20170097 Ver 1_Shoreline Stabilization_20170123

DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
FOR DUKE ENERGY USE ONLY
Duke File No.
Application Fee $ Security Deposit S 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 Completion Required
Date Passed Closeout Inspection*
(Print)
Date of Any Approved Extension
Initials
(Sign)
Initials
Any Stop Work Orders or SMG Violations*? (check one) ❑Yes 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
with Approval Letter and highlight any changes. File copies of Approval and Close-out Cl
Date
PART I. - APPLICANT INFORMATION (Please Print) D -WATE
�t p 4 F E CES
Name (itJ � "` / Telephone s
Lake Address 155 / f /' I✓e- sf .CC C 4 rC, L Mailing Address 7T ZW1 rl L D v
Inoc 'G31lo /Iet /VC �� (If different) �}'1 AP/7
Of
Contractor Company .116.-v e ,C4ec ye w,
Contractor Contact Person
Telephone (70�) 4p 6 'o 5-11 /
LAKE LOT INFORMATION ,J �/�] /
Lake OrM County [ C.Gt City � / I &O I'Z°S Vib-_ State Tax Map No.
Subdivision Nor o r / ^ wo o d Lot / Section No. /D _k/ Lot Size 7 'Z 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 ( Initials (Duke Energy) v I� (applicant/contractor)
Duke Energy Page 1 of 14 rev 9/19/14
Excavation Program
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application 113 10.docx
0/

DUKE ENERGY EXCAVATION PERAHT APPLICATION FORM
PART IL - DESCRIPTION OF PROJECT
A. BASIC INFO
1. Type of excavation: (check one) )4New excavation [ Maintenance excavation
2. Purpose of excavation: (check one)Boat Access Channel [ Water Intake Channel
gwaswwata Discharge Channel [ Other (specify):
3. Lake user category: (check one)&b1
vate OResidential Marina OCommercial Marina
lC [Other (spec):
NO, 80
4. Max. Excavation Area Dimensions (ft): Length A 00 Width —X5 Depth Z/
(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): Cubic yards L
6. Type of material removed (applicant determines by field sample if practical): Ayd i � %b
7. Excavation Site area: Acre (s) Disposal Site area D • 3 L Acre (s)
8. Total Disturbed Area (including equipment staging area): 0-A, Acre (s)
9. Does the project meet the requirements of the applicable General Permit? (check one) )(Yes ONo
10. Do you claim title to the disposal area? (check one) AYes [No
11. Do you claim title to the equipment staging area? (check one) Itles [No
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 entrappedend the erosioncqn rollyd? e.. see att hed grosion controlplan and
disposal area design): li e w K td i !1 174 aame. 6 ay± t— f 72 VAI 3
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) OYes *0
(Ifyes, explain)
16. Will return water re-enter the reservoir? (Check one)
show on Excavation Area Drawing)
[Yes *o ON/A (If Yes, specify points) of re-entry and
IT Is there an existing facility (e.& pier) that access is being maintained to by conducting the excavation? [Yes *0
(If Yes, specify the existing permit number. If No, include a scaled drawing of the proposed facility). Permit #
18. Total planned duration of the work (Include first equipment mobiliton, excavation through final mitigation measures
complete): START CZ / _o j_"] FINISH _ . L4 -� v 7
(Montle) (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 1Q. (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)
Apurx.
Acrean
IdentMadion
Avoid (A1 or Mitigate (Ml
Held ID
Work Area Dwe. ILD
a. Marshland, swamp, ponds, beneficial
aquatic vegetation or other potential wetlands (circle all
that apply)
b. Buffer Zones (specify width & source of
requirement)
'- t�.K4v 6 e 3 oae N
W /
b,WIR--. M+h- r; pl will
c. Environmental Areas as identified by Duke
Energy
I V
d. Natural Areas as identified by Duke Energy
L ( A -
'''�..1
e. Historic properties (specify)
`` I
WIAr
E Rare or threatened species (specify)
or
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)
Approx.
Acreage
Identification Method M
Avoid (A) or Mitigate (M)
**
Field ID
Work Area Dwg. ID
g. Buried gas, water, sewer, communications
or electric lines (circle)
�(
I V k
h. Impact Minimization Zones as identified by
Duke Energy
I
i. Other areas requiring specific avoidance,
protection or mitigation (specify)
I rjrI
* 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 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 PERMPT APPLICATION FORM
C. APPLICANT'S SIGNATURES /���i
j j
Comments: Dcf JA t� C W �ilc r• I �O J CN/tiGssG�- �� "'G� /
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 signal n, 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 REQUIREMENTS FOR A COMP . _TE APPLICATION (see cover leer of application package)
• INCLUDED A SINGLE CHECK TO DUKE ENERGY FOR TIB; APPLICATION FILING FEE AND SECURITY
DEPOSIT
• INCLUDED ALL AGENCY PERMITS OR COMMENT LETTERS AND RESOLVED ALL ISSUES RAISED
• INCLUDED ALL REQUIRED DRAWINGS (INCLUDING PROPOSED FACIIITTES), PERMIT t# FOR EXISTING
FACILITIES, SURVEYS AND PLANS
• INCLUDED COPIES OF DEEDS AND AUTHORIZATION LETTERS
Duke Energy Page 6 of 14 rev 9119114
Excavation Program
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application 113 IO.docx

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
_DWR
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources FORM: SSGP 10-2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent to:
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Info�Fj
ion // ,,
Name: ri sCAMp/1
Mailing Address: Loti✓•i c— bag, 17b1— M/
%`Y7po rCSJt��t� 1i�C -7-8/( 7
Telephone Number: Fax Number:
E-mail Address: CLiriS ►'i ✓ASCorlSt�(�►'i✓q • COM
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 AUTHO
RIZATION FORM. df) must be attached if the Agent has signed this application form.
Name: cAr/) /3Y-J,cs
Company Affiliation: Cl
3C' SrUnre %iCG c��
Mailing Address: 3 9 619-Kr1d i c- 'PAY -P4 14wy
ayY-r-5(/•i /I I
Telephone Number: 70�, 6(00.5 //( Fax Number: �v0 • S1
E-mail Address: cbc,5e qt,_� s o— wiMd5fre*#,r7 . Mc
Person to receive the Certification Approval (',k,4, %3n49G5
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, etc.),
rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations, and
FORM: SSGP 10-2013 Page 1 of 3

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: �Nearest Town: "ores Ir & 11
Subdivision name or site address (include phase/lot number): Mor IJ 00d o 7L
Directions to si - please in lode rod names and numers, Ian
dmar , etc.00 %7 N
A! G 1�00� Gr FdL• 12-0A)
Latitude (in decimai degrees)c1J -6 1 3 � Longitude (decimal degrees) 60 • 16 4F 191
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Y'e-S iAe O�) -�; a t
6. Property size (acres): • Z
7. Lake/ river/ ocean adjacent to property: Ke %�lorWl
8. Describe proposed work (include discussion as to how har enin of shoreline has been
avoided, or why it is necessary): A.-ea.,�00p�Tt S S
9. Will work be conducted from land?From water?
41
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:
Lou X 80'x �3' 3 0O �x a-5 �x �
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 Leve) and 50
feet landward to be impacted (number of trees, for instance): 4VOOd led A,�
Owner/Agent's Sieg rats re; V Printed Name Date
I 15 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

A
/Z
Full Pond/
Normal Water Level
Shoreline
Lake
Normal Water Level)
u�a
IpA-T
TN ssccG'vr1G-
5�' L
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

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one
I Joel H. Patiersan�, made he mb Rd "" — ceder my auperMsbn
t
Page e, my ��an (dam description and/or
Page that
from informati That the troundarles not surveyed are clearly
in Boots
Pori oa calculaton found ed is 1: 10,000+ that this plot creates
with' o county or munkipalMM has Mhas an ordinance"that
if lord. The ratio of precision as calculated Is 1': 10,000'+
Prepared i1 accordance with G.S. 47-30 as amended.
signature, registration number and seat.
3n°--. A.D. 7997.
� Property Zorrert RR
Total bacf to be subdhAfed Mh sheet 34.70+/- Ave,
Total rwmbr or lots aV~ td," sheet t I
1 ''5'" sir lot asofsd Mts sheet Lot 2 O.EJ Acne
1 AN Oreo designated am rM rwevtion
led and mofntoined
by Me homeown u>b �� a
ere aadlo
Inan tM1e afPATTERSON SURV,�'Y11►rG, P.A.
� ns ash IO' ang waterfront lot,
aNy.
P.O. BOX '3871 lit—10, N.C. 20115
[phone] . Fox [phone]
GRAPHIC SCALE
7110 a 100 a»
.aa
woo
( IN FEET )
1 Lace - 200 tL
- OV
�L
��% � JOQ H. PATTFRSON III
REGISTRATION NUMBER: L-3717
_n
nroWy.
the County and state ateresoid, certify that
o Registered Land Surveyor, personally appeared
w1d acknowledged the execution of the forego'
ny hand and official weal,
stomp or this n+ q
4L SEAL"'
Nonl; 4az. na
ofhotdP5 Public
ta+damone
xUi:es my --- —Pir'ea: -01-
the
1..
the su"Asion pat shown hereon has been found to comply
eguldions of the county of Iredell, North Caplin OL I
I etreeta, utilities and other required Improvements ho"
x:ceptable manner a the Installation of the required
and amount and moaner eMisfoctory to the County of
ed, and that the fFIng fee for this PIM it the amount
snreceied This pat hos been approved by the subdivhlal
ding in the Office of the Register of Deeds of Iredell
Subdivieion Admmi� y{rR o�-
rd Subdivision to the beat M my knowledge Iia
xi area of the Lake Norman/Catawba watershed bond,
lorth Carolina Divfslon of EnNranmen 0 Management
WOtershed Protection Mop of bedd County.
V" - --b
Subdivision Administrator
""'e owner of the property shown and daacrbed
l the wrDdivhion
M%1rlsdctior 01 the County of Iredell.
ng setbgFka as
nooted.ia plan of ntewith my Tree consent and
d.
Manger/Northwood Group. LLC
unty
Nm�gef County and State, do hereby
e me this do and aek(1C a limned liebsny eampany.
Y edged the due
7 instrument on behalf of td, company.
doll stamp err seal, ".1L" day
rI
fAL" ry Public
lellrotina my commission
ones "2'2 �Z
f�e
ter.
IJOB NAME:
FINAL PLAT OF
"NORTHWOOD SUBDIVISION'' PHASE I
LOCATION: DAKCISON ro#W p 490EU COU'Vry, NC DRAWN BY: ,MP CHECKED BY: .,FIP
TAX PARM N6 46J9 -5g -6J11
SCALE: t' - 200.
OWNER/DEVELOPER: DATE OF FIELD SURVEY: AIRK 23 1997
NpR7HWOX GROUP, LLC
fB701-A HWY. 73 DATE OF MAP: ,bre 16, 1997
CORNEUUSt NC 280JI
DEED REFERENCE.J02J poge.8f JOB NUMBER BOOK NO:

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