20170101 Ver 1_Shoreline Stabilization_20170123

DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
FOR DUKE ENERGY USE ONLY T
Duke File No.
Application Fee $ Security Deposit Check 4 Date Recv'd Initials
Date of Duke Energy Lake Services, applicant and/or contractor on-site inspections Date 1 C!F--InitialsJM__� _
Date Final Protection/Avoidance Area Markings Field - Verified Initials
Approved to Start Work By * :
Date Completion Required
Date Passed Closeout Inspection*
(Print) (sign)
Date of Any Approved Extension
Initials
Initials
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
Date
* Forward copy of approved application (all pages, plus any attachments that Duke >v6ged) back to appli6ant
with Approval Letter and highlight any changes. File copies of Approval and Close�-o! C6�blis i& JQ top Work
! f
PART L - APPLICANT INFORMATION (Please Print)
Name ,CM' /J I/u 5 Z
Lake Address 13 7 d \eaA-S
Koor-,syi L�f d C x-9117
Telephone (:317) 3 31 • eZs 8 b
Mailing Address
(If dffferent)
Contractor Company C � G
Contractor Contact Person C 1l t P �rt �9 GS
C(i N
'Ja 6 o . S1 l
Telephone (
LAKE LOTORMATTI-1-IOr— _ I� \ Nf k �
Lake d r 1�1f Carroty � L�G` City b01('t%$ V � ►L^State _&(_ Tax Map No.
Subdivision I �. 1 ��- �� Lot / Section No. � O - T Lot Size 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. Initializing this portion of the
application by a DEISR in no way constitutes approval or endwN approval of the excavation or any other lake use
Pin acdVhJ=
Date of on-site inspection 0 t(Y_� �-7 Initials (Dake Energy) J VKUL . (applicantteoutractor)
Duke Energy Page 1 of 14 rev 9/19/14
Excavation Program
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application 113 10.docx
1 0 7

DUKE ENERGY EXCAVATION PERAUI APPLICATION FORM
PART II. - DESCRIPTION OF PROJECT
A. BASIC INFO
1. Type of excavation: (check one) XNew excavation O Maintenance excavation
2. Purpose of excavation: (check one)ll
l lW.. Ace= Channel I7 Water Intake Channel
/0 Wastewater Discharge Channel D Other (specify):
3. Lake user category(check one) Irivate R
esidential M 0 M °a S 1 e
Public Other (spec(fy): 3
4. Max. Excavation Area Dimensions M: Length Width 7 Depth 5 z
(Note. include additional area dimensions ifnecessaryso re-"- #S ljelgw mgr. area dime►utons in N4)
5. Volume of Excavated Material (TOTAL for the project): O to
t�TOrbic yards
a A K�
6. Type of material rano (Q Yhca o, a�nes by field sample ifP►actiQal)" 0. 6 J— I of
7. Excavation Site area 0. 0 33 Lf o (s) Dip—' $r� aro . 0 3 /af'fAcre (s)
6,03 70 1--7 0•o`t hf'3 0.03 /a L
8. Total Disturbed Area (including equipment staging area): . 0 6 /o f � Acre (s)
0•
9. Does the project meet the requires of the applicable General Permit? (check one) yes 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) oes ONo
12. Are them any water treatment facilities within 50 feet of the proposed excavation area? (check one) Dyes *o
(If Yes, specify):
13. How will the excavated mats l be,Sntrappcd and the erosion controlled? (e g. see attached erosion control plan and
disposal area design): S t j �' -f-7 /fit c s (� l i 1 I b u.S eA
14. Type(s) of excavation equipment to be used: _ f D ISI Q �G'T"^ �,S�C-W V A ✓
15. Will waters or wetlands be crossed in transporting equipment to or iiom the site? (check one) Dyes t�qo
(IDOW, explain)
16. Will return wafer re-enter the reservoir? (Check one) Dyes 00 CWA (If Yes, Wec#y pojnt(s) of re-entry and
show on Excavation Area Drawing)
17. Is there an existing facility (eg. pier) that access is being maintained to by conducting the excavation? Yes JINo
(If Yes, specify the existing permit manber. IfNo, include a scaled drawing of the proposed facflity). Permit # M
18. Total planned duration of the work (Include fast equipment mobil on, exwvadon through final mitigation meamw
complete): START 1:--r'o / % FDM /--a'0 L-7
(M (Year) (Mo?* (per)
Duke Energy Page 2 of 14 rev 9/19/14
Excavation Program
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application 113 l0.docx

DUKE ENERGY EXCAVATION PERAUT APPLICATION FORM
Note: Notify Duke Energy Lake Services at 14800-443-5193 prior to commencing any excavation work within
the project boundary.
C40- Q- lc�T
PJ
IG�[) Fa LOU`
�Rc�tAt-� V-3
Ia5
Duke Energy Page 3 of 14 rev 9/19/14
Excavation Program
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application 113 l0.docx

DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
PART IL (Continued)
B. PROTECTION I AVOIDANCE AREA DEICER=
Complete the following table including all land areas within and immediately adjoining the disturbed area:
Idents_ Bean -�
ProtecdonlAvoidance Areas Appm. Avoid (A) or Mitigate (IyD
(check all that apply) Aereaffe Field ID Work Area Dw& ID
a. Marshland swamp, ponds, beneficial IV
/�
aquatic vegetation or other potential wetlands (circle all I(I/
that apply)
b. Buffer Zones (specify width & source of w i 4t 6'L dOtie t(
requirement) r�►�,`,,�0 I
11, W� � Oj rG4
c. Environmental Areas as identified by Duke
Energy
d. Natural Areas as identified by Duke Energy l
e. Historic properties (specify)
f. Rare or threatened species (specify) a I
Duke Energy Page 4 of 14 rev 9/19/14
Excavation Program
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
Idw )1"1
Protectiwd&nidance Areas lid K2& Avoid (A) or Mitieate (Ml
(check all that apply) �4 �W m Work Area Dwa. ID **
_�. Buried gas, water, sewer, communications
or electric lines (circle)
h. Impact Minimization Zones as identified by r I
Duke Energy /A"I
1. other areas requiring specific avoidance, I
protection or mitigation (specty)
* For "Field W" column, specify entity or person that performed the identification and how it was physically marked (e.g. Dube Energy (John DoeyPink and purple -dotted tape.
Corps of Eng. (John Smithy 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
cow: �Qf1 ?lJ �Zli /3 3 �eA-�s RGlf
�- f^rpnlIL e, T
Applicant Name (print) E,-IJIV go 5 Lot #
Applicant Signature* Date 1-2 1 /
Co -Applicant Name
Co -Applicant Signature* -YS.
Co -Applicant Name (print) IDa 0 F2• S� e .
Co -Applicant AJ�
Co-Applicaut Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Lot #
-3
Date 1-9 1 fv-X lan 1 Co
Lot #
Dare 12-1121 %[
Lot #
i1
Lot #
Lot #
Co -Applicant Signature* Date
*Per my shpatue, the information provided in this application is correct to the best of my knowledge.
BEFORE YOU MAIL THE APPLICATION TO DUKE ENERGY LANE SERVICES ENSURE YOU HAVE:
• CTPD THE INFO THOROUGHLY
• MET ALL REQUIREMENTS FOR A CONFINE APPLICATION (see cow 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 =9119/14
Excavation Program
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application 113 10.docx

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Rm
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources FORM: SSCP 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
Name:
Mailing
MQo -csyi 1f, NC 24117
Telephone Number: 317. 331. Z96 Fax Number:
E-mail Address:
2. Agent/ Contact Person Information
M
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http:/Iwww.saw.usace.army.mil/Portals/59/docs/regulatory/reizdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM. df) must be attached if the Agent has signed this application form.
Name: C ' P F�4'--s
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
70t 460.s(/1 Fax Number: 4'0- V/f
C -46C _11G/9 -k) 4- Or' 0 W: n*�015 . Ne-
Person to receive the Certification Approval:
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.
r proposed to be stabilized. (Include a scale of
3. Attach a photograph of the shoreline/ buffe
some sort- a yard stick, shovel handle, etc.)
4. Location of the ropertywhere work is to be conducted)
c d Nearest Town: 00,('GSv,
County
�
Subdivision name or site address (include phase/lot number) --r, e
Directions to ite -olease include road names and numbers,/landmarks, etc.:
Tw. ::b .. V _ &,i " ) I i Ov^ -so 4 /U. 'A - CCWT
Ij 4-0 {N r � �.onl I�C�T� PU
Latitude (in decimal degrees
5 �� 7 Z Longitude (decimal degrees)
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.):
6. Property size (acres):
7. Lake/ river/ ocean adjacent to property:
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): IA'IL /y-Cce 5 9
9. Will work be conducted from land?From water? ED
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal poo
I lake level/ N (mal Water Level in square feet or acres:
.40u a7 X5
11. Total amount of disturbance (including all clearing, backfill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake level/ Water Level and 50 feet land -ward in
square feet or acres: '12150 ,
12. Please describe the vegetation above the normal pool lake level/ Plyrmal ater Level and 50
feet landward to be impacted (number of trees, for instance): v >
/Agent's Signature* Printed Name Date
[15A NCAC 02H .0502(f)l
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSCP 10-2013 Page 2 of 3

Lake
(At Full Pond/ Normal Water Level)
Full Pond/ ; ri ri 1A 50 44It
Normal Water LevelLi
Shoreline a
J_,cam„ 3-►'�
4 ¢ i,:,4 3 txf z
Tl Kws" iosg j4 hidf Lf- Cit-K#-uYNM
"I Ali *Tto.
jk►5o S:P
To-rw1 494 cIA-T45
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

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 VERIFICATION OF ALL DIMENSIONS.
• DIGITAL COPIES OF THIS FILE ARE FOR REFERENCE
ONLY AND MAY NOT BE USED FOR DESIGN WORK.
• NO PORTION OF THE RESIDENTIAL STRUCTURE
IS LOCATED IN THE 100 YEAR FLOOD PLAIN.
• A PORTION OF THIS PROPERTY IS LOCATED IN A
100 YEAR FLOOD PLAIN.
50 0 50 100 150
GRAPHIC SCALE — FEET
I, ROBERT J. DEDMON, CERTIFY THAT THIS PLAT WAS
DRAWN FROM AN ACTUAL SURVEY MADE UNDER MY
SUPERVISION (DB 636, PG 635)(PB 7, PG 12); THAT
THE RATIO OF PRECISION AS CALCULATED EXCEEDS
1:10,000'; THAT THIS PLAT WAS PREPARED IN
ACCORDANCE WITH GS 47-30 AS AMENDED. WITNESS
MY ORIGINAL SIGNATURE, SEPTEMBER 8, 2016.
UPDATED ON OCTOBER 19TH, 2016 TO SHOW SEPTIC INFORMATION.
V 3899
PROFESSIONAL LAND SURVEYOR LICENSE NO.
SURV. BY: MP I DRAWN: RD I JOB# MPK4
VICINITY MAP
SITE
=W
PHYSICAL SURM
5
O
PB 7-12
- — —
LAKE = r
Course Bearing Distance
FOR
NORMAN r
I., L 1 1 s 60.25 00 E 55.00
TEMPLETON ROAD
ANY DOCKS, PIERS OR OTHER' ""' ^'
ppRCy
JEFFREY & EMILY
r IMPROVEMENTS, BUILT ON r
=
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r TARE NOT SHOWN ON THIS —
,-- •- •--- . .SURVEY JPLf4T.- - - ^-
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KUSZ
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APPROXIMATE LOCATION
BRICK
pM f WELL
'1041,-
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OF 760• CONTOUR UNE
ppRCy
137 KEATS ROAD - MOORESVILLE, NC
\
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14" CE . ,\
C\L OF SWALE
LOT 4, R.A. WHITE PROPERTY
• \\i
� 36" OAK
1/2"
DAVIDSON TOWNSHIP, IREDELL COUNTY, NC
CONCRETE
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SCALE: 1" = 50'
DEDMON SURVEYS
\`#4 REBAR
14" HW
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7.4- 6
436
65.,97' 4 "W
14" POPLAR
30"
CHUCK POOVEY, PLS #3762
APPROXIMATE LDCAnoN
OF 100 YEAR FLOOD UNE
20" H
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ROBERT DEDMON, PLS #3899
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3704 NC HIGHWAY#16 NORTH
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P.O. BOX 494 - DENVER, NC 28037
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PHONE: [phone]
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FAX: [phone]
KE,q rs
PB 7-12
WWW.DEDMONSURVEYS.COM
50 0 50 100 150
GRAPHIC SCALE — FEET
I, ROBERT J. DEDMON, CERTIFY THAT THIS PLAT WAS
DRAWN FROM AN ACTUAL SURVEY MADE UNDER MY
SUPERVISION (DB 636, PG 635)(PB 7, PG 12); THAT
THE RATIO OF PRECISION AS CALCULATED EXCEEDS
1:10,000'; THAT THIS PLAT WAS PREPARED IN
ACCORDANCE WITH GS 47-30 AS AMENDED. WITNESS
MY ORIGINAL SIGNATURE, SEPTEMBER 8, 2016.
UPDATED ON OCTOBER 19TH, 2016 TO SHOW SEPTIC INFORMATION.
V 3899
PROFESSIONAL LAND SURVEYOR LICENSE NO.
SURV. BY: MP I DRAWN: RD I JOB# MPK4
VICINITY MAP
SITE
=W
5
O
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GRAPHIC SCALE — FEET
I, ROBERT J. DEDMON, CERTIFY THAT THIS PLAT WAS
DRAWN FROM AN ACTUAL SURVEY MADE UNDER MY
SUPERVISION (DB 636, PG 635)(PB 7, PG 12); THAT
THE RATIO OF PRECISION AS CALCULATED EXCEEDS
1:10,000'; THAT THIS PLAT WAS PREPARED IN
ACCORDANCE WITH GS 47-30 AS AMENDED. WITNESS
MY ORIGINAL SIGNATURE, SEPTEMBER 8, 2016.
UPDATED ON OCTOBER 19TH, 2016 TO SHOW SEPTIC INFORMATION.
V 3899
PROFESSIONAL LAND SURVEYOR LICENSE NO.
SURV. BY: MP I DRAWN: RD I JOB# MPK4
VICINITY MAP
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KEATS RD
BOBWHITE LANE
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D DON ALLEN & ASSOCIATES,P. A -
"Since 1971"
Commercial * Residential * Mortgage Surveys * Multi—Family
Construction Staking * Subdivision Design * Topographical
131 Crosslake Pork Drive — Suite 102 * Mooresville * NC * 28117
[phone] [phone] Fox
I, certify that this map was drawn under my supervision from an actual
survey made under my supervision recorded in deed book_ 203_7 __ page_ 1700 , and/or
plat book_ 7 , page 12 , that the ratio of precision is 1':10,000, that this map
was prepared in accordance with the General Statutes of North Carolina Chapter 89C.
my hand and seal on the __ t4 day of _ OCT.
A.D. 2015 _ R0
_. �
SITEO I _
Yd
VICINITY MAP**NO SCALE
OQ
Ir o (TIE)
L1_
761 CONTOUR L
LOT 3
RACHEL NAGY
1805\1605
LEGEND
c()-3 = P.P. = POWER POI %
E = POWER TRANS.
E.I.P. = EXISTING IRON FOUND
I.P.S. = #4 REBAR SET
R/W = RIGHT-OF-WAY
O = WELL
WILLIAM M. ALLQPSSIp •'; J.9
'Q SEAL
SU
P````��
LAKE
NORMAN
v
A /
hN7fi0 CONTOUR LINFI78.0935'54'O6•E
500LgETBACK N
BLOCK A J,,
LOT 2
0.54 AC.
C bey,
;. G0�'1..cD
SS�Y S�CCO
PIPE
LINE TABLE
LINE BEARING LENGTH
L1 S 35.49'05" W 34.10'
LZ N 59'48'04' W 20-66'
6
LOT 1
KYLE W. FRANK
ZO
0' 25' 50' 100' PHYSICAL SURVEY
I I II OF
SCALE IN FEET 111 KELLY POINT LN.
LOT 2 BLOCK A R.A. WHITE, JR.
SCALE 1" = 50' DAVIDSON TVVSP., IREDELL CO., N.C. FIELD BOOK: 500-I
FILE: RA WHITE 2
ACQUIRED BY:DANIEL STEIN DC FILE
TAX NAP NO: 4645193689
X
NONOTES
PROPERTY MAY BE SUBJECT TO
ASEMENT AND/OR RIGHTS-OF-WAY
CORD.
COMPUTED BY THE COORDINATE
OD.ING
760' & 761' CONTOUR ELEV-
BASED ON LAKE NORMAN LAKE
LEVEL AT COWAN'S FORD DAM (READING
ON 10\12\2015.
4
UNDERGROUND POWER
5
NO GRID MONUMENT FOUND WITHIN
2000 FEET.
6)
SETBACKS SHOWN ON SURVEY ARE PER
IREDELL CO. ZONING.
0' 25' 50' 100' PHYSICAL SURVEY
I I II OF
SCALE IN FEET 111 KELLY POINT LN.
LOT 2 BLOCK A R.A. WHITE, JR.
SCALE 1" = 50' DAVIDSON TVVSP., IREDELL CO., N.C. FIELD BOOK: 500-I
FILE: RA WHITE 2
ACQUIRED BY:DANIEL STEIN DC FILE
TAX NAP NO: 4645193689

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