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Home My WebLink About20171393 Ver 1_Shoreline Stabilization_20171030Duke Enemy Excavation Permit Application Form �iitc iii":�.T?;:ti'tc,��Y"ti�:L��`B..Z• Duke File No. Applievion Fees Security Deposit Cltcx;c # trate Recv Date of Duke EnOW, Lake 5etvic;a, applicant aruilor contractor on-site inspections Date Final ProtectiotVAvoidances Area Markings Field - Vimifiied Approved to Start Work By * Date Completion Required Date Passed Closeout Inspection* Inigrl's,_ (Print) (sign) Date of Any Approved Extension Initials Initials Any Stop Work Orders or SMG Violations*? (check one) ❑Yes ❑No (!f Yes, explain in PART V) Date Deposit R.e Uniled 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 Letter and highlight any changes. File copies of Approval and Close-out Checklists and any Stop Work Orders with application Part I. Applicant Information (Please � tn,t) oT Name "') r CC�i ,+ � ' `- Telephone f ✓ Email address: e c iir� .-°4�+�.� Ca •� -- Lake Ad ess M,ailyAg Ades Cif d1jrerent) Contractor Company �- t "We C c bw� Contractor Contact Person reiephone L' � l'• ter' r - Contractor Email Address: C bC 5eA u -M 5 C.) 5 Aleog M LAKE LOT INFORMATION t Lake O �; � Cc�t nh' C � � City Aw,'--e +� State IV� Tax Map No. Subdivision &dde0J (0 Lot / Section No. Lot Sizac9�2Acres Duke Energy Page 4 of 14 rev 2/6/17 Excavation Program Duke Enerpry Excavation Permit Application Form !tee n Wly C'51-APPU -t6*1? (Chet ori) Oyes :QNo (If Yes. inckde names. addresses or lot numbers, phone nconbers, 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 / tease hotders ofl" roject-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 itom the Applicant and Co -Applicants. Do not continue the application until an on-site inspection has been conducted between a Duke Energy Lake Representative and the applicant and/or the excavation contractor. NOTE: Initializing this portion of the application by a Lake Representative in no way constitutes approval or eminent approval of the excavation or any other lake use permitting activity. Date of on-site inspection 1,01a4l/ Initials (Duke Energy) (applicant/contractor) Duke Energy Page 5 of 14 mv?J6t17 Excavation Program Duke Energy Excavation Permit Application Form Part IL Uescr' tion of Pro'ect A. ,BASIC _INFO 1. Type of excavation: (check one) l/New excavation ❑ Maintenance excavation —/ 2. Purpose of excavation: (check one) Cid Boat Access Channel Cf Wates Uftake Chanel Q Wastewater Discharge Channel O Other (specify): _/ 3. Lake user category: (check one) QPrivate OResidential Marina OCommercial Marina ❑Public ❑Other (specify): 4. Max. E119 tion Area Dimensions (ft): Length 50 Wi&h 5 d Depth (11%te: include additional area dime fans i necessary so respone to #5 below equals max. area dimensions in #4) 5. Volume of Excavated Material (TOTAL for the project): 7 6 3 Cubic yards 6. Type of material removed (applicant determines by field sample if practical: �E `� 7. Excavation Site area: D• Acre (s) Disposal Site area: 0. p6 Acre (s) 8. Total Disturbed Area (including equipment staging area): Acre (s) 9. Does t130 project meet the requirements of the applicable General Permit? (check one) es UNo 10. Do you claim title to the disposal area? (check one) U(es ONo 11. Do you claim title to the equipment staging area? (check one) [9 es ONo 12 Are there any water-tSeatment facilities within 50 feet of the proposed excavation area? (check ane) Oyes (If Yes, specify): 13. How will the excavated material be entrapped ano the erosion control plan and disposal area design): controlled? (e.g. see attached Duke Energy Page 6 of 14 'e"2/6/17 Excavation Program Duke Enerzy Excavation Permit Anolication Form 14. Type(s) of excavation equipment to be used: hA'� e. w'/K /0,6/e-&VdiY"'VAA K- 15. Will waters or wetlands be crossed in transporting equipment to or from the site? (check one) OYes GKo Wyes, exP� tt) 16. Will return water re-enter the reservoir? (Check one) OYes CSNo ON/A (If Yes, specify point(s) of re-entry and show on Excavation Area Drawing) 17. Is there an ex3sting facility (e.g. pier) that access its bei mwintained to by conducting the excavation? ffYes CiND (If Yes, specify the existing permit number. If No, include a scaled drawing of the proposed facility). Permit # 16 0 M TPtW,P14UUM dumfion of the wak (Includefirst equipment mobilization, excavation through final mitigation measures omplete): START t A,,J / P-0/8' FaZ lsq, I%J / /( (Month) (Year) (Month) (Year) Duke Energy Page 7 of 14 m„2/61i7 Excavation Program ;nt„ r+ner�y Excavagot► Permit Ap licaation U. Form PAT II. (Continued) B. PROTECTION / AVt)IDANCE AREA DESCRIPTION Complete the following table including all I;;and areas within and'amod"ely adj'i"'g the disturbed area: Protection/Avoidan a Areas AR"ro v e d ID (check all that apply) a. Marshland, swamp, ponds, beneficial �potential. wetlands aquatic vegetation or other p (circle all that apply) _i Buffer Zones (sp/-cify tividt/i &source j_ )D ��i l{f�� be G�vAte of reoOirement)y � � _c. Environmental Areas as identified by Dupe Energy jV d. Natural Areas as identified by Duke Energy e. Historic properties (specify) / v • f Rare or threateci species (spec) Avoid (AI or Ntitigate (Ml rev 2/6117 Duke Energy Page S of 14 Excavation Program Duke Energy Excavation Permit Auplication Form Protection /Avorid ce Areas (check all that apply) Anurox Acre Identification Field W Me d * Work AM.Owe. ID Avoid (A) or Mitigate (hl) 1� Buried gas, water; sewer, coumul►ications or electric lines (circle) - h. Impact Minimization Zones as ido�tified by Duke Energy i. Other areas requiring specific av-daace, protection or mitigation (specify) t * For "Field ID" column, specify entity or person that perfarmed the identification and how it was physically marked (e g. Duke Eaergy (John Doe)/Pink 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/avoidanoc area. ** List and attach mitigation plans Duke F-nergy Page 9 of 14 rev 21&17 Excavation Program Duke Enemy Excavation Permit Application Form C. APPLICANT'S SIGNATURES i . , /. Commentx e-$' n o d -� --4e I P e �0,5��7 �� d�e�l LAA na:5` ��jer�ti L+ -eco. /35 9-dWaly- t~ Applicant Name (print) �� t" Lot # s 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 Co -Applicant Nam (print) Lot # Co -Applicant Signature* Date *Per my signature, the information provided in this application is correct to the best of my knowledge. Duke Energy Page 10 of 14 my 2W 17 Excavation Program CATAWBA RIPARIAN BUFFER NOTIFICATION FORM /31 I Project Name/address: i fiat �. /-1 ,i%C�t'�`-Yvr and County X7 Print Signa . Contractor/agent: /7 S l�t0A, �, 47Y A Print Signature The approval is for the purpose and design described in your application. Impacts not indicated in the application is a violation of the Buffer Rule.. Site speck work should be provided in the application. [15A NCAC 02H .0506 and $Sa N- CAC 0213.0243(g)] Trees are not allowed to be removed from Zone 1 of the Buffer (within 30 ft of the full pond elevation), unless approved. Exception, those trees that are severely undermined along the immediate shoreline can be removed. Minimal shaping and sloping along the immediate shoreline is allowed. [15A NCAC 02B .0243(6)] Benching, grading in the buffer is not allowed. Excessive disturbance of ground cover. [15A NCAC 02B.0243 (6)) Beaches, impervious patios, impervious walkways, etc. are not allowed in the buffer unless specifically approved by the Division. There arelim4atiom on size for decks. (15A NCAC 02M P7 � A AM ?ewe .. A-44 Work to be. conducted from land must indicate an access and indicate any trees that are to be removed. The work corridor should be described. The approved access corridor shall be restored. Staging, spoil, construction material must be outside the buffer. [15A NCAC 02H .0502 and 15A NCAC 028.0243 (4), (6), (8)] Stormwater cannot be piped or channeled for direct discharge to the lake. All constructed stormwater discharges must be at the natural elevation and discharged prior to entering the buffer directed as diffuse or sheet flow at non-erosive velocities to the lake. [15A NCAC 02B .0243(5), (6)] Acknowledgement of Notification 10 13;C,464 /�46 e, , hereby state that I have been informed of the Catawba Riparian Buffer Rule. Any work conducted in the buffer, not specifically stated in the application and approved by the Division of Water Resources (DWR), is a violation and subject to enforcement. Due diligence will be taken such that the construction will be built within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plan(s); and specificatiion(s):, and other supporting materials. Signature (owner): Date: /40 • ! 7 State of Noi t.h Carolina ! Environmental Quality Wale, Rrsources 512 N. Salisburt Strcrt ! 1411 },t til Scrvic Center Ralcicrh. (dt ?7h90-li i3 State of North Carolina zr.,`f. Department of Environment and Natural Resources Division of water Resources ISA WAC 0214.0500— 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 100 f0afl Service Cenier Raleigh, NC 27699-1650 1. Applicant Information (15A NCAC 02H .0502(-4)] 1. Owner Information Mailing Address: 1 4 t i" ke ": 4• " l 31 1-1;1 AA c A! t,A-,'{- Mboy-cSvi N(0 AIC. .2$a7 Telephone Number: 334 p 1f7%. Fax Number: E-mail Address: ' i s *V4. rar Ac v Q 6-01 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/regulatory/regdocs/Permits/SAMPLE AGENT AUTH ORIZATION FORM.ndf) must be attached if the Agent has signed this application form. Name: C 61112n_e_'7td4C 5 Company Aff— iliat'►on: C Mailing Address: �n Telephone Num E-mail Address: 110 JA/C s 7Y�-'Y'i`�T6'Pai4�G� 43.1 413 i.V1 ikN :iMki kak i4Y i�Y�i 341 iTra_ Fax Number; 'Z&. P60. 5-V6 A41 -511i,- U Al - Al 11. Project Information f15A NCAC 02H .0502(a) & (bl] 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 pian showing property boundaries and proposed locations of vegetation clearing, structures (buildings, retaining wars, (udkb, iiiipci viuii5 5ui ac.c5, 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: Nearest Town: f VI 00v—t5V c nlie /�(L Subdivision name or site address (include phase/lot number): 41e 69m, j�S flir,ortinnc to rites in,-h,rin rnnrl nornar nnri niimkorr Innrlm�rLc ntr 'r -1 7A/ C Latitude (in decimai degrees) 35 - 5W3 4 79' Longitude (decimai degrees) (50 -_ ,.7, l,i ir,}L.f i4i✓ —1c: CXis-i RIg iarics use OF W iUWLjii ut LiiC/IL UL LLiC. til itC. (residential, undeveloped, etc.): rC.5 i A e- "i �1 6. Property size (acres): 7. Lake/ river/ ocean adjacent to property: Z,4Ac err fi 8. Describe proposed work (include discussion as to how hard Hing of shoreline has been e_ 7 JI 9. Will work be conducted from land? ❑ 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 Level in square feet or acres: r � � 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): CIY-A 1-�5• f p' Owner/Agent's Signature* Printed Name Date �1J%3t'F"�.i,.t1+.. LiGii ..atJGC(l '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) Full Pond/ Normal WateIMSr Level JIlGi'4i4T1G' � � 3 7 ciI.a!�cl �g F -g Iro £ 1 f e I Please approximately sketch the following information on this plan (provide dimensions foreoch item, such as !o jr x ou j ) = 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. S. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation a i nrntinn of rnnctr►irtinn arrpss Corridors FORM: SSGP 10-2013 Page 3 of 3 LO R 6 S/ 1111 qq a. 4ev � C � ry� TARA ROAD r t I5 � °ht 1�1� LOT h ^ h b �wwaaaaas.�ae . B. 10, Pg. 51 MERICAN / �m �<a pi.ANNiNG & Q m I SURVEYING o Bo, 3TATEE, N i. ;968 tai ,c i 9E'81 p r...,.n Lr U A J lzsW1 Ret I" —4332 1 Q N.M.J. rt41 It) - 51 I ♦ _ �� $ SC ``h=f@t ry b prC� dY�rly htatCatu 4637-sG-OE5d' % `,,ry, '-_—._'"ti°^.. LOT "?� ,• _'3�0 Tet,It3G��.JAi'.ra f ,° 0.5120 Acre ��' RICHARD RAYMOND PEACE N yp an ` '4ar P A • COHiNfE TAYLOR 00, PEACE —13 f Htd,"svn ;.ane- 10, 30 0 3060 90 ao�,� ,rt+:ldti �:� ►� t: GxAvinr; SCALE --`= FEFr t �3CN3 nQtila SURVEYOR'S CERTIFICATION Thls Su"Y w,13 prepared wlthD ,t the benefit of a tale abwr+;ta,.A a"d 'S made attb^t to tiny dlaaropenr„taa which may L+ d,w0f ,ed by a thorough and acCurato tile simrch All A,ems sht)vm are by Coordinate C<)Mpt,tatfon Method, 1, David 0 Jc,dan, Profi sslonai land Surv,yor, hemby c-l;f l' tttlt111J11, hereby cartfty that this plot was siravvn under my supervision C A,QQwar�� froir, an su4Uai yurvay n'rada under my ttuprrviaion vv,th a ,��`t,� . �Z j/ prZwon ratio of 1 10.0004. .:' .�.� •Q'tEc,SIQ,t; ;�� ;• JWitr)pse rn .mol rate :his ZOtO L-3940 p I L,canse /3940 ' Illi 11114 1�1� LOT h ^ h b �wwaaaaas.�ae . B. 10, Pg. 51 MERICAN / �m �<a pi.ANNiNG & Q m I SURVEYING o Bo, 3TATEE, N i. ;968 tai ,c i 9E'81 p r...,.n Lr U A J lzsW1 Ret I" —4332 1 Q N.M.J. rt41 It) - 51 I ♦ _ �� $ SC ``h=f@t ry b prC� dY�rly htatCatu 4637-sG-OE5d' % `,,ry, '-_—._'"ti°^.. LOT "?� ,• _'3�0 Tet,It3G��.JAi'.ra f ,° 0.5120 Acre ��' RICHARD RAYMOND PEACE N yp an ` '4ar P A • COHiNfE TAYLOR 00, PEACE —13 f Htd,"svn ;.ane- 10, 30 0 3060 90 ao�,� ,rt+:ldti �:� ►� t: GxAvinr; SCALE --`= FEFr t �3CN3 Google Maps Map data OO 2017 G000le United States 500 ft Page 1 of 1 https://vwvw.google.com/maps/@35.5943679,-80.9093962,16z 10/21/2017 MapCard - Print your custom map Page 1 of I 0 0.5 Mi I0 2000 Ft http://map-pass.mytopo.com/mapslprint_local.asp?print=l &scale=5.00&layer=DRG&lat... 10/21/2017 Page 1 of 2 file:///C:/Users/Jennifer4/o20Ford/Downloads/20170517 101126 resized.jpg 5/17/2017