20150291 Ver 1_Shoreline Stabilization_20150323

I
DUKE ENERGY INTERNAL USE ONLY:
Construction 9 DUKE
Date Received. FAF Paid Application ®��r ENERGY,
Application Complete "` is P1'
Permit No Water St at'egy =Hydro Licensing and Lake Services
HEP Fund Duke Energy
PO Box 1006/ EC12Q
Site ID Close -Out Date Charlotte, NC 28201
I. DATE OF APPLICATION* Permit/Tag #
11. APPLICANT INFORMATION (applicant mailing address and contact information)
Name* µDWS T. 13A L- O u 5E K Primary Phone* 1704-662-64-001
Address* / (o I o 9 V C'_ 4a N Rd. Secondary Phone
City* rNe K S I State* [Af� Zip Code* a90 3/ Fax Number
Email*
Ill. PROPERTY INFORMATION (location of permit)
Address* 116,3 Z Cr Ve 4oni RA . County* m rCKL a-mi lwec,
City* OrNCFLtS State* Zip Code* a.$0 3 County Parcel ID number
(e g Pin, Tax ID, TMS pal 3 3 /7-3
Lake *: m A N Number.. )
Subdivision C 1, fT' Io� Lot(s) 1 Plat Book/Page �p 5�
To enter the Latitude and Longitude of the property, please use a Latitude (e.g 35.12345)* 3�, L f 75'/
service /software to easily acquire the location information. Values
should be provided in Decimal Degrees format (35.1245). � -9
Longitude (e g. - 80.12345) * 1 Q , 3 56
example service: fittp: / /itouchmap com%Iatlong.Mtml
IV: PROPOSED ACTIVITY
ew Modification of Existing Structure (' Maintenance of Existing Structure El Is Dock
Covered?
C New /Modification of Existing Shoreline Stabilization C Maintenance of Existing Shoreline Stabilization ❑
(' New /Modification of Existing Structure & Stabilization C Maintenance of Existing Structure & Stabilization # of Slips
(` Transfer of Ownership C1 Other (please describe below) # of Jetports
Area over land (sq ft) Area over water (sq ft) Total Square Feet 1 3
Shoreline Stabilization (feet) Length of Distance From Shoreline 11J,//4 / /pWt iSrii✓ 5k 01fe-
Stabilization Materials I hOW1110- rip rA
Brief Description
of the Activity
�51Aoi�Z� _</W We pJ ;Th eNakAtccA j'Dou,fater rile rAr
Describe Briefly the Existing
Structures Over Land and
Water (include sq ft)
- rAc4NT- YCSiC1e4AiP,( 101

V. Dock Builder or Engineer
Name /Company!
Address �i ,r� �� pGi y� ► Phone Number
yCit y State _..- - ` ^ ^Y ` - � •_,S Zi p Code - _` . Email
./I/. •�-
_❑
VE.Checklist ofRequired Documer*ts _ (to _ include with _ Application Submission)
ecent Survey (stamped /signed by a professional licensed surveyor showing the location of the existing or proposed
structure and /or survey of the existing or proposed stabilization)
[Photos along property shoreline and photos of any existing structures and /or stabilization in or near the water
dAppllcatlon fee (check only, payable to Duke Energy) ❑ Signed User Agreement Letter
applicable local, state, and federal permits [Plan and profile drawing showing all measurements and elevations
Habitat Enhancement payment (If applicable)
VIi. Approval Process
• Application is reviewed and determined if complete. Fields with an asterisk are required.
• If application is not complete or does not include all items and Information listed in the checklist, the
application will be returned as incomplete.
• A Duke Energy representative will visit the site to conduct a visual Inspection.
• Applicant will be notified of approval or denial.
• Applicant is to have the notice, to be supplied by Duke Energy upon application approval, posted and
must be viewable from water. The notice must remain posted until a representative inspects the
project and determines the project is complete and within the application specifications
VIII. Directions by Road
Directions by
Road"
�IX. ApplJcditonSubmission �__--_-•._..,_. �.- �. �.. �..._ __._— ......�__.�__._.r.._...._. .. _ .�...,�,_ -. _._�.
Please complete, print and sign this application. Then enclose all items from the checklist above in an envelope and
submit all the information to the address below.
Water Strategy, Hydro Licensing and Lake Services Print Form
Duke Energy
PO Box 1006/ EC12Q
Charlotte, NC 26201 n _
I agree that the information contained within Is accurate.

I, Thomas Balousek, hereby give Kenneth Bealer Homes, Inc. authorization to act on my behalf in
obtaining any permits for stabilization and any other permits necessary as it relates to my properties
located at 16325 Jetton Road and 16329 Jetton Road, Cornelius, North Carolina.
February 13, 2015
Thomas Balouse

State of North Carolina
Department of Environment and Natural Resources
YR
Division of Water Resources
I , . <
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources 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
401 & Buffer Permitting Unit Q n„
1650 Mail Service Center
Raleigh, NC 27699 -1650 MAR 2 s 2015
DENR - - -
Applicant Information [15A NCAC 02H .0502(a)] ao, R Q;;c� =` kt�OURCES
1. Owner Information _ —�—'
Name: / /l0 m l4 s zi- 13i+1OG(5C K
Mailing Address: W309 909 Rid
Co rN a (; a, s, a C a-8 0 31
Telephone Number: / � 6 62.6 4-60 Fax Number:
E -mail Address:
2. 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
Name: G`1 "
Company Affiliation:
Mailing Address:
Telephone Number
E -mail Address:
must be attached if the Agent has signed this application form.
70¢.600 -S-11/ Fax Number: 70�•6(0 0 °596
14 C .5GR m_)A- J15 0? 1J i AfW51--e_ 401 • Afe
Person to receive the Certification Approval: C`1 i
I
11. Project Information [15A NCAC 02H 0502(a)&(b)]
ridge s
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 4

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) /I
County: ,M eu< t�N 13 u 0— Cr- Nearest Town: n r,JC l i u s
Subdivision name or site address (include phase /lot number):
Id e 1- Q T )a-�- 2 7,1
Directions to site - please include road names and numbers, landmarks, etc.:
7i n( 4 ex ;�a-9, Wo,J A7rn -J ill JVC,, g4-nA1 re*OAI R'( -
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Nj e-M o . e4 I&
5. Property size (acres): Q t3�r�
7. Lake/ river/ ocean adjacent to property: +Re-
8. Describe proposed work (include disc sslon as to how hardening of shoreline has been
avoided, or why it Is necessary); �z-E 5�o�c• ��iJc• �t ,0rC ✓ew
erd 5 i o,J
9. Will work be conducted from land? ❑ From water? [►
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:
_ VX 04- '
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: / ' x ! q4-1
-
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): � A 7�
e e S Nel gr,455
aq-4 JaL4= V-41 6-M
0/s
Owner /Agent's SI ature (15A NCAC 02H .0502(f)1 Date
Agent's signature Is valid only Van authorization letter from the owner is provided.
FORM: SSGP 10 -2013 Page 2 of 3

Lake
(At Full Pond/ Normal Water Level)
Full Pond/,<
Normal Water Level
Shoreline
Please approximately sketch the following information on 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. Location of construction access corridors
FORM: SSGP 10 -2013 Page 3 of 3

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16329 Jetton Rd - Google Maps
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