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Home My WebLink About20170212 Ver 2_Shoreline Stabilization_20170321DUKE ENERGY EXCAVATION PERNUT APPLICATION FORM FOR DUKE ENERGY USE ONLY Duke File No. Application Fee S Security Deposit $ Check # Date Recv'd Initials Date of Duke Energy Lake Services, applicant and/or contractor on-site inspections DatepZ 6 L 11 Initials 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) OYes; ONo (If Yes, explain in Date Deposit Reftinded Initials Date Permit Database Updated Initials Forward copy of approved application (all pages, plus any attachments that Duke Energy changed) back to applicant with Approval lAtter and highlight any changes. File copies of Approval and Close-out Checklists and any Stop Work Orders with ADDliC2ti0n. PART L - APPLICANT WFORMATION (Please Pnnt) NameW06A 1A AIJ 4 WAACY-V i e -W LLC E-4 /Cm` Telephone (70- � ) 6 (P 2_ 6 *6 0 L,akeAddrm,;U?/ CT-v-.45L54opper- drcL- Mailing Address 'PO BoA 3399 (If &fferent) 60 reso. It 4(c_ 117 M boy -5-5 V, a C aS0117 Contractor Compaiiy Contractor Contact Person r -11W., e-5 Telenhone (70 1 LAKE LOT INFORMAnON Lakc county -n-c-A t. ( I — city Moore_s 6 1 state N c- Tax Map No. Subdivision tq I k Lot / Section No. 4-3-7 Lot SizdZL 3 4 8 Acres Are there any Co -Applicants*? (check one) OYes 1JNo (y Yes, include names, addr-esses, phone nos., lot nos., lot sizes in PART V - ADDITIONAL 11#4FORMATION) * Co -Applicants mist 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 T"he 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. Inidalizfng thispordon ofthe applicadon by a DELSR in no way constiftaes approval or eminent approval of the excavadon or any otker kike use pffmWng activity. Date of on-site inspection 0 Z-) e) 1 1 '� Initials (Duke Energy) (applicant/contractor) Duke Energy Excavation Program Page I of 14 rev 9/19/14 c:\usm\axm\appdata\local\microsoft\windows\temporary internet files\contentoutlook\mp7eolj9\c-w excavation application 113 10.docx DUKE ENERGY EXCAVATTON PERAHT APPLICATION FORM PART EL - DESCRIPTION OF PROJECT A. BASIC INFO 1. Type of excavation: (check one) �New excavation 13 Maintenance excavation 2. Purpose of excavation: (check one) Boat Access Channel 0 Water Intake Channel gWastewater Discharge Channel 0 Other (spec#y): 3. Lake user category: (check one) vare OResidential Marina ClCommercial Marina ftic [30ther (specify): 4. Max. Excavation Area Dimensions (ft): Length Width �,Q Dcth OVoge: include ad&tional area &menslons if 11;c-essa?y so response to #5 below equals max area diff, -fisions in 5. Volume of Excavated Material (TOTALfor the project): _ 71/ � Cubic yards 6- Type of material removed (applicant determines byfield sainple ifPractical) j 5 i 7. Excavation Site area: 0, / I _ Acre (s) ' Disposal Site area 0.1 Acre (s) 8. Total Disturbed Area (incluifing equipment staging area). ---P—. pA ;, Acm (s) 9. Does the project med the requirements of the applicable Gencral Pamir? (check one) XYes CINo 10. Do you claim tide to the disposal area? (check one) Xes 0No 11. Do you claim title to the equipment staging area? (check one) *cs C[No 12. Are them any water-treatinait ficilifics within 50 feet of the proposed excavation area? (check one) 13Yes *o (If Yes, specify): 13. How will the e=vated material be eptrupgod and the erosion controlled? (e g see attached erosion controlplan and dhposal area design): 1,2 a /Irdgz� 14. Type(s) of excavation equipment to be used: e, w nnour,4 40eAw" 15. Will waters or wetlands be crossed in transporting equipment to or fi-orn the site? (check one) EMS *0 (Ifivs. 16. Will return water re-aiter the reservoir? (Check one) 13Yes �k4o [3N/A (If Yes Vecift point(s) ofre-entry and show on Excavation Area Drawing) 17. Is them an existing fimility (e -g. pier) that access is being maintained to by conducting the excavation? DY [No (If Yes, speaft the mitingpermit number IfNo, include a scaled drawing of the prWasedfacifity). Permit # r2- 2. q 9 18. Total planned duration of lbe, work (Includefirst equoment InObilizati, excavation throughfinal mifigation measures complete): START 9-0 7 FINISH -2!! -(7 ffear) 0ear) Duke Energy Page 2 of 14 rev 9/19/14 Excavation Prop= c:\users\mm\appd=\Iocal\tmcrosoft\wmdows\tempormy internet ffies\rontentoutlook\mp7eolj9\c-w excavation application 113 IO.docx DUKE ENERGY EXCAVATION PERART APPLICATION FORM PART 11. (Continued) B. PROTECTION C RRA nFACRIP""'"'T C,M,IeW the followinR table including all land areas within and immediately adjoining the disturbed am: Protection/Avoklance Area (check all that apply) Appro& Acrean Idenfifludon Method M Avoid (A) or Iffitintr, Field ED WorkA Dws. ID q/,4 a. Marshland, swamp, ponds, beneficial aquatic vegetation or other potential wetlands (circle all that apply) b. Buffer Zones (specify width & source of requirement) , W;11 & d.OAI-'- koy-V bj Energy c. Environmental Areas as identified by Duke Iq /P d. Natural Areas as identified by Duke Energy a. Historic properties (specify) f. Rare or threatened species (specVy) Duke Energy Page 4 of 14 rev 9/19/14 Excavation Program c:\users\am\appdata\local\microsoft\windows\temporary internet files\content.outlook\jnp7eolj9\c-w excavation application 113 1 O-doCx DUKE ENERGY EXCAVATION PERAUT APPLICATION FORM Protwflon/Avoidance Areas (check all that apply) Agproz. Acreage Identification Mediod M Avoid (A) or Mitleate (M) Field ED Work Area Dwa. ED Buried gas, water, sewer, communications or electric lines (circle) h. Impact Minimization Zones as identified by Duke Energy L 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)/Pink and purple -dotted tape, Corps of Eng. (John Smith)/ yellow flag�ging). For "Work Area Dwg W" 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 c:\users\ann\appdata\local\microsoft\windows\temporary intemet files\content.outlook\mp7eolj9\c-w excavation application 113 IO.docx pili"7MMM 7xvViN i it) I: I w RIM v Q AEWQA=8 BIGNAILMES Commem: arl'oki 6. RoblIA($04 Ap~Nnme dwW A 042� Lati-137 Afp"siftnotumo -5C, Cb-4pVmt Iftme &rinf) -------- co-�"*Uftro c"pp"olownt"o Co-AWV=t N� CO-AnMmiat ftpatmO CmAppUmt Nom C&AMmmiftuo"o Co-Appftutftme&PW�� w N rkb La# Dw W# Dau LM# Daft IA# Co-AppHmmt8lSmatmm* D&W *ParzW skwbu% ft kftmatim provIM inft oppksdm is corrMW do bW ofaWkwwbftc MMZ YOU MMW3 AMWAMON TO DUM XMM LUM SIM"M XMM "U IUV& • CHBCMMMMTIWROUGMY • WrAUWBQUMMMMPORA flAWW (m Caw hW lfqrb=dGRPWhW) • VM=MBDA SDIMB CMM TO DUKREMBROY FORTHE APPUCALTION PnM FWAND SECURny • RMMALLAGBNCY Pmmm OR co&omrLBrn= AM RMMV13D ALL MIES RAISED • RCLUND ALL RBQUMED DRAWRWS MKLUDM PROPOSED FACILXMft PERMFr# PORWaSIM FACRAMM VMVETS AM PLOM • INCLUMCOPMOFDMSAMAtMMItWATIONLarnm DubBmW P4p 6 of 14 xvWIW14 Bumdlonpmpm 1 11 � .. i 1 1 4 11 my hamot fflw%oo�wdod&w7*0Vl*-w omvadm WOC&dm I i i I IV-(4— re rk State of North Carolina Department of Environment and Natural Resources DWR 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 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 f15A NCAC 02H .0502(a)] 1. Owner Information Name: W60h1A-qd*'V)A4ttV-1eV1 eAIA3 eA-14v, Mailing Address: 0 1�!OA '33qg JMbp"syi�l(( aC "117 Telephone Number:70� d Fax Number: E-mail Address: le, Aj e.V Afe h tA-Ier X o rn e -5 . Co wX 2. Agent/ Contact Person Information A signed and dated copy of the Agent Authorization letter (a form can be downloaded here: httD://www.saw.usace.armv.mil/Portals/59/docs/rep,ulatorv/regdocs/Permits/SAMPLE AGENT AUTHO RIZATION FORM.pdf) must be attached if the Agent has signed this application form. Name: a-; 4 - 5 - Company Affiliation'. C /5 C ' 5 1�le 4!1 , 1".f 'Y Mailing Address: 6 -3 9 0*4,r 4,q ,— 64�`r w, WuA4 Telephone Number:7a�—,� �57 � Fax Number: 0. �fj_ I E-mail Address: P tV1f*WA6_-A�1n- Ne -f_ Person to receive the Certification Approval: e --h; 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, 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) Co u n ty: Nearest Town: ADO re3v' Subdivision name or site address (include h /lot mber): a8l ,o 7 43 7 M 00 rr>,v 't A/ C V—S-1 17 Directions to please include road names and numbers, landm ks; t 7-7d 'A 7e 5& 33, Wo W. I -M 4 0AJ /n CkeAfd.-Ce- ".. R4-,O*V Latitude (in decimol degrees)__2� ��.,57�-90 Longitude (decimaidegmes)-- �O- q�qll� 5. Describe the existing land use or condition of the site at the time of this application (residential, undeveloped, etc.): V -e -s- iJ ed�;^ / 6. Property size (acres): 0-366 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): 41 A'- h'CA�- I+Cee-55 e. 9. Will work be conducted from land?E] From water? X 10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.) below the normal pool lake level/ Normal Water . 15"A I X X 0 Y� in square feet or acres: 11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining walls, etc.) above the normal poql lakl level/ Normal Water Level and 50 feet I dwardin 1'W - square feet or acres: At di54UrA4*1"e— iAJ &Asl 12. Please describe the vegetation above the normal pool lake level/ Norm I Wat vel d 50 feet landward to be impacted (number of trees, for instance): �007� . . Me 1!19 sill" - - - Printed Name Date 115A NCAC 02H.0502(f)] 'Agent's signature is valid only if an authorization letterfrorn the owner is provided. FORM: SSGP 10-2013 Page 2 of 3 Full Pond/ Norma %�ateW IL , a; am Shoreline I (P 0 cz- yds Please approximately sketch the following information on this plan (provide dimensionsfor 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 s.n v GRAPHIC SCALE .5b" .4-2 1�1 ORM Ma mmmm=7,WM COWVS"F'Oj 'DEvwL6PVN'Nr ILI' I RECREATION Lg'ow. siccrioN a LCH43-E SURWY AAD MAP PfirPARED 8Y. LAIKE NORMAN SURVEYING & ENGINEERING PUC 610 IM— R—d Nwth Cwofoo 28625 (7j�) ,76-4450 r- (704) 876-4451 -6 s.n v GRAPHIC SCALE .5b" .4-2 1�1 ORM Ma mmmm=7,WM COWVS"F'Oj 'DEvwL6PVN'Nr ILI' I RECREATION Lg'ow. siccrioN a LCH43-E SURWY AAD MAP PfirPARED 8Y. LAIKE NORMAN SURVEYING & ENGINEERING PUC 610 IM— R—d Nwth Cwofoo 28625 (7j�) ,76-4450 r- (704) 876-4451 Google Maps Go gle Maps , IS Page 1 of I Map data 9)2017 Google 200 ft: -11 - https://www.google.com/maps/@35.57802,-80.9311811,17z 2/10/2017 MapCard - Print your custom map SO 17 'j -1 71), le �.-. AN 0 0.5 Mj 0 2000 Ft Page I of I av http:llmap-pass.mytopo.comlmapslprint_local.asp?print=l&scale=5.00&layer=DRG&Iat--... 2/10/2017 -two i 46. Pw: A;'d ZVI n, 4Q, ji Jt