20161227 Ver 1_Shoreline Stabilization_20161212

DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
FOR DUKE ENERGY USE ONLY
Duke File No.
07612
Application Fee $ Security Deposit $ Check # Date Recv'd Initials
Date of Duke Energy Lake Services, applicant and/or contractor on-site inspections Date t -Z el IUB Initials 112—M
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
Initials
rA
(sign) D lS C� I� —
Initials D
��r 1 2 2016 i
Any Stop Work Orders or SMG Violations*? (check one) DYes ONo (If Yes, explain in PART V)
Date Deposit Refunded Initials Date Permit Database Updated
* 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 annlication.
PART L - APPLICANT INFORMATION (Please Print) / fJ n
Name Yr�: e IS Telephone (� 6 lP . 1 v 0
Lake Address 5 R% q IJ e 0 --Tr ft t Mailing Address
9 % 7 (If different)
Contractor Company
etJ ScSC.Vi�{s, LLL
Contractor Contact Person
0 ��a•�III
Telephone (
LAKE LOT INFORMATION y�
Lake Y' County— tJCity 1 \d0Y CSl%l V 4L State _ Tax Map No. A
Subdivision Wbod l A PIA �1 N 5 Lot / Section No. I (0 Lot Size d•8T Acres
Are there any Co -Applicants*? (check one) OYes ONo (If Yes, include names, addresses, phone nos., lot nos., lot
sues 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 1 k4 Initials (Duke Energy) U�Ih111 (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 11- DESCRIPTION OF PROJECT
A. BASIC INFO j
1. Type of excavation: (check one) New excavation ❑ Maintenance excavation
2. Purpose of excavation: (check one) Boat Access Channel O Water Intake Channel
Wastewater Discharge Channel O Other (specify):
3. Lake user category: (check one) 4 "- ❑Residential Marina OCommercial Marina
❑Other (specify):
4. Max. Excavation Area Dimensions (ft): Length Q Width 35 Dept 3
(Note: include additional area dimensions if necessary so response to #S below equals max. area dimensions in #4)
S. Volume of Excavated Material (TOTAL for the project): 02 3 3 Orbic yards
6. Type of material removed (applicant determines by field sample if practical): Amp --f �1
7. Excavation Site area O S Acre (s) Disposal Site area: 6. OS Acre (s)
8. Total Disturbed Area (including equipment staging area): -/0 Acre (s)
9. Does the project meet the requirements of the applicable Geral Permit? (check one) �es ONo
10. Do you claim title to the disposal area? (check one) 14
4es ONo
11. Do you claim title to the equipment staging area? (check one) *es ONo
12. Are there any water -treatment fitcilities within 50 feet of the proposed excavation area? (check one) ❑Yes *o
(If Yes, *ecify):
13. How wt71 the excavated material be enimped and t#e erosion► controlled? (e g. sfe attached erasion co, al and
disposal area &dgn): Wo r K W i lo e, tit) tj & b y ID Aftoac_ i KA W to oi 19 Arq-c-
14. Types) of excavation equipment to be used:
V--
15.
1S. Will waters or wctlands be crossed in transporting equipment to or from the site? (check one) ❑Yes *0
Wyss � )
16. Will return water re-enter the reservoir? (Check one) ❑Yes t 10 ❑N/A (If Yes, specify points) 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?Y ❑/�o
(If Yes, specify the existing permit nutnben If No, include a scaled drawing of the proposed facility). Permit #� rt-�& -
18. Total planned duration of the work (Include first equipment mobiliahlon. excavation through final mitigation measures
complete): START IN/ i�vj 7 FINISH `MN
(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 II. (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)
Aonrox•
Acrease
Identification Method 01
Avoid (A10 * Mitigate (Ml
Field ID
Work Area Dwa. ID
a. Marshland, swamp, ponds, beneficial
aquatic vegetation or other potential wetlands (circle all
that apply)
I i
/VIA
b. Buffer Zones (specify width & source of
requirement)
�B rK dp/l/C
�b 7 'b& -7c- X'"'O(OW
h7 VA* -I e -
c. Environmental Areas as identified by Duke
Energy
, In
N 1'�
d. Natural Area as identified by Duke Energy
AI n
l •
e. Historic properties (specify)
A
L Rare or threatened species (specify)
Duke Energy Page 4 of 14
Excavation Program
rev 9/19/14
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
Protection/Avoidance Areas
(check all that apply)
g. Buried gas, water, sewer, communications
or electric lines (circle)
ARproz
Acreage
Identification Medod ( 1*
Avoid (A) or Mitigate (Ml
**
Field ID
N��
Work Area Dwg. ID
L Impact Minimization Zones as identified by
Duke Energy
NIA
i. Other areas requiring specific avoidance,
protection or mitigation (specify)
N I�
* 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 PERAHT APPLICATION FORM
C. APPLICANT'S SIGNATURES r q
Comments: CAY'Alel,aS
iYIiiNtel' Ttjo( - InT 1 / — 1r5.I- R.nlIw c- (rriI
-A
Applicant Name (print} 19 - r Lot # SSP
Applicant Signature* Date /,
Co -Applicant Name (print)
Lot #
Co -Applicant Signature*
Date
Co -Applicant Name (print)
Lot #
Co -Applicant Signature*
Date
Co -Applicant Name (print)
Lot #
Co -Applicant Signature*
Date
Co -Applicant Name (print)
Lot #
Co -Applicant Signature*
Date
Co -Applicant Name (print)
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 TBE 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 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
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application 113 10.doex

State of North Carolina
Department of Environment and Natural Resources
D WIR
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 I15A NCAC 02H .0502(a)]
1. Owner Informatio
Name: Yr PJe �Y`ZN�
Mailing Address: %iiJ of t er_-T—r_i4;
00rC541,11e.ac '-g 117
Telephone Number: 0. 149 Fax Number:
E-mail Address:
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
httn://www.saw.usace.armv.mil/Portals/59/docs/reRulatory/repdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FOR df must the attached if the Agent has signed this application form.
Name: i 'tiagc 5
Company Affiliate n: _ Y-r't,C,�l 3'c w -pis V i c e s, Lt-C—
MailingAddress: L38 (J KriA4-- Far, y
Telephone Number: 70 �. %& 0.5111 Fax Number: :A-4--
E-mail
D E-mail Address: riie.SeA kA 15 P 6clrA%WS1ft4P1 - Ate -
Person to receive the Certification Approval: C/i;,>D 15 r- d4t5
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.
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 pro erty (where work is to be conducted)
'nn
County: < <�j Nearest Town: I , I Dbr�Su'
Subdivision name orsite address (include phase/lot number): �ood (Apid 4315 10'-_6
decimal degrees) ,� rJ • 16 5g / Longitude (decimal degrees) o d • 7 o
5. Describe the existing land use or condition of the pte,at the time of this application
(residential, undeveloped, etc.): Y'C5iciUJ �F
6. Property size (acres): V. 8'�
7. Lake/ river/ ocean adjacent to property: LoKL OV -K64
8. Describe proposed work (include discussion as to how hardeing of shoreline has been
avoided, or why it is necessary):0#-� �GczsS
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:
(no' x 351x !),
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 0
feet landward to be impacted (number of trees, for instance): r'J4S 5S Ce lS'
Owner/Agent's Signature
[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 Water Level
■.� e . . .�
Shoreline
Lake
Full �Pond/ Normal Water Level)
&L vvoe' K w; I l b e c Owe- � j
/5(0 lq,drq AreCK app
f?oresvll;, �lC.
4233 c�.yds
"C -
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 f t 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

1
5.5'NW
_ FOUND
L1 \
N53026'00"W
24.61' REC.\
24.50' MEAS.
PHYSICAL SURVEY
SECTION FOUR OF WOODLAND HILLS " _ W 0 L
PLAT 800K 16, PAGE 22
PART OF LOT 96 &
ADJOINING TRACT s1T�
TRACT TWO
DB, 1378, PG, 1546 LAKE NORMAN
DUKE POWEP CO.
9CNbb� L {Ltlryt!
K;�,`�
CK LO~
'AdBitt 6
VICINITY MAP
(NO SCALE)
_ EXCEPTION TO �t0ot ONE
N36°50'00" N6o•63'00-W D8, W8, Po, 1948 (209 8Q.PT,)
�(J
II �- •/- Y S50'63'0 •E 95.58' 52,92,
RECO �/5�
11 �' (FORMER LINE OF PB. 19, PG. 22) RDtj) i60' -Nr0
—AIUM prckEr o05E
x
1 � 1 —~` X kENcE
INOROUNd 2.TSE
POOLfn
I I
N I
a0 QQ,1 I CONCRETE
\ 61 L
L
_ 7 _-------=
5 IIIENCE`�'
I I I
\ I I I• L-�-1 2.9.SE
28 q1 I 34, Ili b
1
LOT 95\
N I
PROPOSED —
N/F
\ 1
RESIDENCE --r
r
SAM 6 MYRNA OWENS
O
I o
DB. 837, PG. 305
- - - - -
- EDGE OF PAVEMENT/CONCRETE
PIN: 4636-93-3331
O
I
�1
L. —:
\
15.63
{k
LOT 0C.
( N/P ;
HARRY W. A JOAN bEHRBNi'
\
` b9.1518, OW1840 A d
� h
toot 6NT'41 4 "1 1 (' I
( PIN(48�8Iia-�4i9 ;"' I �'•
' r 7
�
35'SETBACK I •�
) II
TOTAL AF(EA i �p
\
\ 36,089 SQ.PT.
I
0,83 ACRES j I
\
LEGEND
•
FOUND OR SET REBAR
-
- LINES NOT SURVEYED
❑
TELEPHONE PEDESTAL
0
CAN PEDESTAL
A
LANDMARK TIE (AS NOTED).,
- - - - -
- EDGE OF PAVEMENT/CONCRETE
GENERAL NOTES:
LOt 97
MICHAtL BNA JALAP toob
A l61; Pry, 49V,5
r
F6UNDR--1 6 9, 8 9'
2,4'NE2 �4WtI FOUND
L= 9 4 0 01 I I ) 11,v
oi 2.0'NE 3.6'NW ' 6
0.3'SE CH_13 CH 92,8p�1,411+
MNG -NECK TRAIL
60'.B►WtV
1. APPARENT SOURCE OF TITLE: DEED BOOK 1378, PAGE 1546.
2. PROPERTY SHOWN IS AN EXISTING PARCEL OF LAND.
3. LINEAR ERROR OF CLOSURE EXCEEDS 1:20,000,
4. AREA CALCULATED BY COORDINATE GEOMETRY METHOD.
5, N.C.G.S. MONUMENT NOT LOCATED WITHIN 2000' OF THIS SITE.
8. THIS SURVEY WAS PREPARED WITHOUT THE BENEFIT OF A TITLE
REPORT AND IS SUBJECT TO FACTS THAT SUCH MAY REVEAL,
7. UNLESS SIGNED AND SEALED THIS MAP IS PRELIMINARY,
8. YARD REQUIREMENTS SHOWN FOR IREDELL COUNTY'R-20',
i
9S.
S b `
FOUND(D19tUk6ED)
CONO, �IONUMI NT
I, JOHN W. bAL to CEaTII Y tHAt tHid.PLAt
WA9 bFtAWN PROM AN AbtUAL FIELD §URVEY
PERRORMED UNDER MY b0toT SUPERVISION,
19 COIARECt tO THE BEST OF MY KNOWLEDGE
JOHN W, BARER
NCPl3 L3988
SUMMIT PREPARED FOR GRAPHIC SVAL�
TESTA & WIRTH, INC, o' 20' ao'
156 RING -NECK TRAIL 1° ao'
LAND DAVIDSON TOWNSHIP IREDELL COUNTY
SURVEYING COMPANY �....:... ,_,.....:,...,...:,.._.:....�....
18718 W. CATAWBA AVENUE NORTH CAROLINA J08 N0 05-0509
CORNELIUS, NC 28031 JUNE 1, 2005 bWG No, '16•22-96
[phone]
w
I
yat'.
1
{k
F6UNDR--1 6 9, 8 9'
2,4'NE2 �4WtI FOUND
L= 9 4 0 01 I I ) 11,v
oi 2.0'NE 3.6'NW ' 6
0.3'SE CH_13 CH 92,8p�1,411+
MNG -NECK TRAIL
60'.B►WtV
1. APPARENT SOURCE OF TITLE: DEED BOOK 1378, PAGE 1546.
2. PROPERTY SHOWN IS AN EXISTING PARCEL OF LAND.
3. LINEAR ERROR OF CLOSURE EXCEEDS 1:20,000,
4. AREA CALCULATED BY COORDINATE GEOMETRY METHOD.
5, N.C.G.S. MONUMENT NOT LOCATED WITHIN 2000' OF THIS SITE.
8. THIS SURVEY WAS PREPARED WITHOUT THE BENEFIT OF A TITLE
REPORT AND IS SUBJECT TO FACTS THAT SUCH MAY REVEAL,
7. UNLESS SIGNED AND SEALED THIS MAP IS PRELIMINARY,
8. YARD REQUIREMENTS SHOWN FOR IREDELL COUNTY'R-20',
i
9S.
S b `
FOUND(D19tUk6ED)
CONO, �IONUMI NT
I, JOHN W. bAL to CEaTII Y tHAt tHid.PLAt
WA9 bFtAWN PROM AN AbtUAL FIELD §URVEY
PERRORMED UNDER MY b0toT SUPERVISION,
19 COIARECt tO THE BEST OF MY KNOWLEDGE
JOHN W, BARER
NCPl3 L3988
SUMMIT PREPARED FOR GRAPHIC SVAL�
TESTA & WIRTH, INC, o' 20' ao'
156 RING -NECK TRAIL 1° ao'
LAND DAVIDSON TOWNSHIP IREDELL COUNTY
SURVEYING COMPANY �....:... ,_,.....:,...,...:,.._.:....�....
18718 W. CATAWBA AVENUE NORTH CAROLINA J08 N0 05-0509
CORNELIUS, NC 28031 JUNE 1, 2005 bWG No, '16•22-96
[phone]
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DEED REF. - BOOK 60/ , PAGE 54

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