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Home My WebLink About20170104 Ver 1_Shoreline Stabilization_20170123DUKE 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) DYes ❑No (If Yes, explain in P Date Deposit Refunded Initials Date Permit Database Updated Initials Initials _ Initials Date Initials * Forward copy of approved application (all pages, plus any attachments that Duke Energy n edyAwk ylpp�ic�gt with Approval Letter and highlight any changes. File copies of Approval and Close-out Ch kl an an �o�p�f�rk Orders with annlication_ PART L -�A� P,pPLICANNT INFORMATION (Please Print) Name_ i 7� 6 /�i S s C� Lake Address7/9 3 00 /t/ d,4 (er :5r . SAev-r; Its Sri I�C_ 2=N 73 i Contractor Company Contractor Contact Person LAKE LOT INFORMATION Lake r6 V County C.4T A X119 R Subdivision 4 Pe Telephone (ql 7) 9 7a • o -Z 3 S Mailing Address (If different) J —� C S Telephone ((v t ► !o J�� City "_ — � State_ Tax Map No. D/ 1 X 0 300 9 K Lot / Section No. Lot Size • G 3 Acres Are there any Co -Applicants*? (check one) DYes 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. Info dWng 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 ( Initials (Duke Energy) (applicant/contractor) Duke Energy Page 1 of 14 rev 9119/14 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 PERNIIT APPLICATION FORM PART 11. - DESCRIPTION OF PROJECT A. BASIC INFO 1. Type of excavation: (check one) �Ncw excavation O Maintenance excavation 2. Purpose of excavation: (check one) oat Access Channel 0 Water Intake Channel Wastewater Discharge Channel O Other (specify): 3. Lake user category: (check one) 0Pnvate OResidential Marina ClCommercial Marina OPublic DOther (speci&): 4. Max. Excavation Area Dimensions (ft): Length D d Width 5 Depth 3 (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): 167 cubic yards 6. Type of material removed (applicant determines by field sample fprocncal):_rn[A4 7. Excavation Site area . D I Acre (s) Disposal Site area: 0.0 t Acre (s) 8. Total Disturbed Area (including equipment staging area): 1) • 02— Acre (s) 9. Does the project meet the requirements of the applicable General Permit? (check one) 0�es ElNo 10. Do you claim title to the disposal area? (check one) Wes ONo / 11. Do you claim title to the equipment staging area? (check one) 1XYes ONo 12. Are there any water treatment facilities within 50 feet of the proposed excavation area? (check one) [Yes *o (If Yes, specify): 13. How will the excavated material be ant"and the erosion controlled? (e.g. see attached erosion control plan and disposal area design):_ 14. Type(s) of excavation equipment to be used: Ckr e dam IN ; -�-� 10 MCyc}V'++8y 15. Will waters or wetlands be crossed in transporting equipment to or from the site? (check one) DYes *0 16. Will return water reenter the reservoir? (Check one) 17YesT0 ON/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 (If Yes , sped the existing permit numberNo . I , include a scaled drawing o the conducting the excavation? lwwl y ONo f g of proposed facility). Permit # 18. Total planned duration of the work (Include first equipment mobilization, excamdon through final mitigation measures complete): START c�� / _,L-1 FINISH a—AftJ / _at� (Month) (Year) (Monty) (Year) Duke Energy Page 2 of 14 rev 9119/14 Excavation Program c.\users\um\appdata\local\microsoR\windows\temporary internet fileskmtent.outlook\mp'7eolj9\o-w excavation application 113 l0.docx DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM PART II. (Continued) B. PROTECTION I AVOIDANCE AREA DESCRIPTION Complete the following table including all land area within and immediately adjoining the disturbed area: Protection/Avoidance Ares (check all that apply) Approx. Acreaee Identification Method (*1 Avoid (A) or Mitisate (M) Field ID Work Area Dw¢, ID a. Marshland, swamp, ponds, beneficial aquatic vegetation or other potential wetlands (circle all that apply) r% Q b. Buffer Zones (spew width & source of requirement) 1 d �(iVlUl L p of rte- � Waw YA;lt C) � � �;- c. Environmental Areas as identified by Duke Energy d. Natural Areas as identified by Duke Energy 4(� I `� e. Historic properties (spec6) f. Rare or threatened species (spec6) 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 10.docx DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM Protection/Avoidance Areas (check all that apply) g. Buried gas, water, sewer, communications or electric lines (circle) Approx. Acreage Identification Method (*) Avoid (A) or Mitigate (M) Field ID A I� I Work Area Dwg, ID ** 6. Impact Minimization Zones as identified by Duke Energy i. Other areas requiring specific avoidance, protection or mitigation (spec}fy) A t I * For "Field ID" column, specify entity or person that performed the identification and how it was physically marked (e.g. Duke Energy (John DoeyPink 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 c.\users\ann\appdata\local\microsofi\windows\temporary internet files\content.outlook\mp7eolj9\c-w excavation application 113 10.docx DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM C. APPLICANT'S SIGNATURES Comments: 1\ 6 d �' T C _19'VY� I� 21 a q K f t0 /11 d A-1 f- 5T v s i1/5 o4 4t 15T -- Applicant Name (print) LU S s /� G!i l Lot # Applicant Signature* Date ��. , a . 2-0 14 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 MALI. THE APPLICATION TO DUKE ENERGY LAKE SERVICES ENSURE YOU HAVE: • CHECKED THE INFO THOROUGHLY ' MET ALL REQUIREMENTS FOR A COM LM APPLICATION (see cover tetter of application package) • INCLUDED A SINGLE CHECK TO DUKE ENERGY FOR THE APPLICATION FILING FEE AND SECURITY DEPOSIT • INCLUDED ALL AGENCY PERAMS OR COMMENT LETTERS AND RESOLVED ALL ISSUES RAISED • INCLUDED ALL REQUIRED DRAWINGS (INCLUDING PROPOSED FACILITIES), PERMIT # FOR EXISTING FACMxnES, SURVEYS AND PLANS • INCLUDED COPIES OF DEEDS AND AUTHORIZATION LETTERS Duke Energy Page 6 of 14 rev 9/19/14 Excavation Program c:\users\ann\appdata\local\microsoft\windows\temporary internet fdes\contentoutlook\mp7eolj9\c-w excavation application 113 l0.docx State of North Carolina Department of Environment and Natural Resources 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 Applicant Information [15A NCAC 02H .0502(a)] 1. Owner Informatt�' jn Name: < i � r � � �uSs I Mailing Address: _7/o23 K N d, 1-c.-5-6Ger _Sker-ri (S f--;Y-A, At r 0296 Telephone Number: c?/7 ?7.7. O .13 5 Fax Number: E-mail Address: e U 2. Agent/ Contact Person Information A signed and dated copy of the Agent Authorization letter (a form can be downloaded here: http://www. aw.usaqearmv mil/Portals/59/docs/reeulatory/reedocs/Permits/SAMPLE AGENT AUTH ORIZATION FORM.gdf) must be attached if the Agent has signed this application form. Name: Company Affiliation: Mailing Address: Telephone Number: E-mail Address: c D. '5l l 1 Fax Number: 7 f 6 C e C -A 60 IJW454Y-e i . nr Person to receive the Certification Approval: ll. Project Information [15A NCAC 02H .0502(a) & (b)I 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: CA-T_A k) Nearest Town: Sk vrv-.ms Enrd Subdivision name or site address (include phase/lot number): 71 �3 i�1IbAA-It Sr She-�^� U 5 R&,4 dr Directions to site -- please include road names and numbers, numbers,ll]andm/arks, etc.: 4 �. � 16. L I Awl TIL., 1.45 0 T1 *,./ / � a&., � pleA Latitude (in decimal degrees), 3 5.5 886 (? Longitude (decimal degmes)A) • 61175 2 •] 5. Describe the existing land use or condition of the ite at the time of this application 11 (residential, undeveloped, etc.): re-'>aGJ p- 6. Property size (acres): 1 0 3 7. Lake/ river/ ocean adjacent to property: 1,-,AAe 4D1^►'►'I oqA) 8. Describe proposed work (include discussion as to how hrdening of shoreline has been avoided, or why it is necessary): c r apv� AectS S 9. Will work be conducted from land?From water? El 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: 16t) , X IZ5'X 3 ` 11. Total amount of disturbance (including all clearing, back fill, 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): D oA 4 104-VU*01-5.5 (See - [15A l Sed D�C rC5 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 73 Full Pond/ NormaWaterLevel Shoreline Av-A Ate' Lake (At Full Pond/ Normal Water level) DO /5/ �!a 14.7 cw- ,4- ,;$6-3 am em WX am N&L I&C"ys !p0 5' r. Please approximately sketch the following information on this plan (provide dimensions foreach 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 [RIIII DON ALLEN & ASSOCIATES,P. A. DA "Since 1971" —ZALd Commercial * Residential * Mortgage Surveys * Multi -Family Construction Staking * Subdivision Design * Topographical 131 Crosslake Park Drive - Suite 102 * Mooresville * NC * 28117 (704) 664-7629 (704) 664-8041 Fax I, certify that this map was drawn under my supervision from an actual survey made under my supervision recorded in deed book .3187 page plat book page--- that the ratio of precision is 1'10 t was prepared in accordance with the General Statutes of North Car olirt�� my hand and seal on the _ 29 day of — JULY A.D. 20-16 WILLIAM M. A LS LEGEND C -CU - P.P. — POWER _ POLE Ej — POWER TRANS. E.I.P. - EXISTING IRON FOUND I.P.S. = #4 REBAR SET R/W - RIGHT-OF-WAY CP - COMPUTED POINT 760 CONTOUR LINE PER ACTUAL FIELD SURVEY LAKE NORMAN PIER 520 fk3 �� r, M _ ',%0 INA g32 O 0- W i�».."Jill 118.30 - lis %y ! 751 CONTOUR LINE PER T ACTUAL FIELD SURVEY OWOOD WAENCROAC N co w N O 0' 20' 40' 100' o SCALE IN FEET MILDRED L. CAMPBELL -- 953/239 1 sas' E 0 v; .r NOTES 1) THIS PROPERTY MAY BE SUBJECT TO ANY EASEMENT AND/OR RIGHTS—OF—WAY OF RECORD. 2) AREA COMPUTED BY THE COORDINATE METHOD. 3) EXISTING 760' & 761' CONTOUR ELEV— ATION BASED ON LAKE NORMAN LAKE ON7/28/16 AT )ELENA ON S FORD �A7 (READING 4) .47 OVERHEAD POWER �j I 1? �� cB�P 1 10 1.04 AIF. r \ R� ct.11F 0 `�� PDX,eR / WOOD /f BLAG. METAL BLDG. jo j� l 1 N49 2�8-E 125.01' e"I e /o*r map 1A R o 148p,? '1R �-.0 R/W EO 0 �D�L � T v rte'' •..� PHYSICAL_SURVEY OF s GRIDTONUMENr FOUND WITHW 7123 K L O N D A L ESTREET 1"= SCALE 40'MTN_ CREEK TWSP., CATAWBA CO., N.C_ ACQUIRED BY' KENNETH HILL h� PK Nau FIELD BOOK: 5001 FILE 7123 KLONDALE ST DC FILE:- TAX ILE:TAX MAP NO, 460701059244 Google Maps GO ale maps Page 1 of 1 Map data 02016 Google 200 ft https://www.google.com/maps/A35.588617,-81.0175927,17z 12/9/2016 H® feathers Roadhouse and Park i lets KE Y M- Z G o�--gie Page 1 of 1 Map data 02016 Google 200 ft https://www.google.com/maps/A35.588617,-81.0175927,17z 12/9/2016 �j 0 0.5 Mi 0 0 2000 Ft http://map-pass.mytopo.com/maps/print_local.asp?print=l &scale=5.00&layer=DRG&lat=... 12/9/2016 kit Ale �als� I It, 7m Iwo , or Q4