20171499 Ver 1_Shoreline Stabilization_20171121

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500— Water Quality Certification, Shoreline Stabilization
FORM: SSCP 10-2013
,�)a_;9(� Shoreline Stabilization Application Farm
Three copies of the application (including attachments) and the application fee should be sent to:
DiViSiiOM Of fttt�
401 lX S7 ibl t'er l�efl�{ t1F.l 11 %b' .Y 1�i:
162 ;' Ma i! St:r:ice Center
Raleigh, NC 27699-1617
Applicant Information [15A NCAC 0211 0502(a)1
1. Owner
Name:
Mailing
�I NOV 2 1 2017,".
i
.1E T1rr,�Y;
Number:_
E-mail Address: #4 rrrZY, J
2. Agent/ Contact Person ormation
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
i►—plw,savu.usace_army millPortatsl59ldocslreguiatory/reedcvMPLE AGENT AUTHO
RIZATION FORM ndf) must be attached if the Agent has signed this application form.
Name: UO..^J,1
Company Affiliation: Y7 3
Mailing Address: n
Telephone Number:U. Fax Number:
E-mail Address: i
Person to receive the Certification Approv Lit/.
v
II. Project Information [15A NCAC 02H .0502(a) & (b)]
L. Attadi a vicinity reap i.e. street_ map' c'earfy 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
vegeta- iOn ctearing, structures jbui sings, retaining Wars, a0cKs, irrtperviru s surfaces, etc.),
rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations, and
FORM: SSCP 10-2013
Page 1of3

construction access corridors. You may use the diagram provided at the end of this
application form.
3- Attach a photMMPh of the shoreline/ buffer
sone sort a Yam shovel proposed to be stabilized. (include a scale.of
4.
l�rr►dte, �}
iacation of the property (where work is to be conduct
County: Ne. roam: CO� � i us
Subdivision name or site addre4finclude phase/ipt number): q
Qkgcdons to site
5. Describe the existing land use or
6. Property sire (acres):
7.
8. Dftcribe used wmlc(kidd ,
9. No work be conducted from land?
10.
of the site at the time of this application
n
Of-shorekie has been
From water7
Totem amount of &Wrbance (includk* all exuviation,Lp rap,
.
the normal pool lake k,neV Normal water level incres:
11. Total amountof C?3. 7 2nV O i k �t i� '
(� ► back_
walls, etc.) ' �,'
the normal pool lake level)Ncx mal Water level and 50 feet
Square feet acres: _ r i� A- 7 end -ward in
n
12. Please describe the vegetation above the norma} pool Faire level/ Alormal !water leve) and St?
Met to tw *pMVWd fi tW vf
f
r � �
s Suture
N* Printed Name
15A NCAC 02H 0502[f;i Elate
'AgaftsVnWwe is Valk! onlY yon ouMwhatio» letter from the owner is prev,deCl
FORM SS6P 10-2M3
PSW2of3

Lake(At FUR
s p.r i z't3
! ; i�pfF7ii 1' Baer d �VN3;
Y
Full Pond/
�
Normal Wmter6t,euel
r
.. 04 NOW
Shoreline
.. MOM 004 w1u,.
,
Y2, ..
item,such as loft x i0oft)-
1-Oposed Vegei„alion cleating
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 watts, docks, etc.
5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
•.••••v •rv.. vi LU.'.Sii ii C- i1 OcceJ.]-..
l.ar ridorJ
FORM; SSGP 10.2013
Page 3 of 3

Duke Energy Excavation Permit Application Form
ICOR DUKE ENERGY USE ONLI
Duke<File No:
Application Fee S Security D4m*,S Check
Date Raxv'd [aitiaYx
{ Date of Duke Energy Luke Services, applicant and/or contractor on-site inspections Date
initials
Date Final Ptotection/Avoidance Area Markings Field - Verified l_
Initials
Approved to Start Work By * :
() lit
Date Completion itequitrci Date of Any Approved Extension (Sign)
4rri4iala _
Date 1' NW Ckwout).ncpection* 1"WS
Any Stop Work Orders or SMG Violations*? (check one) DYcs ONo WYes, erp/ain in PART V)
Date Deposit Refttnded. Initials
Date Permit Database Updated__ Initials
* Forwards espy of approved application (all
pages,
Wali Approval Letter and highlight any chanFilille copies tof Approval aqd klke Energy
gy changed)
d anyapplicant
Litt back to Stop Work
Part L Applicant Information (Please Print)
Name 011 H V • Fy-a Ayd
Email address:
Lae Addre s$ , L
Contractor Company
Telephone 0 - 53- G�?jl� j 5
Mailing Address (if different)
C�wl�l i LAC Yk/7 Zt3ty�
N(Ul I i lAfA
Contractor Contact Person
►i 40-f Ha,011(1 Telephoned(
Contractor Email Address: a di P71� to l r" A,.7
LAKE LOT INFORMATION
�.a?ce roxmty,.�► ,ty' ,,, ;> ; State Tax Map No.
Subdivision Lot / Section No.
Lot Size Acres
Duke Energy Page J of 14
Excavation Program my 2/6117

Duke Ener Excavation Permit ARDlication Form
Are there any Co -Applicants*? (check one) Oyes: ONo.
lot numbers, phone ittumbers, lot sizes in PARI' V — ADDITIONAL INFORMATION) 'vey or
work is being
Performed by a single contractor as one continuous projcct�
, and s done toe under a lb nefit`multiple will be
owners / lease holders of Project -front properties within a single development. The check for th
application filing fee and security deposit should be from the party shown as Ap licant e
several checks from the Applicant and Co -Applicants p
Do not continue thea licatlon ung an on-qf`e q, a }on has y. eouducted between
'''"uk'e �Lrip ' Lake kgimentntive and the applicant and/or the excavation contract a
NOTE: Initializing this portion of the application by a Lake Representadv or.
constitutes approval or eminent approval of the excavation or any other lake i use Permitting
g
Date of on-sW hnwtiowLZ -4l % / "7
Initials (Duke Energy) '"-�-
Duke Energy
Excavation Program Page S of 14
(applicant/contractor)
rev 2/6/17

• Duke Ene E�ccav tion Permit � (/cation Form
Part 11. Description of Project
A. msic two.
1. Type of excavation: (check one)
ew excavation ❑ Maintenance excavation
2. Purpose of excavation: (check one) -C Boat Access Channel
P Water Intake Channel 13 Wastewater Discharge Channel
❑ Other (specify):
3. Lake user category: (check one) 64rivate
❑Commercial Marina [7Residential Marina
s ect C]Public
❑Other
(P ,fy}:
4. Max. Excavation Area Dimensions (ft): Length HO Width 4 0
Depth
(Note: L ulude additional area dimensions if necessary so response to #S below
dimensions in #4) equals max, area
5. Volume of Excavated Material (TOTAL for the project):(p
Cubic yards
b• Type of material removed (applicant determines by field sample if
practieut); rnUC( 040
7. Excavation Site area: n•03 Acres
(s} () Disposal Site area: 0• D3 Acre
8. Total Disturbed Area (including equipment surging area): 0 ('SCO
Acre (s)
9. �� est"€. ONd)6 project O
the requIrenrents of the applicable Gene:., Pe�kLLi�' (check one)
10. Do you claim title to the disposal area? (check one) 'Yes ONO
! l . Do YOU claim title to the equipment :staging area? (check one) ',ZYes 13No
12. Are there any w c- t r-:nI �cilitiL within sn t,� �a.�
(check one) Oyes "t i1 "he
proposed excavation area?
0
(If Yes, specify):
13. How will the excavated material be entrapped and1e erosion controlled? (e,g• s e attuchecf
erosion control plan and disposal area design): l tet'
Duke Enemy Page 6 of 14
Excavation Program nw 2/6/17

14. ;3i of excavation ecrer�p►,_ e
15. Will waters or wd
(check one) i3x� din
equkwtft to of fiva be SW
(j%)ws, awlaini
lb. Will Mtorn water m -enter the MMWii°? (Check one)flYes o
point(s) of re-entry and sh a�w on E ion Arm DrnwiV) �/A (yYes, qwdfy
17. to there anti g facility (e,g. Pipet) tha# accent is being mqi iu to b
"f des, s;�ct,1y th,e T3N° y � the
y). Permit # 8',uer►ntt r�unrber. Mo, include a srA�+ed �g °f wd
18. Total Planned duration of the work (MCWe
d�xot{�i1tl+t+ral iarrt 'fit einomn# �r,►$�iiufan, e�rnvaAian
8,1, U /--9�r lete).FfNMH t
Month) (Year)
Mv,2M7

Duke E-, Xcavation mil Auolication .corm
PART IU„ (Continued)
B.gqL' �N / AVOIIYI NCE AREA DE LI ION
Complete the following table including all land as ;as within and itn ":!iiately adjoining ihe disturbed area:
`muslumfAyolaance Ali.
(check all that apply) A
a. h" irshland, swamp. pond -,beneficial
aquatic vegeta ' ion or other potential etlands
(circle all tl*� t apply)
b. Bt Ter Zones {specify ivf�i%li & sourice
of requirernera{)
Or
IWCt 0.401 SPVO 4
OU Silk 19Y'Wrld +t -LL
VtV4,11.
c. rn xonmental Areas as id:= Rifted by
Duke Energy
d• Na.,` tial Areas as identifier[ by Dube
Energy
e. Hisx.+Pic propertip (spec:
"'VV �
f Ram .).F threatened specter (s-neci
y)
Avoid (A) or -%Ik e i
Duke Energy '�—
Exca%mtion Pro.,t, m # aSe 8 of 14
a,
rr+. '+✓6.�i 7

Uake Enerzv Excaiion,ermit Aoplw atin Form
Parotectfan/.woi ce eas P�Ox
(check all that abnlvl
—I I ................
sewer,
co�.unicaLions or electric Iues (cu c1e)
i
---r _
IV '
_ _h. Impact Minimiza=ion Zones as
idenii ed by Duke Energy
1 14
O Wer areas requi�lgg sp&iftc
6
avoids ace, protection or miti-iition (specify)
AvoidT,.o� liti ai
* Fow "Field ID" colun-+n, specify entity a person that ons
Energy}/pi P ed the identificatioq and how it was physically marked (John Doe)/Pink <�nd purple -dotted t�pe, Corps of Eng. (rohn Smith}/ yello��r fla Die
show the cymbal that is used on the drawini; to identify the pro<bctioniavoidance arca. Wig) For " V4' 4rk Area Dwg ID" CIOlumn,
** List and attach mitigation plans
Duke Ea>lcW
Excavation Program
Page 9 of 14
nw 3/&17

APPUcsnt Name (print) _ l� t�/� , t�kr` •� � Lot #
APPt Mare*
Ca-Appiieatt Name (print}
Co-Applirent Signature*
Co -Applicant Name (print}
Co -Applicant Signature*
Co'AA't N (Prinz]
C-o-Appicaret Signature*
Co-AppUcaW Name (print)
Co-AppHmnt 3ignatare*
Lot #
Lot #
Date
Lot #
Date
Lot #
Date
Lot #
Date
*Pet' MY signature, the inforination provided in this application is Correct to the best of y
knowledge.
Duke Enagy Page 10 of 14 my 2W17

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• Additional lld}, roteren•. f,n :
1) `Wnter 111110#a A uilvA 1roM 7nlva N. Murlaw"
now 8 7,1 1943 Mt. lalasad Cdr. No, 1031
2) "laird Eii-Juufpe will) J. W, MoKunder"
keylhnd .4 •IO -1961 uMl ISM
3) "I1 C N4111v I5tate"
[Wed 11..27-1962 - DD: ;.104-:528
4) 11oundary, llnua were taken from a Survey
Plot prohurod by GCS Group Fnginoern, t 1 P,
dated fel, 27, 2014
b) Minor 8u1,•Rvlfon I lot racotd J in
Map Cloak 1.+6 pogo 508',. sprHitnlr'd
by Dole If, Itlldartuan, PU.,
V J I r, r ,!.•`! ' •r8js /� b1�'t. Qih
41
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1r � ri�.hC•r .s�1
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4
4
`� •4o n IAAF' NORMAN
1, . _-(1•dn R.-t+ildr,rbrrft• _ lh,reby Ce,!dy that th:, 111,11 we, dnlxn troll,
un o6afnl survey no!a,, undo, my di, -.t ( Deed hrccdpllena ,aeo•ded u,
good Patin ZII7.8;' r'm-•"9.N) Dnod Trak-29a?,l? parts !r.%._); (IxA the RotK+
orf Pritial,,n ;s t : 'f;PO" k _- ou rVleulottrd, flint the 11,01,14flam not gur,,.rj
nil rM,dn It, brokon )msw pl,tt!a from t,)turmotgnn n,r rMCV41••11 netren; Itun lh,;.
r'fal wa=.' prapaf°d ir! a -or Mvt,v ,0th tl-e N C. 51W-dards1 ra Ilae (It uhf RUICU
Ceetion 1hn0 V's errunded), .-� t' t�w....,...
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ViciWty Map ria .5rtrf,
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1 frn.ff 100 11.
Uvonfl
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C.M f r rMe ft nument
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X, 2611 141J)aIr 82,14 ,",t
�I1r.v, cr t ,r, r,,vv.; :.,,, . .S,f Esu+.lndtary and Recombination Surv`lly Plat For
J��� -R,—Bl
W''URR� IIS...-- --
town of Cornelius Lemley Township Mee klenburg Corrrrty^— North 6'urolimt
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`)'Cale i" - 100' Plofled donuory 4, 2016
Relcrvnce
Utpnd Book A7782 f"age NJO Parcel ID 001 tali t 82
Dowd Book 29280 Page W Parcel 10 001110161
Mop Book ,A Pager 833
:,- • pt �� .,'.IIIA :�..._.
LAND SIU ING an4 SUOUIVIS1ON 0OWNING
PJ419 Kom C1rivd StImrflls lard, N. C. 21`167.4
Phone (AP8) 4714—J2J4 Mobil" (98o) YJ1 5ti;"' _--•
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4��/lrt�G��ptA�ApEjd�r�s
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WIN
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(Nit" 1„1•f„
ViciWty Map ria .5rtrf,
ttl��� 1 ��•�
n !p Ino 441
1 frn.ff 100 11.
Uvonfl
rip E'',sting h„n P;re
t•IR f Ming 1,im Rod
MR .Nee err Rad
C.M f r rMe ft nument
RAV,.. ... ._.. JNgPt n1` Way
t n,r o . f.,,,�7,
a r2a a t 11 vi't, QUAY OWN910;
{1`n Ho 1 r (III J ( ASNOf 1ATION, INC
X, 2611 141J)aIr 82,14 ,",t
�I1r.v, cr t ,r, r,,vv.; :.,,, . .S,f Esu+.lndtary and Recombination Surv`lly Plat For
J��� -R,—Bl
W''URR� IIS...-- --
town of Cornelius Lemley Township Mee klenburg Corrrrty^— North 6'urolimt
�.
`)'Cale i" - 100' Plofled donuory 4, 2016
Relcrvnce
Utpnd Book A7782 f"age NJO Parcel ID 001 tali t 82
Dowd Book 29280 Page W Parcel 10 001110161
Mop Book ,A Pager 833
:,- • pt �� .,'.IIIA :�..._.
LAND SIU ING an4 SUOUIVIS1ON 0OWNING
PJ419 Kom C1rivd StImrflls lard, N. C. 21`167.4
Phone (AP8) 4714—J2J4 Mobil" (98o) YJ1 5ti;"' _--•

Google Maps
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