20170079 Ver 1_Shoreline Stabilization_20170119

DUKE ENERGY EXCAVATION PERAHT APPLICATION FORM
20?
FOR DUKE ENERGY USE ONLY
Duke File No.
Application Fee $ Security Deposit L—S7 hec # — 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*
Date
(Prnd) (sign)
_ Date of Any Approved Extension Initials
Initials
Any Stop Work Orders or SMG Violations*? (check one) OYes 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
Orders with aoolication.
PART L - APPLICANT INFORMATION (Please Print) /
'Oe #� Ycr, NC �_V 3 7
Mailing Address
(If different)
1J,qJV 19 to applicant
20.
04) '1-0/. /0 9 5
Contractor company C50,
Contractor Contact Person C 3A 6 r r al t c -S Telephone (�) 6 to e. -S-
LAKE LOT INFORMATION
Lake O rN kAHI County 4 1 NC,0 IV City D e A WCr State � Tax Map No.
Subdivision W C _4 p o r A- Lot / Section No. 44 Lot size D .3 1 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: InNaWng this portion of the
application by a DBLSR in no way constitutes approval or eminent approval of the excavation or any other lake use
permWng activity.
Date of on-site inspection ' r _ Initials (Duke Energy) (applicant/contractor)
Dake 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
079

DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
PART H. - DESCRIPTION OF PROJECT
A. BASIC INFO
1. Type of excavation: (check one) New excavation ❑ Maintenance excavation
2. Purpose of excavation: (check one) at Access Channel ❑ Water Intake Channel
Wastewater Discharge Channel ❑ Other (specify):
3. Lake user category: (check one) Private ❑Residential Marina ❑Commercial Marina
Public ❑Other (spec):
4. Max. Excavation Area Dimensions (ft): Length -5-0Width 30 Depth
(Note: include additional area dimensions if necessary so response to #5 below equals mwL area dimensions in #4)
5. Volume of Excavated Material (TOTAL for the project): A9.1- Cubic yards
L
6. Type of material removed (applicant determines by field sample if practical): M Lj-A e 5 i 1
7. Excavation Site area: b. t5 3 Acre (s) Disposal Site area: Q . D 3 Acre (s)
8. Total Disturbed Area (including equipment staging area): v. a 6 Acre (s)
9. Does the project meet the requirements of the applicable General Permit? (check one) *CS ONO
10. Do you claim title to the disposal area? (check one) *es ❑No
11. Do you claim title to the equipment staging area? (check one) Yes ❑No
12. Are there any water -treatment facilities within 50 fed of the proposed excavation area? (check one) ❑Yes )(No
(If Yes, Hifi')•
13. How will the excavated
disposal area design):
entrapped and the erosion controlled? (eg. see attached erosion control plan and
14. Type(s) of excavation equipment to be used: e- W �, 10 N 9 re -A e - h
M4v-
15. Will waters or wetlands be crossed in transporting equipment to or firom the site? (check one) ❑Yes *0
(If>wsl
16. Will return water re-enter the reservoiO (Check one) ❑Yes *o 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 by conducting the excavation? gYes Mo
(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 (Inchidefirst equipment mobilization, excavation through final mitigation measures
complete): START F�-b / 2-o r7 Fmig 6/.moi 7
(Month) (Year) (Month) (Year)
Duke Energy Page 2 of 14 rev 9/19/14
Excavation Program
c:lusers\annlappdatauocal\microsoft\wmdows\temporary imernet filesVcontenLoutlooklmp7eolj9\c-w excavation
application 113 10.docx

DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
PART IL (Continued)
B. PROTECTION I AVOIDANCE AREA DESCRIPTION
Complete the following table including all land areas within and immediately adjoining the disturbed area:
Identification `
Pro*�a/Avoidance Areas ►E Pp Avoid (A) or Mideate (M�
(check all that apply) Acreage Reid ID Work Area Dwa• IOD
,.
a. Marshland, swamp, ponds, beneficial WIA
aquatic vegetation or other potential wetlands (circle all
that apply)
b. Buffer Zones (speck width & source of j _ ��K ;' I 6C JoAt e -
requirement) �lV
b k�',c s A�eJ
y.
or4
c. Environmental Area as identified by Dake . /�
Energy 1� A
d. Natural Areas as identified by Duke Energy
a Historic properties (specify) 9[A
E Rare or threatened species (specify) �� ^
Duke Energy Page 4 of 14 rev 9/19/14
Excavation Program
c:\users\ann\appdata\locaNmicrosoR\wmdows\temporary Internet files\content•oudookNmp7eolj9\c-w excavation application 113 l0.docx

DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
Protecdon/Avoidance Area
(check all that apply)
Apnroz.
Aems
Identification Mahod (*)
Avoid (A) or Mitleate (M)
**
Field ID
Work Area Dwe. ID
s. Buried gas, water, sewer, communications
or electric lines (circle)
It. Impact Minimization Zones as identified by
Duke Energy
i. Other areas requiring specific avoidance,
protection or mitigation (specify)
* For "Field ID" column, specify entity or person that performed the identification and how it was physically marked (e.g. Duke Energy (John Doe)Mink and purple -dotted tape,
Corps of Eng. (John Smith)l 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
Excavation Program
rev 9/19/14
c:\users\ann\appdata\local\microsoft\windows\temporary internet files\content.outlook\mp7eoij9\c-w excavation application 113 10.docx

DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
C. APPLICANT'S SIGNATURES
Comments:
'^l J- r; X 3 % 3-- 40A e 54rt lets /e,/- '/-3
Gev lnl 'c 3 9!8 e S S Q !fs'
Applicant Name (print) LNI►wk �,lyi'-� QpyQ1�N.r,ah� �yful`C 60 v §
Applicant Signature* I
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (print),
Co -Applicant Signature*
Co-Applicaut Name (print)
Co-Applicaut Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (prim)
Co -Applicant Signature*
Lot # /./`7
Date
Lot #
Lot #
Date
Lot #
Date
Lot #
Date
Lot #
*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 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 FACILTITES� PERMIT # FOR EXISTING
FACILrnES, 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\locai\microsoft\windows\temporary internet fi1es\content.oudook\mp7eo1j9\c-w excavation
application 113 10.docx

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .oSoo — Water Quality Certification, Shoreline Stabilization
Division of water Resources 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 [15A NCAC 02H .0502(a)]
1. Owner Information
Name: off tilde'd&u a
Mailing Address: 3218 ZA-X f sr(t.o rC
�Dea/i✓'e-y-. HC X803
Telephone Number:Fax Number:
E-mail Address: 5Q14 i r -e3
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/reedocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM. df) must be attached if the Agent has signed this application form.
Name: Y, rd
Company Affilia on: C e ml,'Al
Mailing Address: 39 Dfl-Krldij
t C_ � w
M t2,occ5v; W e. AI C
Telephone Number: 70 • �p(o0. 5-11( Fax Number: 70 0. X969
E-mail Address: chc ofAo.)Ai &)
Person to receive the Certification Approval: a; b /fired., c s
H. Project Information [15A NCAC 02H .0502(a) & (b)1
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: 11;Af"Af Nearest Town: 7)<AJ v -e v
Subdivision name or site address (include phase/lot number):� or 16 r 14q -
Directions to site - please include road names and numbers, landmarks, etc.:
o rr. /Qo/.
Latitude (in decimal degrees)1- - SOT� l0 3 LOngltude (decimal degrees) o • 9840 49
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Y—e_5 A ca -p-
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):�iY_<
9. Will work be conducted from land? 1" From water? fVI
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:
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/ NormallWat�r Level and 50
feet landward to be impacted (number of trees, for instance): "Ss c�J
1 o 1- 0* 4- 0. -JoeaJ -tY C_ v- S
e« 5`,Y -r e1)67� �f
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
(At Full Pond/ Normal Water Level)
I
i
3d
Full Pond/
Normal Water Level
am Zam ow
Shoreline o201A
9/,y /M -C- NS
ZDrAlrer,1YC ZP37 /oP' W
Please approximately sketch the following information on this plan (provide dimensions far 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

BOUNDARY SURVEY
VACANT LOT
LOT 44, BLOCK W, WESTPORT, SECTION 1 MAP 2
LINCOLN COUNTY NORTH CAROLINA
MAP BOOK C, PAGE 126
PREPARED FOR COPPER BUILDERSPROPERTY IS SUBJECT To DECLARATION _
COVENANTS, CONDITIONS AND RESTRICTIONS DATE OF FIELD SURVEY: 08-02-1& i
RECORDED IN DEED BOOK 410 PAGE 447 v
AND DEED BOOK 412 PAGE 401 THIS PLAT IS SUBJECT TO ANY
LINE -ETR -NTS Tits SURVEY IS NOT INTENDED TO MEET CS EAPRIOR OR R DATTSE OF WAY OF
S 70'11'04' E 47-30 IEQUREIAETNTS. THIS SURVEY WASTHIS
18&45 PERFORMED PER THE STANDARDS OF PLAT, WHICH WAS NOT VISIBLE AT
PRACTICE FOR LAND SURVEYING INNORTHTHE TIME OF OUR INSPECTION
TIE UNE -ETR CAROLINA WITH AN ERROR OF CLOSURE THAT
'18'33' E MEETS MINIMUM STANDARD OF 1:10,000 AND
7418'33'
THAT THIS SURVEY IS PREPARED WITHOUT THE
BENEFIT OF A FULL AND LEGAL TITLE SEARCH
1E UNE -ER LAKE NORMAN
S 7�, ' E FULL POND
LOC PROYWHIN MY PERTY 6 NOT U,IA PHICALLYDESIGNATED
l R ELEV-760.2 SCALE: 1•-40' .
SPECI�FLOM HAZARD AREA AS lE0 S
IDEN1mED ON COMMUMTY PANEL 3S34p?5'
#370146-3710451400K. DATED 3-18-0& tor am T3 £
ALL EItS 3 SIRS ARE FLUSH VATH
EIOSTING GROUND LEVEL UNLESS
OTHERWISE NOTED.
AREA DETERMINED BY
COORDINATE COMPUTATION
rS LUNE-EIR-NTS
696,119,3or E
PER COVENAN
EIaSTING IRON ROD
OB 410 PG 447& oo
• -
SET IRON ROD
DB 412 PG 401
_.�
1
RIGHT-OF-WAY
POS,/
REAR PROPERTY LINE
Fd10WS THE 760 CONTOUR
PATia l !
MB C PG 126
/ 1 1
DEED BOOK
/
NOT TO SCALE
ET. �( I I
4' SPLIT
WALL
V METAL
FENCE CLEAR
OF PROPERTY U
CONC. PAD
0.9' OVER -
PROPERTY LIE
DECK STEPS OVE
PROPERTY UNE
D.5'
LOT 43W
MB C PG 126
5 DUE
PER COVENANT'_
08 410 PG 447 .
08 412 PG 401
IV DUE O
TE LAE -EBV -NTS PER COVENANTS ; L
447,
S WOW E 08 4 2P PC * I 2
I
DR
EIaSTING IRON ROD
SIR
SET IRON ROD
M8L
MINIMUM BUILDING LINE
R/W
RIGHT-OF-WAY
MB
MAP BOOK
PG
PAGE
D8
DEED BOOK
NTS
NOT TO SCALE
CONC CONCRETE
DUE
DRAIN ILC UTILITY EASEMENT
01
DROP DEET
AM
AS MEASAUREO
LAKE -SHORE ROAD
60' PUBLIC R/W
MB C PG 126
ORMHUL SURVEY NUJ. CONTAIN A CRIMP SEAL.F THIS CRU
DOES NOT APPEAR ON THE SURVEY,
THESURVEY COULD C
CHANGES NOT PA�NBUHSURVEYOR.PREY;
DELTA LANO SERVICES INC.
Firm License # C-733
608-C Matthews Mint Hill Road
Matthews, North Carolina 28105
[phone]
REVISED:
T V ramngs\COPPER\westpomW EST-0044.dwg
U METYPE
SET BAM LINE
PROPERTY LINE
ADJ O MG LAE
(NOT SURVEYED)
------ COVENANTS LICE
TIE LANE
— --- ---- SEPTIC LIMIT
DWN: .DA CKD:
DATE: 08/04/ 16
RAA. FENCE
Iol
' SEPTIC LIMIT UNE
PER
0PC47COVENANTS
DO 410 PG 447 Nk
1 I{i
I N
08 412 PG 401
/
Q n
10!
I 1 j
Nw
s i LOT 44 1
BLOCK W I
0.328
762.211
/ FPE i
/ I 1
/ I j
LOT 45W
t// I
M8 CPG 126
/ II
/ I I
cn 31
I 1
m i0
I I
ZP
-'~ J
— -
< o
30,MEIL
i
in Z
s' atm
!
PER COVENANTS
�..
;:° .._..-.._..- .....i
08 410 PG 447 do
08 412 PG 401
LAKE -SHORE ROAD
60' PUBLIC R/W
MB C PG 126
ORMHUL SURVEY NUJ. CONTAIN A CRIMP SEAL.F THIS CRU
DOES NOT APPEAR ON THE SURVEY,
THESURVEY COULD C
CHANGES NOT PA�NBUHSURVEYOR.PREY;
DELTA LANO SERVICES INC.
Firm License # C-733
608-C Matthews Mint Hill Road
Matthews, North Carolina 28105
[phone]
REVISED:
T V ramngs\COPPER\westpomW EST-0044.dwg
U METYPE
SET BAM LINE
PROPERTY LINE
ADJ O MG LAE
(NOT SURVEYED)
------ COVENANTS LICE
TIE LANE
— --- ---- SEPTIC LIMIT
DWN: .DA CKD:
DATE: 08/04/ 16

Google Maps Page 1 of 1
al Maps
https://www.google.com/maps/(a),35.5044703,-80.9840166,17z 12/28/2016

iviapt-,ara - rnnt your custom map
Page 1 of 1
-
http://map-pass.mytopo-com/maps/print_iocal.asp?print= l &scale=5.00&layer=DRG&lat... 12/28/2016

lu:-A
m
Prop"In