HomeMy WebLinkAbout20171393 Ver 1_Shoreline Stabilization_20171030Duke Enemy Excavation Permit Application Form
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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
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Google Maps
Map data OO 2017 G000le United States 500 ft
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file:///C:/Users/Jennifer4/o20Ford/Downloads/20170517 101126 resized.jpg 5/17/2017