20171245 Ver 2_Shoreline Stabilization_20171030

Duke Energy Excavation Permit Application Form
FOR DUKE ENERGY USE ONLY
Duke File No. r
Application Fee $ Security Deposit $ Check # Date Recv'd Initii�l3 3 Q 20 7
Date of Duke £ntrgy Lake Services, .applicant and/or contractor on-site inspections Date I
1 BUFF R p
I
Date Final Protecation/Av6dance Area Markings Field-Veritted Initials
Approved to Start Work By * : Date
(Print) (Sign)
Date Completion Required Date of Any Approved Extension Initials
Date Passed Closeout Inspection* Initials
Any Stop Work Orders or SMG Violations*? (check one) OYes ❑No (If Yes, explain in PART V)
i14Y :illi
* 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 aaplication.
Part I. Applicant Information (Please Print)
Name Telephone
��cr Telephar:e---
Email address: ; 5 �ttt-�doy C� q 11V1M1-� • to r► -
Lake Address
/ 8/01 �h" At d/Ne.r �
14 C,
Contractor Company
Contractor Contact Person
Mail inF Address (if different
!TVW1t VJ
;T-opjc i 'eect
Telephone Te 4 0 - S1(
Contracor'Eniai Address: /�C 5 � Com' "N � rel+nt • Nc '�
LAKE! SLOT INFORMATION
Lake IV 0-,fM AW County M «K City
Subdivision
6 rNc 1;tcs
Lot / Section No.
State 66�- Tax Map No. 00 19 4
Lot SizeO•gcres
Duke Energy Page 4 of 14 rev 216/17
Excavation Program
11

Duke Energy Excavation Permit Armlication Form
Are there any Co -Applicants*? (check one) ❑Yes ONo .(If Yes, include names, addresses or
lot numbers, phone numbers, lat sizes in PART V — ADDITIONAL INFORMATION)
Co-Appiicants exist when the proposed work i'8 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 appRcniion 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 I'
Initials (Duke Energy)
(appiicanttcontractor)
Duke Energy Page 5 of 14 rev 2/6/17
Excavation Program

Duke Enerav Excavation Permit Application Form
Part It. Description of Project
A. BASIC INFO
1. Type of excavation:.(check one) l*New excavation ❑ Maintenance excavation
2. Purpose of excavation: (check one) Boat Access Channel
0 Nater Intake Channel 'wastewater Discharge Channel
❑ Other (spec):
3, Lake user category: (check one) Private ❑Residential Marina
❑Commercial Marina ❑Public
❑Other (specify):
4. Max. Excavation Area Dimensions (ft): Length �a iuidth `?G
Depth
(Nol so reyp swe lel 0 oeiow a Caw tnLLYarea
dimensions in #4)
5. Volume of Excavated Material (TOTAL for the project): 4W- Cubic yards
b. Type of material removed (applicant determines by yield sample if practical): hu "i 51-H-
7. Excavation Site area: • 0 7 Acre (s) Disposal Site area: 07 Acre
(3)
8. Total Disturbed Area (including equipment staging area): Q • I Y: Acre (s)
9. Does tete project meet the requirements of the applicable General Permit? (check one)
l es CNo
10. Do you claim title to the disposal area? (check one) LI -Les ❑No
11. Do you claim title to the equipment staging area? (check one) WYes ❑No
12. Are there any watertreament facilities within 50 fleet of the proposed excavation area?
(check one) f3Yes o
(If Yes, specify):
13. How will the excavated material be entrapped andt e epion controlled (e.g. see attached
erosion control plan and disposal area design): S -tY4cl-S. txlr
Duke Energy Page 6 of 14 rev 216([7
Excavation Program

Duke, Enex, �y Excavatlb. Perm•t Applic a►norm
PART U. (Continued)
B. OTECTION / A 4? DAWCE AREA OES�TION
Complete the following; table including all lard areas within and iimnediately adjoining the disturbed are' >
Protection/Ayojdan.Artyts_
(check all that apply)
rotntcatlon
re
Metho '
Avoid A cVtiti,�ate M
, Fit ID
Work Area
a. Marshland, swamp, ponds, beneficial
aquatic vegetation or other poteatiatl wetlands
(circle all that apply)
b, Buffer Zones (spec -6 wie t & source
of regtairement)
h x -Q A*I
// Va(
�c. Environmental Areae as identified by
Duke EjieW
d. Natural Areas as idO itified by Duke
Energy
W
`e. Historic properties (*pecif)
d
f. Rare or threatened species (specify)
Duke F=gy rage 8 of 14 rev 216/17
.Excavvion Program

Duke Energy Excavatio;A Penrdt ADplicatt u For --
I!rot�ction voidan Areas
(check al! that upfy)
j,,Zo:x
a
}ti tion
Method *
Work Area
Avoid W L iti"k (M)
_Ile�l
field �D
AIIA
(
Buried gas, water, seer,
communi, _ations or electric ling (circle)
h> Invact Minimization Zones as
identified by Duke Energy
I
/ A'
/14-
1. Other areas requiruig pacific
avoidance, protection or mitigatirn (spec)
* For "Field ID" colurno; specify entity or pF rson that performeO the identification q tid how it was phyt;tcally marked (e.g. puke
Energy (,john Doe)/Pink awl purple -dotted tape, Corps of Eng. (Jo'in Smith)/ yellow i)_agging,). For "Work Area Dwg ID" column,
show tb Symbol that is usf-3 on the drawings t� identify the prott,(tion/avoidance area.,
List and attach mitigatli)n plans
Duke Et*.,�gy Page 9 of 14
rev 2/6/17
Excavatigoi Program

Duke Enersy Excavation Permit Application Form
C. APPLICANT'S SIGNATURES
,�
• r `� , �� al Comte �'�
Comments: (�
M
Applicant Name
AppIlicant Signat
C-19117
*Per my signature, the information provided in this application is correct to the best of my
knowledge.
Duke Energy Page 10 of 14 rev 2/6/17
Excavation Program
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-App4icant Sign e*
Date
Co -Applicant Name (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 rev 2/6/17
Excavation Program

Duke Energy Excavation Permit Application Form
14. Type(s) of excavation equipment to be used: r
15. Will waters or wetlands be crossed in transporting equipment to or from the site?
(check one) DyesNo
(Ifyes, explain)
- X
16. Will return water re-enter the reservoir? (Check one) OyesI o ON/A (If Yes, sped
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? #Yes ONo
(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 mobilization, excavation
through final mitigation measures ,complete?:
START / FINISH /
(Month) (Year) (Month) (Year)
Duke Energy Page 7 of 14 rev 1W 17
Excavation Program

State of North Carolina
Department of Environment and Natural Resources
DWR-, Division of water Resources
Dh4sion of Water Resources IM NCAC 0214.0500 — Water Quality fin, Shoreline Stabiitzation
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
&AufferFerm tfragUnit
1654 Mall Service Center
Raleigh, NC 27699-1650
i. Applicant information [15A NCAC 02H .0502(afl
1. Owner lnforr 01`011
Name: rr^.
Mailing Address:
Telephone Number:
E -maid Address:~
S'A" A -t v
2. Agent/ Contact Person information
Fax Number:
PAA; 1. 69fN
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
httr)://www.saw.usace.army.mil/Portals/59/docs/reitulatory/readocs/Permits/SAMPLE AGENT RUTH
ORIZATiON FO no must be attached if the Agent has, signed this application form.
Name: Cb rh Bri[kAe-S
Company AfOraflon: r "-,' G Ai
Mailing Address: 3$ K r i d.cA-rmi Ww
[A00"syi 1 -f & xA5-
Telephone Number( -701) 4 � 0• 5� 11 Fax Number: ?$ 4..4&0 . ��Ifoq
E -magi Address: t' C .5 ,e A vJA- 0 • WW 5 "%cA ww► . Ale-
Person
ePerson to receive the Certification Approval: e- D JZ3 eti d yes
IL 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 r aiy ed ske sNowMg vro5er1r ;Normdar;�es ana MDpose6 aoca�ticros of
vegetation clearing, structures (buildings, retaining walls, docks, impervious surfaces,
FORM: SSCP 10-2013 Page 1 of 4

construction access corridors. You may use the diagram provided at the end of this
appllcafflon form.
3. Attach a photograph of the shoreline/ bufferproposed 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: KtC.K Nearest Town: COrNCI %u 5
Subdivision name or site address (include phase/lot number):
Directions t site - please include road names and numbers, landma , etfj.: -7 7 N/
00 Jo ?D til Af e- r
Latitude {in dedmai ftrwsl �5 • 33 Longitude (decimal degrees) SP • 2a5l 3'T
5. Describe the existing .land -use or conditiori of the site at the time of this application
(residential, undeveloped, etc.): 1r't 51 d. ��►'�
6. Property size (acres): _ O . S 1
7. Lake/ river/ ocean adjacent to property: A -A k e ,NO r -m* ^/
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): er-eell t 4y, 4966"; Ac4{ SS
9. Will work be conducted from land? 9 From water? W
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, 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): k r'&�, 4 l5 e
3 _A»,S uA A Lvay '0/q1
Owner/Agent's Signature's Printed Name Date
JJ15A NCAC 02ii .0502f }
Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

—Ke
( tFull FondJNorma#_1Af�a,ter 3)�
\�
X :A
Full Pond/
Nortm Shoreline
l Wa tr l.ev�l
i
0l�'�� % t
5e-Ale,11*1"I VC_
A'Cr"t 55
gg30 5.�.
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: SSCP 10-2013 Page 3 of 3

,3; 4:
C
F
CA
WATERSIDE DOCKS &PIERS
LAKE NORMAN
SHALVOY-JOHN CONNER
AUG 3 2017

NOT1>S-
I. NO NCOS MONUMENT
FOUND W ITIHN 2000'.
2. PRTN'ERTY MAY BE Sk rBJFCT
TOc'CNGRCOVENANIB,
RISIRICCRTNS. FASEMENTS
OR R1614TS-OF-WAY NfAT
MAY BE OF RECORD.
3. SeFBACKS SHOWN ARE PFR
TOWN OF CORNELR,iIS CR
7QNANG. Sts O3ACiS Ai2E AS
FOLLOWS:
FRONT -39
SIDE -1L1 U • (R) 20'
REAR -30 J'ROM LIAKE
CONTOUR. OR 25' FROM
PROPERTY LING. WHICHEVER
IS GREATER
i. THE PROPERTY 13 AL,LOWFD
W -40F THE LOT AREA POB
MAXIMUM iMPERWO(JS
COVFRAGF_ PER THF
CORNFAJUS PLANNR40 DT1'T.
S. $3W RlIiNCRNY'M ROAD
W(Paw w WAY SHOWN ON
111, PROPERTY IS BASL'D
UPON MAP BOOK 28. PC 10 &
MAP HOOK 27, PO 441, AND IS
OFRSCT 60' FROM THE RIGHT'
OF WAY LINES AS DESCTUHEO
IN SAID MAP BOOKS,
S. THE INTENT OF THE 60' JOHN
CONNOR RIGITT OF WAY IS TO
ZAX
NORM AJIMM
ASSISI IN 17EW3.0nM 114E /
BLTLnngj CEIVFL.OPF OF TITF
PROPERTY. TT IS NOT 1111:
INTENT TO DEDICATE: RIGIIT
OF WAY.
7. CO%UC'r WIRtCiQVC•RNfNG
v
�Zw
6GENCY FOR PRGVAHJNO
-ANDDEVEIOPMFNFAND
•0'
WNING REQUIREMENTS
��
'RIOR TO DESIGN OR /
. ONSl71UCTION OF ANY
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LEGEND:
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CORNER AS DESCRIBED
O
e �j7 -1 y�
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Eva C. Connor
COMPUTED PONT
•
r
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UTILITY POLE
O• Q
#
Si/BJECT #PW'kTtAY ;LJNE
On
ADJOWER PROPERTY LINE
LJ
BUN.DWG SETBACK —
h
J=
O3ffAD U'RL171E5
\�
ROAD RY;FFr OF WAY
NOT1>S-
I. NO NCOS MONUMENT
FOUND W ITIHN 2000'.
2. PRTN'ERTY MAY BE Sk rBJFCT
TOc'CNGRCOVENANIB,
RISIRICCRTNS. FASEMENTS
OR R1614TS-OF-WAY NfAT
MAY BE OF RECORD.
3. SeFBACKS SHOWN ARE PFR
TOWN OF CORNELR,iIS CR
7QNANG. Sts O3ACiS Ai2E AS
FOLLOWS:
FRONT -39
SIDE -1L1 U • (R) 20'
REAR -30 J'ROM LIAKE
CONTOUR. OR 25' FROM
PROPERTY LING. WHICHEVER
IS GREATER
i. THE PROPERTY 13 AL,LOWFD
W -40F THE LOT AREA POB
MAXIMUM iMPERWO(JS
COVFRAGF_ PER THF
CORNFAJUS PLANNR40 DT1'T.
S. $3W RlIiNCRNY'M ROAD
W(Paw w WAY SHOWN ON
111, PROPERTY IS BASL'D
UPON MAP BOOK 28. PC 10 &
MAP HOOK 27, PO 441, AND IS
OFRSCT 60' FROM THE RIGHT'
OF WAY LINES AS DESCTUHEO
IN SAID MAP BOOKS,
S. THE INTENT OF THE 60' JOHN
CONNOR RIGITT OF WAY IS TO
ZAX
NORM AJIMM
ASSISI IN 17EW3.0nM 114E /
BLTLnngj CEIVFL.OPF OF TITF
PROPERTY. TT IS NOT 1111:
INTENT TO DEDICATE: RIGIIT
OF WAY.
7. CO%UC'r WIRtCiQVC•RNfNG
v
�Zw
6GENCY FOR PRGVAHJNO
-ANDDEVEIOPMFNFAND
•0'
WNING REQUIREMENTS
��
'RIOR TO DESIGN OR /
. ONSl71UCTION OF ANY
Z
MPROVEMGMB.
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O'
TOTAIARIA
i 22,62�Ff
/
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0.519 ACRES
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s*
001.841-34
SUITE A
Property of
Timothy A. Guerry
'%q�0•,ti,S»UR`i, 0
{
Jennifer G Guerry
Wrrmm
Cornelius, NC 28031
DS 28222, Pg 955
t,3765O,R.
Deed Book 2578, Pg 343
MB S4, PG 907
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i cam nx'ri4"W 155.4 ` TOTAL 1' PIPE
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DARYICIP.LONG P.L.S.=*Ij'r.
s*
001.841-34
SUITE A
Property of
Timothy A. Guerry
'%q�0•,ti,S»UR`i, 0
18335 Old Statesville Road Ste. A
Jennifer G Guerry
/
Cornelius, NC 28031
DS 28222, Pg 955
Deed Book 2578, Pg 343
MB S4, PG 907
1�
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A"AW
�24Y
/
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DARYICIP.LONG P.L.S.=*Ij'r.
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SS LA15
SUITE A
Property of
CORNELIUS. N.C. 28031
(Wi 765-5134
'%q�0•,ti,S»UR`i, 0
1' .IyS.ica., Nury ✓y V! Y N it' U1 .iom Cor -mar A1e1/aa
L3
\L4
m Property
' /Im
/// Inc.
Property of
As Recorded in:
Site Address -,Address -,Surveyors,
18101 John Connor Road
18335 Old Statesville Road Ste. A
hin Shalvoy
/
Cornelius, NC 28031
Co ieti_ NIC 29031
`0-t- 63�3 1N lilYdlll# r at
Deed Book 2578, Pg 343
Mecklenburg Col3nV
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L41 3.711
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/
LB 520.1
1.20
L8 7.78
1A 7
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/
CURVE TAME
CURVE I LENGIN I RRIAIS Cl10RD CHLIRQ MG
/
el 82: �,2 M4
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C21 3IZ641 37.1551 310.98 88'04
1' .IyS.ica., Nury ✓y V! Y N it' U1 .iom Cor -mar A1e1/aa
Professional
m Property
' /Im
/// Inc.
Property of
As Recorded in:
Site Address -,Address -,Surveyors,
18101 John Connor Road
18335 Old Statesville Road Ste. A
hin Shalvoy
Deed Book 2604, Pg 336
Cornelius, NC 28031
Co ieti_ NIC 29031
`0-t- 63�3 1N lilYdlll# r at
Deed Book 2578, Pg 343
Mecklenburg Col3nV
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