20190087 Ver 1_Shoreline Stabilization_20190116

State of North Carolina
Department of Environment Quality
Division of Water Resources
_DWR
IV IV
Division of Water Resources 15A NCAC 02H .0500 – Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application f$SIR4117 t
to:
Division of Water Resources
401 & Buffer Permitting Unit �� �� (�-� \� 2 0 9 O O
1617 Mail Service Center �� 8
Raleigh, NC 27699-1617
Applicant Information [15A NCAC 02H .0502(a)]
1. Owner
Name:
Mailing
2.
6/^'`
Telephone Number: O — q0 - Fax Number: _ 7D- VE3 - 2YI
E-mail Address: M I 152.1— a- )bP/
Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http://www.saw.usace.army.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
J4"
-4— 0
ORIZATION FORM.adf) must be attached if the Agent has signed this application form.
xw,� ,
Name:
Company Affiliation:
V%y1 J
Mailing Address:
k
Telephone Number: Fax Number:
E-mail Address:
Person to receive the Certification Approval:
II.
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 detailed site plan showing property boundaries and proposed locations of
vegetation clearing, structures (buildings, retaining walls, docks, impervious surfaces,
FORM: SSGP 10-2013 Page 1 of 3

etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
and 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: G( �[Nearest Town: ��l'l' /VC
Subdivision name or site address (include phase/lot number):
11(po 3 15 (�- 16-14,4 /4
Directions to site - please include road names and numbers, landmarks, etc.:
Latitude (in decimal degrees) Longitude (decimal degrees)
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): r-051
6. Property size (acres): % 53 aG elf
7. Lake/ river/ ocean adjacent to property: 44a /ViyMgd,
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): co
9. Will work be conducted from land? [0 -'—
water? ❑
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool lakeevel/ Normal Water Level in square feet or acres: ,,,,//
r o 5b3 0-F a `I`' .504
11. Total amount of t-4.ce (including all clearing, back fill, excavation, rip rap, retaining b4411
walls, etc.) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres: ser"*, A2
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):
Z
/// ` I MI �y
Owner/Agent's Signature* Printed Name
[15A NCAC 02H .0502(f)]
`Agent's signature is valid only if an authorization letter from the owner is provided.
Date
FORM: SSGP 10-2013 Page 2 of 3

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: SSGP 10-2013 Page 3 of 3

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PHYSICAL SURVEY FOR:
MICHAEL L. &
ROBIN S. KISER
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Perch 10: 461602562879
AREA BY COORDINATE METHOD
TOTAL AREA 1.153 ACRES3 TOTAL
MOUNTAIN CREEK TOWNSHIP
CATAWBA.000NFY, NORTH CAROLINA
OWNERS: MICHAEL L. k ROBIN S. KISER
4603 KISER ISLAND RD
TERRELL, NC 28682
SEE DEED 2319/0894.
ZONING CLASS: R-30 -
I MIS PROPERTY MAY BE SUB.ECT TO ENYSRNG EASEMENTS
AN0/01? RIWIS RECORDED OR UNRECORDED, 08SCRWD
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FLOOD PLAIN NOTATION
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LICENSE NUMBER AND SEAL THIS StA, DAY OF NOVEMBER, AO.. 2018.
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FACTOR: 0.90965562 Jg2�g9 FAGS *.IW SIM NS"
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1641!X.4'
NEWTON, NC 26656
[phone] OIi1Cf APPflOVEO.BY: MAW 1335-001
[phone] FAY
SCALE: 1' . 30'

11-4603 1_ SHEET 5 OF 5
PHASE 5
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*NOT TO SCALE*
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PHASE 5 DISMANTLING NEW WALL STEPS:
1. REMOVE SOIL FROM BACK OF SECOND BLOCK COURSE
TO 8" ABOVE OLD WALL.
2. INSTALL RIP -RAP ON SLOPE.
DESCRIPTION ( DATE
[phone]
DETAIL
O D
Fax: [phone]
4603 Kiser Island Road
� ¢
4090 N. 16
P.O.Box 2
2189
RETAINING WALLS
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DENVER, NC 28037
Terrell, NG
Www.WWEgeo.Com
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DESIGNER MICHAEL KISER, PE DATE�L 11 14 18 INSP. pA7P
CONSU�TING ENGfNEERS & PLANNERS -*'
MLKiser0abe11south.net
DRAWN CCH 11/14/18
DATE APPR DATE

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pr

Michael L. Kiser, P.E.
\�
lone:-, 704_.408-0080
NC Dept of Environmental Quality
Division of Water Resources
t & Buffer Permitting Unit
Dear Sir/Madam,
Per the instructions of Duke Energy Lakeshore Management representatives, I am notifying you of my application
to remove a segmental retaining wall at my residence listed above. The retaining wall is approximately 155 linear
feet with geogrid, #57 washed stone, and fill soils installed up to a width of I I feet from the wall face. The wall
height ranges from 3 to 5 vertical feet. This installation is less than 5 / 100 of an acre. My instructions are to
request from you a receipt of this notice and instructions for providing additional information, if needed.
Best regards,
l _
Michael L. iso~, P.E.
704-408-0080
12/10/2018

Duke Energy Excavation Permit Application Form
FOR DUKE ENERGY USE ONLY
Duke File No.
Application Fee $ Security Deposit $ Check # Date Recv'd Initials
Date of Duke Energy Lake Services, applicant and/or contractor on-site inspections Date Initials
Date Final Protection/Avoidance Area Markings Field - Verified 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) ❑Yes ❑No (If Yes, explain in PART V)
Date Deposit Refunded 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 Rork
Orders with application.
Part I. Applicant Information (Please Print)
Name� ¢�[ L1� I Sy>� Telephone (%D
Email address:
Lake Address
Contractor Company
Contractor Contact Person
Contractor Email Address:
LAKE LOT INFORMATION
Mailing Address (if d fferent)
Telephone
Lake K)YmA County Ca Al G• City State IVC Tax Map No.
Subdivision
Duke Energy
Excavation Program.
Lot / Section No. Lot Size aAcres
Page 4 of 14 rev 6/20/17

Duke Energy Excavation Permit Millication Form
Are there any Co -Applicants*? (check one) 13Yes M'I O (ff yes, include names, street
addresses or lot numbers, pier numbers, phone numbers, and email addresses 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 / lease holders of Project -front properties within a single development. There can be no
more than 4 co -applicants in addition to the lead applicant on any application.
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; Initialling 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
.LAL
Initials (Duke Energy) &W
(applicant/contractor)
Duke Energy Page S of 14
Excavation Program, rev 6120117

Duke Energy Excavation Permit Application Form
Part H. Description of Project
A. Basic Info
1. Type of excavation: (check one) ❑ New excavation UA ainteance excavation
ie 5=
2. Purpose of excavation: (check one) ❑ Boat Access Channel
❑ Water Intake Channel ❑ Wastewater Discharge Channel
❑ Other (spec): 'lam r, y
3. Lake user category: (check one) ['Private ❑Residential Marina
❑Commercial Marina ❑Public
❑Other (specify):
4. Max. Excavation Area Dimensions (ft): Lengthy / Width
Depth 34-o 7= L
(Note: include additional area dimensions if necessary so response to #5 below equals max. area
dimensions in #4)
5. Volume of Excavated Material (TOTAL for the project): a Cubic yards
6. Type omaterial emoved (ap licant determines by field sample if,
6:t< _ (Jf, , #� 7 ✓�,Sh e ,O L5," _ -sin
7. Excavation Site area: VQ D 5 Acre (s) Disposal Site area:'
6. 1 Acre
(s)
8. Total Disturbed Area (including equipment staging area): . o� Acre (s)
9. Does th roject meet a requirements of the applicable General Permit? (check one)
es CY'� 5 66 - - ass [/j, acf�-,
10. Do you claim title to the disposal area? (check one) 01-Ye"s ❑No
11. Do you claim title to the equipment staging area? (check one) LF]Yes ❑No
12. Are there any water-treatmentfacilities within 50 feet of the proposed excavation area?
(check one) ❑Yes UNO
(If Yes, specify):
13. How will the excavated material be entrapped and the erosion controlled? (e.g. see attached
erosion control plan and disposal area design):
Duke Energy Page 6 of 14 rev 6/20/17
Excavation Program.

Duke Energy Excavation Permit Application Form
14. Type(s) of excavation equipment to be used:J/ d� �i/� S
15. Will waters or wetlands be crossed in transporting equipment to or from the site?
(check one) ❑Yes MNo
(If yes, explain)
16. Will return water re-enter the reservoir? (Check one) ❑Yes MKO ❑N/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 QN6
(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" '7-�Ti FINISIf FZtr 7
(Month) (Year) (Month) (Year)
6 -'� 4) 2- 0 100
Duke Energy Page 7 of 14 rev 6/20/17
Excavation Program.

Duke Energy Excavation Permit Application Form
Part H. (Continued)
B. Protection / Avoidance Area Description
Complete the following table including all land areas within and immediately adjoining the disturbed area:
Protection/Avoidance Areas
(check all that apply)
Approx
Identification
Method N
Avoid (A) or Mitigate (M)
Acre
Field ID
_Work Area Dwg. ID
Lin
a. Marshland, swamp, ponds, beneficial
aquatic vegetation or other potential wetlands
(circle all that apply)
/V
b. Buffer Zones (speck width & source
of requirement)
c. Environmental Areas as identified by
Duke Energy
d. Natural Areas as identified by Duke
Energy
/1 /
l M—
e. Historic properties (spec)
f. Rare or threatened species (spec)
Duke Energy Page S of 14 rev 2/6/17
Excavation Program

Duke Enemy Excavation Permit Application Form
Protection/Avoidance Areas
(check all that apply)
Approx
Identification
Method *
(A) or Mitigate (M)
Acre
Field ID
Work Area Dwe. ID
_Avoid
*�*�
V�
g. Buried gas, water, sewer,
communications or electric lines (circle)
n /
V V
h. Impact Minimization Zones as
identified by Duke Energy
/ /
/V V
i. Other areas requiring specific
avoidance, protection or mitigation (spec)
* For "Field ID" column, specify entity or person that performed the identification and how it was physically marked (e.g. Duke
Energy (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.
** List and attach mitigation plans
Duke Energy Page 9 of 14 rev 2/6/17
Excavation Program

Duke Enerzv Excavation Permit Application Form
C. Applicant's Signatures
Comments:
Applicant Name (print)
Applicant Signature* /G Date
Co -Applicant Name (print)
Co -Applicant Signature* Date
Co -Applicant Name (print)
Co -Applicant Signature* Date
Co -Applicant Name (print)
Co -Applicant Signature* Date
Co -Applicant Name (print)
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

11-4603 1 SHEET 1 OF 5
PHASE 1
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REV.DESCRIPTION DATE
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RETAINING WALLS
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DESIGNER MICHAEL KISER, PE DATE 11/14/18 INSP. DATE
DRAWN CCH DATE 11/14/18 APPR. DATE

PHASE 3
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DESIGNER MICHAEL KISER. PE DATE 11/14/18
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DRAWN CCH DATE 11/14/18 AppR DATE

11-4603 1 SHEET 4 OF 5
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DESIGNER MICHAEL KISER. PE 11 1a is
DAT 1/L_ INSP. DATE
CONSIJ47 G ENGINEERS &PLANNERS
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DRAWN CCH 11 /14/18
DATE AppR DATE

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REV. DESCRIPTION DATE
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www,WWEgeo.COM DESIGNETt MICHAEL KISER, PE DATE 11/14/18 INSP. DATE
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LICENSE NUMBER ANDSEAL 61h_ DAY OF NOVEMBER AD.. 2010.
%NIS
SITE
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NOVEMBER 6, 2018
Pi,10 ID: 461602582879
AREA BY COORDINATE METHOD
TOTAL AREA 1.153 ACRES3 TOTAL
MOUNTAIN CREEK TOW IP
CATAW.BA.000NTY, NORTH CAR INA
OWNERS: MICHAEL L: k ROBIN S. KIBER
4603 RISER. ISLAND
RD
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SEE: DEED 2319/0894
IWINO CLASS: R-30
I. THIS PROPERTY MAY BE SUBJECT TO EXISTING EASEMENTS
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