20171129 Ver 1_Shoreline Stabilization_20170906

20171129
DUKEIENERGY INTERNAL USE ONLY Construction DUKE
Date Received App Fee Amt Application 1]DUKE
ENERGY
Check # Check Date version 17a
Duke Energy Lake Services
Site ID Mail Code EC12Q
HEP Fee 526 S. Church St.
❑ Application Comp ete
Charlotte, NC 282
I. DATE OF APPLICATION* Tag #:
08.29.2017 + ? 017 I
II. APPLICANT INFORMATION applicant mailing address and contact information L1.
Name* Garry & Debbie Zage Primary Phone* �' 7 27 Z
Address* 11230 Ash Lawn Dr Secondary Phone
city Lake Forest State IL zip Code 60045
Email [e-mail]
III. PROPERTY INFORMATION (location of permit)
Address* 17029 Jetton Rd County* Mecklenburg
city* Cornelius I
State* NC zip Code* 28031 Lake* Norman
Subdivision Mtn View Beach Lot(s) 17
To enter the Latitude and Longitude of the property, please use a
service/software to easily acquire the location information. Values Latitude (e.g. 35.12345)* 35.47015
should be provided in Decimal Degrees format (35.1245).
Example service: http://itouchmap.com/latfong.html Longitude (e.g. -80.12345)* 180.93285
IV. PROPOSED ACTIVITY (check all that apply)
❑New/Modification of Existing Structure DMaintenance of Existing Structure Dock is covered M
0✓ New/Modification of Existing Shoreline Stabilization ElMaintenance of Existing Shoreline Stabilization # of slips
UTransfer of Ownership ❑Other (please describe below) # of Jetports
Area overland (sq ft) Area over water (sq ft) Total Square Feet
Shoreline Stabilization (feet) Length of Distance from Shoreline/ c� sr
Stabilization 94 FEET [Wk- �/
Brief Description of
the Activity
Materials
FIELDSTONE BOULDER WALL - SET OF STEPS
Install a fieldstone boulder wall -Install set of steps with the steps curving.
Describe Briefly the Existing
Structures Over Land and
Water (include sq ft)
private home with a pier.

V. Doric Builder or Engineer
Name/Company
Address I 107
65C 51 -or -le anJ
O&k Qqe FARM
ccs c le tt
Phone Number 1-70q bb n y j(
City yr V f ®=15 EmailState Zip CodeGhe S-Gi t IS Edi! OlAf ow • Ne*
VI. Checldist of Required Documents (to include vwth Application Submission)
Uy �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
d Application fee (check only, payable to Duke Energy) 2/Signed User Agreement Letter
Pian and profile drawing showing all measurements and elevations
(Applicable local, state, and federal permits Habitat Enhancement payment rif 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 represpecifications.ent pew the
project and determines the project is complete and within the application
VIII. Direct4ons by Rona --
Directions by
Road*
.1 en! C
IX. App1",cotion submission
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. Prirti Form
Water Strategy, Hydro Licensing and Lake Services
Duke Energy
po Box 7006/ EC72Q
Charlotte, NC 28207
I agree that the information contained within is accurate: Signed

State of North Carolina
Department of Environment and Natural Resources
" Division of Water Resources
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
1650 Mail Service Center
Raleigh, NC 27699-1650
1. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name:
Mailing
Telephone Number: 9fT o277- *2 -* Fax Number:
E-mail Address: 0_ e -S ft r co vh
2. Agent/ Contact
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
ORIZATION FORM.pdf) must be attached if the A—nt has signed this application form.
Name: rid
Company Affiliation: G/3CS 11>7-owe- s A ��"U
Mailing Address: 6 19 ©,#X ncla-s- Arm wl
Telephone Number: Fax Number: -7b 19( 6 41D. S 6
E-mail Address: e- *4 ")411-5 41W5freAPI , Aorc
Person to receive the Certification Approval: 6A''2
II. Project Information [15A NCAC 02H .0502(x) & (b)j
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

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) �r
Y' -
Nearest Town: ( o r
County: > L
Subdivision name or site ad rens (include phaase/lot number): /6T %7 ?D 31
Dir ctions to s%te - pleasei elude road names and numbers, landmarks e/t"c�.:
_ n h 1 p i �n i- � l/ I 'd�7,V -. w / . �C ! f
'' !! ,70on D 0 • + 3 -' 95
Latitude fin decimaldegrees)�S • T �� Longitude (decimal degrees) g
5. Describe the existing land use or condition of the site at the time of this application
Lv v✓ ,� j 4,ut I+
(residential, undeveloped, etc.): ly �'r""�� be �.� �
6. Property size (acres): D S
7. Lake/ river/ ocean adjacent to property: 0 Y'01 Ad
9. Describe proposed work (include discussion as to how hardening of shoreline has b en
avoided, or why it is necessary):
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:
, retaining
11. Total amount of disturbance (including all clearing, l Wack ter t
er eve and So eetll, excavation, rippland-wad in
walls, etc.) above the normal pool lake level/ Norma
square feet or acres:
ormal pool lake level/ Nor a��ster Level and 5Q
12. Please describe the vegetation above the n
g
feet landward to be impacted (number of trees, for instance): S
9/1
* Printed Name Date
Owner/Agent's Signature
f 15A NCAC 02H .0502 (f)l
if an authorization letter from the owner is provided.
`Agent's signature is valid only
Page 2 of 3
FORM: SSCP 10-2013

Full Pond/
Normal Water Level
shoreline <
z
f
t
I I ' 6� ovc-
Lake
(At Full Pond/ Normal Water Level)
-T
70 Z9 �^J
Co rN-ci: it e.
/ C -�t-g'D 31
.-7g ou. /dS
-1 1 bjo,')
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

LEGEND
I4 REBAR FOUND O
#4 REBAR SET V
COMPUTED POINT •
FENCE X—
FIELD LOCATED
/ 760' CONTOUR
DARY1 W. 1 ()tiG. P.I_ 'i1
18335 COLD STATESVILLE ROAD
SL ITE A
COR%FLICS. \.C” 28LLT1
170.1, ?65-� 1 -14
1
LA KE
�" NORMAX
wnw DOCK';
k PIER
�1E Lr
aONUM o. T� ! C7 41.27 0
0"E LP V44514'OO�E
75. o 10.7
DRIVEWAY EASEMENT JD' REAR SETBACK O 4
09. 8878. PC 731 ,r FROM 760' CONTOUR
PER TOWN AND 1
06 2536 PC 269. �� Fr
12' SIDE SETBACK
PER TOwN-
001-751-02
JOHN H FRANCIS
MILDRED F. FRANC.:_.
Q
OR 4275 P; 714
17 1` CP
20.638 SQ. FT. 1� o O
LOT t8
O
0.473 AIC- L% RS 0'a (?'_
sSS
As Recorded in
17029 Jetton Road
7 1
GARY /AGE
0.
r
m
Sic. -?. Cnrrelius. N 'X037
B
Map Book 11. P -,?43
M1te(:klenburg Count}
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v 9 LO
EXISTING BLOCK
40JOINERS' 3- ROPE FD4CE
aT y
WITH WOOD POST
'V
_ p N --4
01
f 1
546'10'18 yr\
S58'44'28"W 78.0 7' 56.02'
I '.t, NCOS MOM All va I(N ND%XifillA
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\[\t,
R[ SI)I \FIAT K:KI
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(IR\tI it'CI^ it .4-11
fR(R` T 25'
SUN I--
I'Rtr\IR["ARPROI'F-.Rl%'iINI %%[7ICHI 'Vit
IS(iKl %LFK
001-75'-04
W!7LL1AM R. NUTT
GB 462E PC 687
COT t6
TIE LINE
t446-12'37"F-
:i- r
106.0
2' VALLEY CURo
JETTON ROAD
vRl,Pr-ICI, \I\N"m tir7+_ircrTrrt)-Im 70' PUBLIC R/Vd 36' BC TO BC
(Y)\ I %A\1 S. Rf STRI(IIONS. l-ASE\II'VIS S.R. 2151
"1 (CWJ st L7 %%I III(A)VI RSI\G :N61,NC) [OR
!'RLC:\!! IN( 14\D DF\F1 t)P\IP\7 AND
/_UCI*:O Ki'�)7 `IK7;417_ATS PK!C3R 1(T ITGSI(15
If ..501!'„Sd R7.v[Pit ."Tf(I": As orxpimScal,
RL(-ORDUDIND142536Pt1_`(,9OFI'M. dt) _'(i
\11(. 1:1 I:\BC-R(,t of �\1) RFt.I,,IRY
.4c.�teo[I)rJ,ong I Inch JI, Feet
Physical Survey of Lot 17 of Mountain View Beach
LOT N
Professional
17 1` CP
20.638 SQ. FT. 1� o O
60-
ac
0.473 AIC- L% RS 0'a (?'_
sSS
As Recorded in
17029 Jetton Road
}
GARY /AGE
Dced Book 20630. 1'c 639
m
Sic. -?. Cnrrelius. N 'X037
B
Map Book 11. P -,?43
M1te(:klenburg Count}
U[
v 9 LO
EXISTING BLOCK
FOUNDATION 7C„o
_ p N --4
01
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an
sETeaac�~ 1� °' 1`'
m
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o �
!1 SE7BAC
f 1
546'10'18 yr\
S58'44'28"W 78.0 7' 56.02'
I '.t, NCOS MOM All va I(N ND%XifillA
_'INNr
t'1'RRF\7 ZS)
\[\t,
R[ SI)I \FIAT K:KI
\4173 Wks PROVI1)i l) BT :114. 7( A%\ : 4
(IR\tI it'CI^ it .4-11
fR(R` T 25'
SUN I--
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IS(iKl %LFK
001-75'-04
W!7LL1AM R. NUTT
GB 462E PC 687
COT t6
TIE LINE
t446-12'37"F-
:i- r
106.0
2' VALLEY CURo
JETTON ROAD
vRl,Pr-ICI, \I\N"m tir7+_ircrTrrt)-Im 70' PUBLIC R/Vd 36' BC TO BC
(Y)\ I %A\1 S. Rf STRI(IIONS. l-ASE\II'VIS S.R. 2151
"1 (CWJ st L7 %%I III(A)VI RSI\G :N61,NC) [OR
!'RLC:\!! IN( 14\D DF\F1 t)P\IP\7 AND
/_UCI*:O Ki'�)7 `IK7;417_ATS PK!C3R 1(T ITGSI(15
If ..501!'„Sd R7.v[Pit ."Tf(I": As orxpimScal,
RL(-ORDUDIND142536Pt1_`(,9OFI'M. dt) _'(i
\11(. 1:1 I:\BC-R(,t of �\1) RFt.I,,IRY
.4c.�teo[I)rJ,ong I Inch JI, Feet
Physical Survey of Lot 17 of Mountain View Beach
Site Address:
Professional
W ipr„pert
Propert." of
As Recorded in
17029 Jetton Road
Suric\6rs_ Inc.
1.41 i5 OW titu7cstill: Rndd
GARY /AGE
Dced Book 20630. 1'c 639
Cornefws \C'_8b t%
Sic. -?. Cnrrelius. N 'X037
REVOCABLE TRUST
Map Book 11. P -,?43
M1te(:klenburg Count}
ill 1111) : 1 i1 P 1 RtfTR).\t 1 M Tn,t I,
'04-765-51Y4 Plwfw l ax
i ,rtn i_sM;erv:- (-TS+.o
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Map data 02017 Google United States 500 ft
https://www.googic-com/maps/@35.4701533,-80.9328597,16z 8/28/2017
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Map data 02017 Google United States 500 ft
https://www.googic-com/maps/@35.4701533,-80.9328597,16z 8/28/2017

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