20170421 Ver 2_Shoreline Stabilization_20171127

DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM lqt�_
FOR DUKE ENERGY USE ONLY
Duke File No.
1
Application Fee $ Security Deposit $ Check
Date of Duke Energy Lake Services, applicant and/or contractor on-site inspection
Date Final Protection/Avoidance Area Markings Field - Verified _._
Approved to Start Work Bev
Date p'letiou'�RWAwed
1 Date Passed Closeout Inspection*
Date Recv'd _ �,_ Initials _ �.__ —
s Date O S G). 171 lnitials.__A�2al _..
(Print)
(sign)
-_- 'Date of Amy Approved Exwrision
Initials
,
Initials
;Date
'Initials yt'
Any Stop tVori Orders or SMC, Violations*7 (check one) oyes EiNo (If Yes, explain in PART V)
?3ar�1 � IR.erWIL4er.'' _ ;!t amps r}ax:' raaart t?a/a ase das ,rn681s
* Forward copy of approved application (all' pages, plus any attachments that i°tnhe Energy changed) back to applleau
wrath tpprrsval t,errer r a f sem. r ,�, s, It r�r a• crani iu crcr: i~ cc , s: uc av�y'' v'Wf'+tatrA 1
Orders with application
PART 1. - APPLICANT INFORMATION (Please Print) —�
Name
e.(C GA { 0'(-S Telephone (�) fio C
Lake Address�� -I�w. Mailing Address 7
(Ifdifl'erent) 7 2017
Ce•rr� u s C 61,1
nen .,. _ _
Contractor Company
Contractor Contact Person
J
Telephone i )
LAKE LOT IMS ORMATION
Lake \ or*) County 1� 1N -City %�r� t t'tk 5 State _ l.r Tax Map No.
attS 1, � - 2 i,cst SizAeres
t r
Arm riu's e arty j ra-At `:i+ „$s '? j;r�ieek 't ycs o ;�f'i?es, im,-fzrde names, addresses,
p#iane nos., lot res., lot
sizes in PART V — ADDITIONAL INFORMATION} * Co -Applicants exist when the proposed work is being done under a
single application, will' be perforrr d by a single contractor as one continuous project and is done to bencftt multiple owners !
1_€ti4C
Q,!dM
S _ PCr6 wtrtSrrq B g"� !C 6eVrZ }P!y11Xm -nx C --!,MK for (% 4,p±YC�•'.i'o.' ° -dog "m vy, secur:-
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: Inidaliving this portion of the
appdcation by u DELSR in noway constitutes aproval or eminent apprvvW of the excavation or any other lake use
permuting activity.
nate of on-site inspection D—_') C> l l i Initials (Duke Energy) << (appliennticontractor)
P l 4i 1A
rev 9/19114
r3+ske Enec�ry � -
Excavation Program
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application 113 10-docx

DUKE ENERGY EXCAVATION PERMIT APPLICATION FORINT
PART H. - DESCRIPTION OF PROJECT
A. A&SIC L —
1. Type of excavation: (check one) New excavation ❑ Maintenance excavation
2. Purpose of excavation: (check one)Boat Access Channel 17 Water Intake Channel
Wastewater Discharge Channel ❑ Other (specie):
3. Lake mw dory: (check a w)rrvate ❑Raidentiai Marina 0commereai Marina
Public 00ther (specify):
4. MaX. ,EXCA *-9ion A Dii-nmSioM (H): LW9tk #� wida, 3--qy.,,h _
(Note: include additional area dimensions if necessary so response to #3 below equals max. area dimensions in #d)
5. Volume of Excavated Material (TOTAL for the project): � a Cubic yards )
6. Type of material removed (applicant determines by field sample if practical): /'Y1 51( 4-
7. Excavation Site area:._,_O. 0 3_ Acre (s) Disposal Site area: Acre (s)
S. Total Disttxrfied Area (including equipment siring area): 0 • _ A (s
9. Does the project meet the requirements of the applicable General Permit? (check one) *Yes ONo
10. Do you claim title to the disposal area? (check one) *Yes ONo
11. Do you olairrl:title to the equipnwnt shwing ? (check one) *es UlNe
12. Are there any water -treatment facilities within 54 feet of the proposed excavation area? (check one) oyes p(No
13. How will the excavated teriaj bentrapped an4 the erosion controlled? (e.g. see attached erosion control plan and
disposal area design):_y ,1/t✓� —
14. Type(s) of excavation equipment to be used:
15. Will waters or wetlands be crossed in transporting equipment to or from the site? (check one) (Yes No
(ifyes, explain
i6. Wiii return waterre-entfffner=mAr?l Cneek one't Dym �,,o UN/A off Yes. specy poins(s) ofre-emry 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, speck the existing permit number. #-No, include a scaled &awing of the proposed facility) Permit #1
l% To* .pWmed dvn6m of work (fitick4okfirst, equOwe& niablUzatioA excawgim AhroughfiAd + gation measures
complete): BTAk %.J%Li r F FI tSi / F
(Monl%) (Year) (U.4h) (Year)
Duke Energy Page 2 of 14 rev 9/19/14
Excavation Program
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application 113 i4.docx

PUKE ENERGY , CAVATION PLY. , T APPLON FORM
PART 11. (Coit#.meed)
B. PROT Ti )i / "QMAKE AK A DESCRIPTION
Complete the fbl# 1 Vying table including all I14W areas witbin and irmr,', tiately adjoining the disi,gbed area:
P121. 'lien/Avoidance Amp to
(" %Meek all that apply) Atreage
a. Mare14nd, swamp, ponds, ben0 10sl
aquatic vegetation Qr other potential wetland A (circle all
that apply)
b. Buffer Zones {specify width & ,s- force of
requirement}
/, JA-
W OM w;1� ( AVO- -
hy b
c. Envirolmental Areas as ident Y+.:l by Duke ��
Energy 6
d. Natur 41 p identified by D5-' Energy `
e. Histor c; properties (spec(fy) JIA
f. Mare Oj threatened species Qpec,y)
:!'Pork Area Dwe. ID ' Avoid (A) or Mitiff- l t(M
Duke Energy Page 4 of 14 rev 9/19/14
Excavation Prowxam
c:\users\ann\aplA Ata\focal\microsoft\wi 1 101ows\temporary intern -A. files\content.outloo)e,rrp7eolj9\c-w excavati()n application 113 104 ,;x

DUKE ENERGY Ej�rAVATION PERVIIT APPLICATt1)N FORM
MotiliMethod M
Pratt _*n/AvoidanceAreas Aurtrox.
(r. trick all that apply) Acreagea N.York Area RM ID Avoid (A) or MitizaLc' M
!;. Buried -qas, water, sewer, comntt..lications
or electric lines (cir, �!e)
At
hImpact Minimization Zones as WAIgttified by
Duke Energy M1 Or
i. Other a-gs requiring specificauc„a.ance,
protection or mitigtion (specify)
* For "Field ID” column, specify entity o, Berson that performed th•` identification and how it ,%,as physically marked (0!!. Duke Energy (John Do ; ).'Pink and purple -dotted rape,
Corps of Eng. (J&,,) Smith)/ yellow flagging). For "work Area Dwg 10" s" column, show the sym ,t>1 that is used on the dra , rings to identify the prole, don/avoidance area.
** List and attac', thitigation plans
Duke Energy Page 5 of 14 rev 9/19/14
Excavation Pros+ tem
c:\users\attrl\app,'ata\local\microsoft\wit::lows\temporary internot files\content.outlook\,, tp7eolj9\c-w excavation application 113 104 it x

DUKE. ENERGY EXCAVATION PERMIT APPLICATION FORM
C. APPLICANT'S SIGNATURES
Comments:
Applicant Name (print)
Applicant Signature*
Co -Applicant Name (grin# -
Co -Applicant Signature*
Co-Anulicaat Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
C€3-App~L'caa: '!5;.1 natu.e*
WIF
Lot # '1 o0
Date � ./0. r7
Lot #
Date
Lot #
Date
Lot #
Date
Lot #
Date
Lot #
Dae
*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 tetter of appiwation package)
• INCLUDED A SINGLE CHECK TO DUKE ENERGY FOR THF APPLICATION FILING FEE AND SECURITY
DEPOSIT
"• ^��^ �: .,�.,.:>'ti;vt'.�"'°��' . �^,�rn�-;� .,� �� �ti .,ix ��0:`.�.a�Aa;i.3SSS
•
INCLUDED ALL REQUIRED DRAWINGS (INCLUDING PROPOSED FACILITIES), PERMIT # FOR EXISTING
FACILITIES, SURVEYS AND PLANS
• INCLUDED COPIES OF DEEDS AND AUTHORIZATION LETTERS
Duke Energy Page 6 of 14 rev 9/19/14
Excavation Program
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application 113 10.docx

�v7
State of North Carolina
Department of i rrvkmff M and blatural Resources
DWR
Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSCP 10-2013
h lir, +-chili-,-r+inr� r��Aiti , n C rm
ihrne rnr;`: S M tr'o 3. i t,.ra:,on inti) 'a.�i�t�a�l�mar3#c�� ar3r\ tL�Q arnrntsyat;nn ee.s, ..1►.d. be Sent to.
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
L Applicant Information M15A NCAC 02s i .05 M atj
1. Owner Information
Name: Information
SA-111Vy'S
Mailing Address: 3c
e Yfcr*e ;-urr-iber: 1;V +rte:;-. 40 1 - rax Niiif+be:
E-mail Address:
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
htto://www.saw.usace.armv.mit/Portals/59/docs/reRulato re docs Perin is SAMPLE AGENT AUTHO
RIZZATION FQgM Jfl must be attached if the keent has signed this aoolication.formax.
Name: %� TWC '•_ Iee''Y�/"'/y
Company Affiliation:
Mailing Address:
Vep�lo ►e'%%Urn' r:
E-mail Address:
Person to receive the
IL. Project Information [15A NCAC 02H .0502(al & (b[l.
1. Attach a vicWdty map (ire. street meps cWarly showft the location of the property, with
respect to iocai 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: SSCP 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)
County:
4-AZ &A-11? Nearest mown: I -A e l%S
Subdivision name or site ad re(include phase/lot number): TA - &i -sexA /07' 3 eO
Directions t site- please include rear! times and numbers, landmarks, etc.: T777
Latitude (in decimal degrees) 'V- � Longitude (decimal degrees) & - 7.32 r �
5. Describe the existing land use or condition of the at the time of this application
(residential, undeveloped, etc.): �e5 Z1'4 �
7. Lake/ river/ ocean adjacent to property: 4A xe- Ao rin,4AI
8. Describe proposed work (include discussion as to how h rdenling of shoreline has been
avoided, or why it is necessary): ti -Ce -e sS
:H k I I�VI 14 YY 00::1
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool lakelevel/ Normal Water Level in square feet or acres:
46/X 30tx z '
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.! ku r? tl)-- !^atlr+vi�1 ",00 takte (raveY f�lnrm?� Cter'-evel.? f-, 50Feet Iand-r z,A
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):
Owner/Agent's
Printed Name
e
15A NAC iQH i-502(f'l7
'Agent's signature is valid only if an authorization letter, from the owner is provided.
Date
FORM': SSCP 10-2013 Page 2 of 3

RA PwWl
Normal WateUevel
Shoreline
Lake
(At Full Pond/ Normal Water
As,
169334
ra��sarra�
Please approximately sketch: the following information on this plan (provide dimensions for each
it
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 cra�nstructio+n access .cor -dep rs
FORM: SSGP 10-2013 Page 3 of 3

S1 TE
Y ATi7CW RD
VICINITY MAP
NOT TO BGAIE
AREA 5LIMMARY
LOT 300
0930 ACRE
36,152 SaFT.
NOTES
1) Ana errrmFad ey GaoFrar Capubtbn WMae.
Z) "mi, muni to my keb fMt mar r Asabaae by a rM
and aaawvfe ttlr casae,
J) PVenrY arer dear (o mr A'rrtrrlfenr, faeenrntA and/
Rrgee N Aeyr N r.md me Mar .er N ov n M.y .Ort
4) A 000 A N cWy Roomy b boob! F a 9raaAN Oral Nang Afr
AE) m fee by � FEYA FLOW McSIR.NM;E RAZE YApi
Ser Abp !Omen J7f0I62JOL1C - [NOON eoI4 JA/zom
{� Ab liaeaNc AlorNwnr ANrnd NMF IOGw' N S:b)ral P—ty
.fi% `a.lerw Apar is SaWp bw � iR
�) Eubtiol t4apnfy
CUM TAMP
NLlY DELTA
ARC
RADII7S BiAR7NCDISTANCE.
LNlE TABLE
`\
NUN BEARNG DISTANCE
Ll 52MVIVIN 1 24,45'
\
L2 S3635'00'E
2a.9r
\
U 5109200 W 1
19.31
IA 544Y2'00 E
57.74
\
L5 S1553'DO'E
43.32
\
L8 579'44 f70'E
24.]1
L7 s1m9oBw
n.az
\
N O
LEGEND \
FROANrY tn+E (P/7)
I RMT OF WAY (R/W)
A V-WWG PROPFRTY Lw
LEet7 -ire
V -------------- FX&L POW
_________ FEMA n0O AYE
FENP6
PDIIER LME
BYILOYMO SETBACK LRE
So' wGUA?7 BORER
EX ENS7WC
PP POWN PLY£
NOW WATER AATER
TP 7ELOPNONE PEDESTAL
PS PRESSURE SEVER BOX
t
40 0 40 80
SCALE :1' = 40'
wir'i r;h2+ ar4a�'.� m,ati...M1 •;v .':� ai'i�<n ih:.F =�. ,'+T^.7:85•S+tcJ&44is RtT4-tG.F
iVilliams Land Surveying, Inc
e74
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pboRs.
(7W19M-9C06 - atrya rOOR/grptTTdtrO0e7rsutQnet
far feTtz.�
A /Mayr E N6 - —M fMt Mr Plat er ser+ ererr mY.% e
Nan m mbd re.e Baer Ones mY 4mrMNm (Are s �'i�Mw � F
Aber :7pN, ReAr Iii ar eMr n/eerar seer farm
Ma M. fam0►'ir na res a. wr+r o. ta.r w. r..r F,.n
FAmnetbr IErNre F r ewr sM afar a r OMS
Mrt M refb N Mreobhn / t : f0,Qx1F: ere Noi Nr Mrf meeb OM
..rW0. to N 6e JTenevAr Nnmro. a Lore YwMyp F tZ R•vNr
aamnrp r Mru orrF. AsnlrYbatlu ber JMr r. OAmN ae. 61rcBrr IMIMO -,r of m r MV po a n po om4 N rae r not
me ea
ape a ass rbrt n d." r.Wft ~.
TFrr .21st eby Of AWK ZW
1 77Oe OfFOEtI�IT tIPgBLILLY 1�T7� AND ]YAO®
Mr84-NA.Nie Nlfl'YJ. YIO1 Nrtg.SSilM9RkY:M1..td3trY11'M'lld��1 T.YAU1Ci[T
7harro6 E. N9trms NCPLS 4718
,44��jACARp<i
r 4Q SEAL 9!':
Alagerr4
boundary and Physical Survey
16833 Jetton Road
C.L.&T. CORP LAKE NORMAN
RECREA TION LOTS
SECTION 2 .LOT 300
Torn of Connelius Mecklenburg County, NC
..Aa,rcwi # :urvs ,lt1& - LB 27g4,�'-i,67 - 46E 17-549
Property of: Kimberly Carr Walls

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