20171561 Ver 1_Shoreline Stabilization_20171205

L 0 1 7 1 5 6 1
Duke Energy Excavation Permit Application Form
FOR DUKE ENERGY USE ONLY
Duke File No.
Application Fee S Security Deposit S Check M Date Recv'd
Date of Duke Energy Lake Services, applicant and/or contractor on-site inspections Date
Date Final Protection/Avoidance Area Markings Field - Verified
Approved to Start Work By * :
Date Completion Required
Dale Passed Closeout In pcction'
Initials
Initials
Date
(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 Refunded Initials Date Permit Database Updated Initials
* Forward copy of approved application (at) pages, plus any attachments that Duke Energy changed) back to applicant
with Approval Letter and highlight any changes. Fite copies of Approval and Close-out Checklists and any Stop Work
Orders with application.
Part I. Applicant Information (Please Print)
Nameo" T ` Telephone
Email address: cy" - �� �v "_ krV' corn
Add ess
�� ey►""[6L
T -Y I (�[� 28 �r82
Mailing Address {j dajferen"
Contractor Company
Contractor Contact Person (MV x,10 S Telephone � t� - �gvc ----
Contractor
Contractor Email Address: Cllr 96L"�U l S (2 ,t,� V1dS*1Q.M • 0 -e -i -
LAKE LOT INFORMATION
-A�C4 Ca�yyGVd-�: i State NZ—Tax Map No. Q_�O1"+b�Z--
Subdivision Lot / Section No. I Lot Size�$�Acres
Duke Energy Page 4 of 14 rev 2/6/17
Excavation Program

Dake Enersiy Excavation Permit Application Form
Are there any Co -Applicants*? (check one) OYes ONo W Yes, include names, addresses or
lot numbers, phone inimbers, tot sizes in PART V — AiiDff IONAL MORMATIOi�
* Co-ApPlicalits exist when the proposed work is being done under a singe 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 conla nue the eatl� .� aA QWSIU6M hS4" eeft6%Cx between a
Dake 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.
Die of =-sme jos"Methm
Initials (Duke Energy) i44,M
(applicant/contractor)
Duke Energy Page 5 of 14 my 2/6/17
Excavation Program

Duke Energy Excavation Permit Application Form
port q Descri� Im of Project
1. Type of excavation: (check one)
2. Purpose of excavation: (check one)
0 'Water Intake Channel
❑ Odwr (spedifvk
U'New excavation ❑ Maintenance excavation
/Boat Access Channel
❑ 'Wastewater Discharge Channel
1
3. Lake user category: (check one) nvate
❑Commercial Marina ❑Public
❑Other (specify):
OResidential Marina
4. Max. Excavation Area Dimensions (ft): Length X10 Width LeO
Depth 457
(Note: include additional area dimewrions If necessary so resparae to #3 below equals n= area
dimensions in #4)
5. Volume of Excavated Material (TOTAL for the project): 333 Cubic yards
6. Type of material regioved (app jcan/determines by ffjd sale if,
.. ., 1... _ J ".4.. i C'
7. Excavation Site area:d • Acre (s) Disposal Site area:
(s)
(9 .0" Acre
8. Total Disturbed Area (incltiding equipment staging area): �?. d � Acre (s)
9. Does project meet the requirements of the applicable Genaal Permit? (check one)
in es L7No
10. DoY ou claim title to the disposal area? (check one) 1'es ❑No
11. Do you claim title to the equipment staging area? (c wck one) OAKS [No
L 2_ Are ;th= any wat
lr- t facilities within 50 feet of the proposed excavation area?
(check one) ❑Yes o
(If Yes, specify):
13. How will the excavated material be entrapped and t erosion controlled? (e.g. see attached
eroslon controlFI an and &Tosal area design):
Duke Energy Page 6 of 14 rev 2/60
Excavation Program

Duke Enemy Excavation Permit Application Form
15. Will waters or wetGeos
be crossed in transporting equipment to or from the site?
(check one) OYes
(Ify-es. explain
16. Will return water re-enter the reservoir? (Check one) OYes CW/O ON/A (If Yes, specify
point(s) of re-entry and show on Excavation Area Drawing)
17. Is tbzrc amees
ing f azi i y l a& picr) &V, �L � � `ov 7 r; :�> twt; ��=�:R�� to vr,� ? ? *i �L� 2tg theexcavation? ONo
(If Yes, specify the existing permit number. If No, include a scaled drawing of the proposed
facility). Permit #J5
18. Total planned duration of the work (Include f rst egluprnent mobilization. excavation
through final mitigation measures complete):
START V1_1, --,'k FINISH t
(Month) (Year) (Month) (Year)
Duke Energy Page 7 of 14 rev 2/6/17
Excavation Program

Duke Ener
cavation Pe 't � Dication For
FART 1I. (Con; inued)
B. PROTEC ON AAVOIDANCE t�REA DESC o the di. turbed =
table incic.�iEtg all land areas tivithin and immedla�ly adjoining
Complete the following_ Method
t
Prot t A iAvoidance Areal �cr 7e
(C Lu, all that apply)
A. Marsh;gtztxi, swamp, Ponds, b <'e&ial
aquatic vegetation or other potential wetl'ds
(circle all tlutt apply)
b. Buffer Zones (specify width source
of requirement)
c. Environmental Areas as iden''fied by
Duke Energy
d. Natural Areas as identified b
Energy
e. Historic progzrties (�peCih')
f. Rare or
species (s eeify)
M
�' done- �� V6c
t1wo b�
NI P-
s ok
M%Pf
0A-
page S of 14
Duke Energy
Excavation Pro;raxn
r,-_./ 26/17

IN F.neM ExcavLL,tion Permit Application Form
Avoid, (A).or Miggate (ND
Protection/Av idauCe Areas
rex
(check all that ply)
A
Nip-
-a. Buried gas, water, sewer,
copimutiications or electric lines (circle)
j
h. Impact Mininxization Zones as
identified by Duke Energy
_i. Other areas requiring specific
avoidzce, protection or mitigation (specify)
* For "Field ID" column, specify entity or person that perfC=ed.the identification and how it was physically marked (e.g. Duke
Ener 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/avoidance area.
** Gist and attach mitigation plans
rev ?rw»
Dune Energy Page 9 of 14
Excavation Program

Duke Energy Excavation Permit Application Form
C. APPLICANT'S SIGNATURES
Commas: ZWVCA
d M 0( CII [I S+ VI f, C* qto .-�N (�D wi ag- (a Dri es
---I�WtA I NC 7WO6 Z ,*12 (,off'
Applicant Name (print A44 xi Lot #zL
<<
Applicant Signature* Date !l J
Co -Applicant Name (print)
Lot #
Co -Applicant Signature*
Date
Co -Applicant Name *int)
Lot #
Co -Applicant Signature*
Date
Co -Applicant Name (print)
Lot #
Co -Applicant Signature*
Date
Co -Applicant Name (print)
Lot #
Co -Applicant Signature*
Date
Co -App- caut 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 Ti o QQ rev 216117
Excavation Program

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address:
Owner:
County: �A Y_A wh A
Contractor/agent:
Print Signature
The approval is for the purpose and design described in your application. Impacts not indicated in the
aoolication is a violation of the Buffer rRLile. Site specific work shotild'be provided in the application. 115A NCAC
02H.0506 and 15A NCAC 02B.0243(8)1
Trees are not allo%ved to be rem -w -d from 7_one 1 of the Ruffer (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 n)""'"'
Benching, grading in the buffer is not allowed. Excessive distur
Beaches, impervious patios, impervious walkways, etc. are not
by the Division. There are limitation on size for decks. 115A NG
Work to be conducted from land must indicate an access and i,
work corridor should be described. The approved access corridc
material must be outside the buffer. [15A NCAC 02H .0502 and
AcC­0 P e�- cessi �%
'�te..1 Vl+lar��su�
Stormwater cannot be piped or channeled for direct dischari
discharges must be at the natural elevation and discharged prioi
sheet flow at non-erosive velocities to the take. [15A NCAC 02B .0
Acknowiedgement of Notification
-6 ka_A_Xk (ia
AJI_L�-
hereby state that i _.,..,,Cn mtormed of the Catawba
Riparian Buffer Rule. Any work conducted in the buffer, not specificai'+y stated_ ill t' e apP'ncanan anis 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 Lie built w(0170 auuSiar'itia l J111F�/FC rr� Y�I�i `�' •"t `'
Quality Certification and Buffer Rules, the approved plan(s) and specification(s), and other supporting
materials.
Date:
Signature (owner):
state of North Carolina 1 Environmental Quality 1 Water Resources
512 N. Salisbury Street i i6i1 Mail Service Center I Raleigh. NC 27699-ibtt
919.707.9000

State of North Carolina
DeparbrAm of EwAronraent and Natural Resoinves
Division of Water Resources
D.
-. . W. ].5A MAC 02H .0500 — Water gVafiity Certdimoon, Shwetine Stablitmdon
Division of Water Resources FORM: SSCP 10-2013
Ch�ralirrw C#m►l �%��ti Ai�1�nitratton I"[Wt'!':
,
Four copies of the application (including attar-nmentsi and the ap "cation fee snorus),o: oe seni'W;
Division of Water Resources
401 & Buffer Permitting Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: 411VA ii
Malling Address:
Telephone Number: ( ill T
E-mail Address:
0
N
Uax Number:
Fo:;:100 ni. Vo— o kW-r0k] . l nVV1
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be. downloaded here:
�;...rr...;�;.��r.� �L�Mco acmv m+IJRr►rr 1e( 9'/docs/regutatm--I cs/Permits/SAMPLE AGENT RUTH
na17ATinNi FORM_ndfl must be attached if the Agent has signed this application form.
Name: LJrllV
Company Affiliation: ✓) 2 I
Mailing Address:-
Telephone Number: Fax Number:
E-mail Address:
Person to receive the Certification Approval: 1 U
IL Pso ect information 15A ICAC 02N .U5Q2(a� & (blj
clear
1. Attach a vicinity map (i.e. street map} IY showing the location of the property with
respect to local 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,
Page 1 of 4
FORM: SSCP 10--2013

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.)
A. R nr-A ir%rk �otf thou rtrnnprtu iwhPrP work is to be conducted)
County: Nearest Town:
Subdivision name or site address (include phase/lot number):
Directions to site - please include road names and numbers, landmarks, etc.: N
_44V AinA 'PFVIlO(�IA,6A_ TM we
Latitude (in decimal degrees) ?j�• v� Longitude (decimal degrees)
5. Describe the existing land use or 1condition of the site at the time of this application
(residential, undeveloped, etc.):
6. Property size (acres): • i4V
� � i h R,v�nM Ail
7. Lake/ river/ ocean adjacent to property: ,� �����
8. Describe proposed work (include discussion as to h w hardening of
avoided, or shoreline has been
why it is necessary): l 1 v
Ot
9. Will work be conducted from land?
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:
pox �nxIe
—�-------------
11. Total amount of disturbance (including all clearing, backfill, excavation, rip rap, retaining
t ^No=l =rtrk rn fppt tand-ward in
walls, etc-) above the normal pool rate �:C v , ,v, , _� • • M - -- _ _
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):
—►v�ce �I.SS .
tkJ-> PQI- /c
- -- . * Prin'tPd' Dame Date
uwneriAgeili-i` ,:-�aLu
i15A -CAC 02H---- .05E12(f?1 +� l� pr from the owner is provided.
`{;(�Pnts 5��3�OiLi�iS ✓tTitt7 �rtiy rj�trrr uw,.f,4,.;:--•�-,_..._-.. ,
Page 2 of 3
FORM: SSCP 10-1U13

Full Pond/
No
I
Lake
(at Feil Pored/ Normal Waw SIL
P1pam-P AnnraximateIv sketch the fogowing -information nn this plan (provide dimensions for each
item, such as 10 ftx 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. Loca-cion oi' conscrucwn access L:u. stir a s
Page 3 of 3
KAM: SSGP 10-2013

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�"JTF DE VE1-UPWNT PLAN
NOT RESPONStiiLE. FOR ANY
CHANGES DUE TO UNRECORDED
COVENANTS AND RES7RICTiONS
1
1; SCALE: 1' 4V
3r
3
�'�FIEID LOCATED
R, 6-26-15
LAKE NORMAN
94 L1 Env --
LOT 11 -._
s, 1
LAML 111JIUA G LFY-s_- I
1��4K+�1 b
P:,R PLATk0s 12 PC 9,
V
�2 [V
1 VI
11 t O.d.4:_�� .._ kat La
POW, 2 +�
to
cn r.
�
ig ` I v;
� 'K il CS, 1.01 12
LUT l li L N.8 12 PG 96
tt8 12 PG 86
} �4•L7•�ry15�."' .P.�ill: 1 C;
r �+"wUA1' 11.5x' k1
Pi`ri A!Ayy 1;OQ'
N4.00' Fl.aC1c4 PIAN fa� s
411ril 7
LrTAtlov
60' PUBLIC ft/'W
N!H 12 PC, yb
t3_ a+1rw!j
1G�..i--j
CJR1lE RADIUS 0'%; tkiURO BEARM13 Ih.LTnV
et
- A P[AT SKa1MMra '1+� S:13Ci1dc nru a' r ANU fJEEU 10 NRS G Hlti1.ARQ
Scrbd;'v,SiOn
Address 8wa4 PEN!NSt1LA DRIVE
11,
Block_-. pion CU5_T01� Elevation . �.. Drive (I eft
I'.nt ..__
it. I.CU:. -'av _._ Uther _ ave, --- -
M'L.
REVISED: 540w r1EU1 LOCATfo S -""Y.
l \CT1P.�CR\8844 uan nsu!APiN 9844 dv.0
SIAVE(;'a I
7 _Q_------
_(Riot) CID (Courtyord)•--Deck.X
?4 ..Curium Wall
DWI:': JDA CKD: DAIL: 10/ W 19
PREPARED BY:
THIS SITE PLAN IS TG SHOW
-A LAND SERMCil_1-
S, 1.==..
r,',� nal,r ncrn 1 nr t1 f1F
TPTM HOUSE ON THF. L171 ANI>
15 N07 TO IE RELIED UPON 6U8—G Mattes»s Mint HRR, Raad
FOR CONSTRUCTION. MATTHEWS, NORTH CAROLINA 28105
NOTE. DELTA LAND SERVICES IS [phone]
NOT RESPONStiiLE. FOR ANY
CHANGES DUE TO UNRECORDED
COVENANTS AND RES7RICTiONS
1
1; SCALE: 1' 4V
3r
3
�'�FIEID LOCATED
R, 6-26-15
LAKE NORMAN
94 L1 Env --
LOT 11 -._
s, 1
LAML 111JIUA G LFY-s_- I
1��4K+�1 b
P:,R PLATk0s 12 PC 9,
V
�2 [V
1 VI
11 t O.d.4:_�� .._ kat La
POW, 2 +�
to
cn r.
�
ig ` I v;
� 'K il CS, 1.01 12
LUT l li L N.8 12 PG 96
tt8 12 PG 86
} �4•L7•�ry15�."' .P.�ill: 1 C;
r �+"wUA1' 11.5x' k1
Pi`ri A!Ayy 1;OQ'
N4.00' Fl.aC1c4 PIAN fa� s
411ril 7
LrTAtlov
60' PUBLIC ft/'W
N!H 12 PC, yb
t3_ a+1rw!j
1G�..i--j
CJR1lE RADIUS 0'%; tkiURO BEARM13 Ih.LTnV
et
- A P[AT SKa1MMra '1+� S:13Ci1dc nru a' r ANU fJEEU 10 NRS G Hlti1.ARQ
Scrbd;'v,SiOn
Address 8wa4 PEN!NSt1LA DRIVE
11,
Block_-. pion CU5_T01� Elevation . �.. Drive (I eft
I'.nt ..__
it. I.CU:. -'av _._ Uther _ ave, --- -
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