn c;\usm\ann\appdatauocaDmicrosoftlwindowsVempomy internet files\content.outlook\mp7eolj9\c--w excavation 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. Acreage Identification Method.M Avoid (A) or Miti¢ate (Ml Field ID Work Area Dwa. ID a. Marshland, swamp, ponds, beneficial aquatic vegetation or other potential wetlands (circle all that apply) t (' I VIA b. Buffer Zones (specify width & source of requirement) e - c. Environmental Areas as identified by Duke Energy WIA d. Natural Areas as identified by Duke Energy f A e. Historic properties (specify) -11A f. Rare or threatened species (specify) Duke Energy Page 4 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 DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM Protection/Avoidance Areas (check all that apply) Approx. Acreage Id cation Method (*1 Avoid (A) or Mitigate (M) ** Field ID Work Area Dwe, ID e. Buried gas, water, sewer, communications or electric lines (circle) , / /� Nl/ h. Impact Minimization Zones as identified by Duke Energy N!/� L Other areas requiring specific avoidance, protection or mitigation (spec6) A111+ 1 * 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 Smithy yellow flagging). For "Work Area Dwg W" 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\locaAmicrosoft\windows\tempomry internet files\content.outlook\rnp7eolj9\c-w excavation application 113 10.docx DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM C. APPLICANT'S SIGNATURES Comments: �N�t�c v s 4er-i /3 N Ar4 TR 3 6alrrcrs /�SSoC- . Applicant Name (print) W Applicant Signature* �— Co-Applicant Name (print). Ce -Applicant Signature* Co -Applicant Name (print). Co -Applicant Signatnre* Co -Applicant Name (print) Co -Applicant Signatnre* Co -Applicant Name Oft)---- Co-Applicant Signature* Co -Applicant Name (print) Co-Appliant Signature* Lot # AA Date / / —/ S-- ZO i 6 Lot # Date Lot # Date Lot # Date Lot # Date Lot # IN *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 REQUI)MM fS 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 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 Energy Page 6 of 14 rev 9/19/14 Excavation Program c:\userslatmlappdata\locallmicrosoft\windows\temporary internet files\c4ntent.outlook\mp7eolj9\c-w excavation application 113 l0.docx State of North Carolina RWIL Department of Environment and Natural Resources be DWJL%-, 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: 1. Division of Water Resources 401 & Buffer Permitting Unit 1650 Mail Service Center Raleigh, NC 27699-1650 Applicant Information 115A NCAC 02H .0502(a)] Owner I form tion Name:Kt&lr 5 Mailing Address: % ox 39 (o rM t, t: it -s , 9 K Telephone Number: 0 4%,1..354-1- Fax Number: E-mail Address: lag 4asli,- to /9lcT�oo�C . [gym 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: t" r Company Affiliation: Mailing Address: Telephone Number: %cl �o iia d• -5711 E-mail Address: CAC g),4-11-5 Person to receive the Certification Approval: Fax Number: 0'f Co & d• AV /t /i A4'6 rra M. fee 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.) 4. Location of the property (where work is to be conducted) County:T)r4e I k Nearest Town: -1 r o k-�rhlotPJ Subdivision name or site address (include phase/lot number)/I� r�etc4 e_ R4 (o -,2A Directions t site - please include road names and numbers, landmarks, etc.: Latitude (in decimal degreesJ6 453 T 971 Longitude (decimal degrees) O t • 9 t 55_-w 5. Describe the existing land use or condition of the site at the time of this application (residential, undeveloped, etc.): re Sie1eA- ; A 6. Property size (acres): S_.44 7. Lake/ river/ ocean adjacent to property: f- Igor M A,J 8. Describe proposed work (include discussion as to how -harrdening of shoreline has been avoided, or why it is necessary):rtctq� 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 Ike level/�lormap Water Level in square feet or acres: 40 t 5'0 X �5 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: 4-0 )( 1570' X 5 12. Please describe the vegetation above the normal pool lake level/ Normal Water �evel and 50 feet landward to be impacted (number of trees, for instance): s /.5e e- Owner/Agent's 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 Lake Full Pond/ Normal Water Level) 1 5t) Full Pond/ Normal Water Level Mi ii i 77 —1" Shoreline W5s % 11 46 I 1,47 Ap"e- �J- Y-0 YroWtanl, 37a cuYds 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 li LAMM: souldwY LINE SAIRARY StWOU UAE —�— NOINWAL GC LINE �iwwv�n� 0,641 URTES — IROETORDUNDWAVER L09 1E1EP140NE CPP - COMPUTED Few (Umeewm) -OTED) R/W NOW--OF-MY VP EDOE OF FMADOO f Ca� CEIIIE]tlE unnr PONE STATE OF NORTH CAROLINA COUNTY OF REDELL L 424 I'Nt+aT`. REMEII OFFICER OF REDIIL COUNTY. CETTIFY THAT THE TAP OR RAT TO WHICH MS CERTIFICATION AFFIXED MEETS ALL STATUTORY REOUAREIIENTS FOR RECORDING. DATE Doc ID• 016Bt0160001 T02: CRP ReeorMd: 06/01/2012 at 02:16:04 Ph Fee Ant: 621.00 Pete 1 Of 1 IreMll County. NC matthow J. HcCbll Realeter of DI -59 -115 DEDMON SURVEYS VICINM 11AP v A a STATE FI RO Z A y .r — STATE OF NORTH CAROLINA C — — I. DAMP C. POTIVEY CERTIFY THAT THIS INP WAS (DRAWN BY ME) (DRAWN UNDER W SUPERMSION) FROM (M ACTUAL SURVEY MADE BY ME) (AN WrumE "VEY MADE 1D6 DESCRIPTION RECORDED M BOOK W PSIPERVL4'34 (DEED flMnN \ tS Y /4 PIN .` B" PAGE BOOK , PAGE ,,\/UIIIJIYY Ir�Ji THAT THE RATIO OF PRpp5K1N AS CALCULATED BY LATITUDES AND. ` �{ CA " !7 \ 6 — \ DEPARTURE IS 1: 10.000 m (TINT THE BOU DRIES NOT SURVEYED : •p� Fw"""rsi ' a \ \ ARE SNORT AS BROKEN LINES PLOTTED FROM NFOMATON FOUND M BOOK PB 27 PAGE 52 1; THAT THIS MAP WAS \/— — ,� • ( PREPARED N ACCORDANCE WITH G.S. 47-30. AS AMENDED. = = /4 PN 5 DAZ,B 60, SNE PU j D c— Room L.n/1h Ovd 0—d Bear. A5C �L 5 PM 41 1 4 .1 N -�•AD• . 1 1114. 4 1 42 IN 4 w \ R \ i 0 23 �- NOTES • PROPERTY MAY BE SUBJECT TO RECORDED OR UNRECORDED RIGHTS OF WAYS OR EASEMENTS NOT OBSERVED • OWNER TO VERIFY ALL SETBACKS AND ZONING REGULATIONS PRIOR TO ANY PLANNING OR CONSTRUCTION. • DIMENSIONS OF ALL IMPROVEMENTS SHOWN ON THIS PLAT SHOULD NOT BE SCALED OR RELIED UPON FOR DESIGN OR CONSTRUCTION WITHOUT A FIELD VERIFlGTION OF ALL DIMENSIONS. • DIGITAL COPIES OF THIS FILE ARE FOR REFERENCE ONLY AND MAY NOT BE USED FOR DESIGN WORK. • 10' DRNINGE h UTILITY EASEMENT ALONG LOT LINES • NO GEODETIC MONUMENT FOUND WITHIN 2000' OF PROPERTY I ' I DATE 5-6-12 DEDMON SURVEYS SCALE: 1 e - 60, CHUCK POOVEY, PLS #3762 ROBERT DEDMON, PLS #3899 4837 NC HIGHWAY #16 NORTH P.O. BOX 494 - DENVER, NC 28037 PHONE: 704/483/4908 FAX: 704/483/2170 CPOOVEYI @CMAIL.COM SURV. BY: CP 1844 PG: 1348 PG: 52 PG: 27 FALLSTOWN TOWNSHIP IREDELL COUNTY, NC DRAWN: CP I JOB/ APACHE PB 52 `1 1/06/2422 GARDEN r � L J /4 PIN 01111 IPPRO� RIB . O_ -�NoR>tuL1--- ON - w4r bFoa. A06 ow oT1elr- = � Tae .NKc PN J cy u w x27.25MpK NAIL N CONCRETE FRAME/fie-�j/ i BLDG. I 6.% OVER LINE 60 I 0 60 120 180 GRAPHIC SCALE — FEE[ EXEMPT COMBINATION MAP FOR APACHE ROAD TRACT #2 PLAT PREVIOUSLY RECORDED IN PB 52 PAG THE PURPOSE OF THIS MAP IS TO COMBINE TRACT #2B WITH EXISTING LOT #700 OF PLAT BOOK 52-27 & ALSO SHOW REMAINDER TRACT. �OT• \ N \ \ WITNESS W IwID AND sEAL THIS THE 8 TN DAY OF MAY AD. 2012 , \ \ "9ILs"MwmM•0�.�• \ \ I FURTHER CERTIFY •TNT THE SURVEY CREATES AN EXEMPT COMBINATION 77ji %%i \ OF LAND WITHIN THE AREA OF A COUNTY OR MUNICIPA(IIY THAT HAS IIIIPAY``. /5 PIN \ AN ORDINANCE THATWE PARCELS OF LANG' \ FIIOFFS9wINL LARD 9A6EY0 - /3762 1 to 1 p PIN --LAIO;=:: �:: \ �° _-= NOltmm �.weneeo�m6q�wT�sTo�olKw'�_ 5 PIN \\�\ ~~---_— 780• CONTOUR The plat in eXertlpt from the reDulations of the UI 0evelopmwk LTS 14-20 OOrrdineyaCe Off�ON, Town of Troouulmon pwamM ISO -376. No '7` Aji i � 14 PIN TRACT #2A P 5.660 AC.+- Z— s %4 PIN 1 #5 PIN N , #5 PIN4 - TRACT #2B f f4 PN1 - ' 1.088 AC.+- 05 PIN —_ — G I --- -"`•ci ZONED RA -- -- --- — -- -- -- -- -- — tD BE _ �. — ZONED RR COMBINED /4 PN 5 DAZ,B 60, SNE PU j D c— Room L.n/1h Ovd 0—d Bear. A5C �L 5 PM 41 1 4 .1 N -�•AD• . 1 1114. 4 1 42 IN 4 w \ R \ i 0 23 �- NOTES • PROPERTY MAY BE SUBJECT TO RECORDED OR UNRECORDED RIGHTS OF WAYS OR EASEMENTS NOT OBSERVED • OWNER TO VERIFY ALL SETBACKS AND ZONING REGULATIONS PRIOR TO ANY PLANNING OR CONSTRUCTION. • DIMENSIONS OF ALL IMPROVEMENTS SHOWN ON THIS PLAT SHOULD NOT BE SCALED OR RELIED UPON FOR DESIGN OR CONSTRUCTION WITHOUT A FIELD VERIFlGTION OF ALL DIMENSIONS. • DIGITAL COPIES OF THIS FILE ARE FOR REFERENCE ONLY AND MAY NOT BE USED FOR DESIGN WORK. • 10' DRNINGE h UTILITY EASEMENT ALONG LOT LINES • NO GEODETIC MONUMENT FOUND WITHIN 2000' OF PROPERTY I ' I DATE 5-6-12 DEDMON SURVEYS SCALE: 1 e - 60, CHUCK POOVEY, PLS #3762 ROBERT DEDMON, PLS #3899 4837 NC HIGHWAY #16 NORTH P.O. BOX 494 - DENVER, NC 28037 PHONE: 704/483/4908 FAX: 704/483/2170 CPOOVEYI @CMAIL.COM SURV. BY: CP 1844 PG: 1348 PG: 52 PG: 27 FALLSTOWN TOWNSHIP IREDELL COUNTY, NC DRAWN: CP I JOB/ APACHE PB 52 `1 1/06/2422 GARDEN r � L J /4 PIN 01111 IPPRO� RIB . O_ -�NoR>tuL1--- ON - w4r bFoa. A06 ow oT1elr- = � Tae .NKc PN J cy u w x27.25MpK NAIL N CONCRETE FRAME/fie-�j/ i BLDG. I 6.% OVER LINE 60 I 0 60 120 180 GRAPHIC SCALE — FEE[ EXEMPT COMBINATION MAP FOR APACHE ROAD TRACT #2 PLAT PREVIOUSLY RECORDED IN PB 52 PAG THE PURPOSE OF THIS MAP IS TO COMBINE TRACT #2B WITH EXISTING LOT #700 OF PLAT BOOK 52-27 & ALSO SHOW REMAINDER TRACT. Go: gle Flaps Fig /F tM� 3- �ffi ac, c el Map data 02016 Google 200 ft https://www.google.com/maps/@35.6534971,-80.9155257,17z 11/25/2016 MapCard - Print your custom map 7 A Page I of I N 0 0.5 Mi A0 2000 Ft http://map-pass.mytopo.com/maps/print_local.asp?print=l &scale=5.00&layer--DRG& tat... 11/25/2016