20191560 Ver 1_Shoreline Stabilization_20191112

State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
15A NCAC 02H .OSOO — Water Quality Certification, Shoreline Stabilization
Division of Water Resources FORM: SSGP 10-2013
Shoreline Stabilization Application Form
One copy of the application (including attachments) and the application fee should be sent to:•
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
RECEWEDIDENIRT 1 M
Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: V lAM*r Rookources
Mailing Addres . I L4-11) Y, i �-%u Cn�e,�r- lyrmdt g ec zon
� mu�y�noxl . N C a 81 lQlo
Telephone Number: 101-1 U314 - 1111 Fax Number:
E-mail Address: r k mAii i esi 'a') 4nna_"I . ecm
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
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name:
Company Affiliation:
Mailing Address:
Telephone Number: J6q - U(oh - 5111 Fax Number: q04 - (e(40 - S1RUq
E-mail Address: c 6 c- s e-o. w cd[-.n7 w', n A -s+ re c-m . n e_-E
Person to receive the Certification Approval: Ta.n', ce
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,
etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
FORM: SSGP 10-2013 Page 1 of 3

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: Lrede.11 Nearest Town: (Ylc�r,resvt��e_
Subdivision name or site address (include phase/lot number): a,aa 1^ reen6 Qd .
ooresvi Ikea NC'.81 m L + 4 1 kLio Cresce_(4 Lana rs T rni"Or- Cic-n.
Directions to site - please include road names and numbers, landmarks, etc.:
See o_+4�ed
Latitude (in decimal degrees) 35, 5qJ (975 Longitude (decimal degrees) — 80, q a 5 A53
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.)::j 25 t dena-taA
6. Property size (acres): X , SIS acres
7. Lake/ river/ ocean adjacent to property: y,lnr rnagn
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): l�_redgke 6sA �pacRe. , clreAge Sroi l Ieh+ ons'4e_
Shorel i nt : "Tas-ka b (A I lo_r)_T�IocA wa.(l -Icy feptace exi51i no, wood (knl(
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:
-Ur eda y n-c e_S Slnore.line: y i dow Si o47 'irnoac�i
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:7r� tU' x (0' I or tea► na S )nrel in2.' l a.6ave.
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): Qca65 V,U�Vtra
2 r v ;116')Pv -
are m, e,rial to 10e le on5i+e_ , Vy\ n',rnal �i5�urhance-}� I�,�Fer
CfAer/Agent's Sign
Agent's signature is i
* [15A NCAC 02H .0502(f)l
to �a3�IQ
Date
only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

Full Pond/
Normal Water Level
Shoreline
G Q
Lake
(At Full Pond/Normal Water Level)
160' 5 ' c u+
30'
1 ACL. IoNq e.
A l l('�n 110C-
®.�®�
No Tees rzrno v ed
home.
to be derno'cl
Loj to be deo.re-d
(r1;,n'� ma.l d i5+0 Aanc2
-�o 61�F r.
17. red92 tYu�-l-er i a.l
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
Raymond May
222 Greenbay Rd.
Mooresville, NC 28117
Page 3 of 3

11/1/2019 610 East Center Avenue, Mooresville, NC to 222 Greenbay Rd, Mooresville, INC 28117 - Goog le Maps
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Recombination Survey
222 Oreenbay Road
CRESCENT LAND & TIMBER CORP
LAKE NORMAN SECTION 10
LOT 1140
Davidson Township, Iredel! County, NC
PIN# 4627-77-6925 — DB 2266-315 — PB 16-91
Property of- Cynthia Lafoy
Survey for. Raymond May

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Shoreline 222 Greenbay Rd.
Mooresville, NC 28117

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: aa2L(ztreeAn" A. ooresv I ] fie, IBC QR11-County: Creme l l
Owner:
Contractor/agent:
Print L /I I Signature
The approval is for the purpose and design described in your application. Impacts not indicated in the
application is a violation of the Buffer Rule. Site specific work should be provided in the application. [15A NCAC
02H .0506 and 15A NCAC 02B .0243(8)]
Trees are not allowed to be removed from Zone 1 of the Buffer (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 .0243(6)]
Benching, grading in the buffer is not allowed. Excessive disturbance of ground cover. [15A NCAC 026.0243 (6)]
Beaches, impervious patios, impervious walkways, etc. are not allowed in the buffer unless specifically approved
by the Division. There are limitation on size for decks. [15A NCAC 02B .0243(4) and (6)]
Work to be conducted from land must indicate an access and indicate any trees that are to be removed. The
work corridor should be described. The approved access corridor shall be restored. Staging, spoil, construction
material must be outside the buffer. [15A NCAC 02H .0502 and 15A NCAC 02B .0243 (4), (6), (8)]
Stormwater cannot be piped or channeled for direct discharge to the lake. All constructed stormwater
discharges must be at the natural elevation and discharged prior to entering the buffer directed as diffuse or
sheet flow at non -erosive velocities to the lake. [15A NCAC 02B .0243(5), (6)]
Acknowledgement of Notification
I, Cklj Y1 . m M OAl , hereby state that I have been informed of the Catawba
Riparian 6u4r Rule. Any wort onducted in the buffer, not specifically stated in the application and 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 be built within substantial compliance and intent of the 401 Water
Quality Certification and Buffer Rules, the approved plan(s) and specification(s), and other supporting
materials.
Signature (owne : Date: 10 123 ig
State of North Carolina I Environmental Quality I Water Resources
512 N. Salisbury Street 1 1611 Mail Service Center I Raleigh, NC 27699-1611
919.707.9000

DREDGE SPOIL DISPOSAL FORM
Project Name/address: aaaa �reeXl�0o�1 1`1d. (1lmresui(le, WJ811-7 County: -r reC(e l�
Location Address:7D1spa=� reenl�,a.0 t?id. �oc�r'eSy'1lle , NC a 11�
Parcel M _ Ll 6 a -I -I -1 LD G 2.5
Parcel/lot size 1. 8 t acres
Disposal area required (sq ft and/or acreage) toy' X ( o 0 l
Acknowledgement of Notification
I, Ro-ornond lmam aware that the site must adhere to all state regulations
and rules 49arding sediment d erosion control and water quality. And give permission for
Name of Individual and Company
to dispose of their dredge material at the above stated loc
Owner: RJAYIh.N o L , AU Y 4s
Print / Signature
Date: 10123II01
Along with form, please provide:
Aerial of parcel/lot (County GIS)
Photo of proposed spoil site
Identified proposed spoil site

Duke Enersv 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 1�3 1q Initials
Date Final Protection/Avoidance Area Markings Field - Verified
Approved to Start Work By * :
Date Completion Required
Date Passed Closeout Inspection*
(Print)
Date of Any Approved Extension
Initials
Initials
Date
(sign)
Initials
Any Stop Work Orders or SMG Violations*? (check one) ❑Yes ONO (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 Work
Orders with application.
Part I. Applicant Information (Please Print)
Name -P)Q4A 'nnC1 aij Telephone (_) `l014 - ln3y ` 11-71
Email address:
Lake Address
_aaa, reen . c+ul
Mailing Address (if different)
IH-1 t76i4ujocd06vl?-T)r.
Contractor Company Ch 2 6 \`� CU i no . LLC
Contractor Contact Person Juxt; C2 Telephone (_) t[0g- UUc) -5111
Contractor Email Address: ebc Secxvuct \lS G-1) Li ► Ad5-4-r'e QXY1 rt :�-
LAKE LOT INFORMATION
Lake tJorm&n County Zcede I t City Moore_-, iltf_ State t�r, Tax Map No.
SubdivisionCresewn end Lot / Section No. _ tNO Lot Size L%I Acres
Duke Energy Page 4 of 14 rev 6/20/17
Excavation Program.

Duke Energy Excavation Permit Application Form
Are there any Co -Applicants*? (check one) ❑Yes 01,4o (If 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 10 0 3 l
Initials (Duke Energy) �Jcw_
(applicant/contractor)
Duke Energy Page 5 of 14 rev 6/20/17
Excavation Program.

Duke Enemy Excavation Permit Application Form
Part II. Description of Project
A. Basic Information
1. Type of excavation: (check one) ❑ New excavation IN Maintenance excavation
2. Purpose of excavation: (check one) ❑ Boat Access Channel
❑ Water Intake Channel ❑ Wastewater Discharge Channel
09 Other (specify): rat w
3. Lake user category: (check one) ®Private ❑Residential Marina
❑Commercial Marina ❑Public
❑Other (specify):
4. Max. Excavation Area Dimensions (ft): Length 1001 Width 3n Depth —
(Note: include additional area dimensions if necessary so response to #5 below equals nzax. area
dimensions in 94)
5. Volume of Excavated Material (TOTAL.for the project): 55 $ 55 Cubic yards
6. Type of material removed (applicant determines byfreld sample if practical):
7. Excavation Site area: ©, 3LN _ Acre (s) Disposal Site area: . _QCL"�Acre(s)
8. Total Disturbed Area (including equipment staging area):-AO.�10 Acre (s)
9. Does the project meet the requirements of the applicable General Permit? (check one)
des Jo
10. Do you claim title to the disposal area? (check one) ®Yes No see cx*adn ed /
deed /
1 1. Do you claim title to the equipment staging area? (check one) PYes Ito ( Bee a-�+oacNled
12. Are there any water -treatment facilities within 50 feet of the proposed excavation arrea9 )
(check one) Yes .to
(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):
W'It-h s�l-F�enee a.b6vt 5b' ��F�,
Ne�shbor ca-Ir a5Z Grcen'o . Rd. will be lec���r,9 dredge bpo',15
Frain �-he a, clred a} fhe aaa 6+reen6o,y 9d, address.
aa2�Gtrce0 b� t5 cXvtn9 mob'ile home demo axed (off Cleared
Duke Energy Page 6 of 13
Excavation Program rev 10/1/2019

Duke Energy Excavation Permit Avocation Form
14. Type(s) of excavation equipment to be used: on j reach 2Y.caga.No,r
1.0
15. Will waters or wetlands be crossed in transporting equipment to or from the site?
(check one) WYes ONO
(If yes, explain)
Lj
16. Will return water re-enter the reservoir? (Check one) ❑Yes ONO
(If Yes, specify point(s) of re-entry and show on Excavation Area Drawing)
❑N/A
17. Is there an existing facility (e.g. pier) that access is being maintained to by conducting the
excavation? R)Yes ONO
(If Yes, specify the existing permit number. If No, include a scaled drawing of the proposed
facility). Permit # no ew docK � rtv %i 0.Pp1Ied (vr,
18. Total planned duration of the work (Include first equipment mobilization, excavation
through final mitigation measures complete):
START I— / -20 FINISH �� / 20
(Month) (Year) (Month) (Year)
Duke Energy Page 7 of 14 rev 6/20/17
Excavation Program.

Duke Energy Excavation Permit Application Form
Part II. (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
Acre
Identification
Method *
Avoid (A) or Mitigate (M)
Field ID
Work Area Dwe. ID
a. Marshland, swamp, ponds, beneficial
aquatic vegetation or other potential wetlands
(circle all that apply)
b. Buffer Zones (speck width & source
of requirement)
to' w icde- arm eSS
redge b
barge
�cedse �q}�riaC l �or
Z 52. and Z22 Gar een a d.
e as RE-
SO' W %dam, � 9q'--r
46 leave dreda►e nrc.
c. Environmental Areas as identified by
Duke Energy
d. Natural Areas as identified by Duke
Energy
e. Historic properties (spec)
L Rare or threatened species (spec)
Duke Energy Page 8 of 14 rev 2/6/17
Excavation Program

Duke Energy Excavation Permit Application Form
Protection/Avoidance Areas
(check all that apply)
Ai3prox
Identification
Method *
Avoid (A) or Mitigate (M)
Acre
Fi eld ID
Work Area pwg. ID
¢. Buried gas, water, sewer,
communications or electric lines (circle)
h. Impact Minimization Zones as
identified by Duke Energy
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 2/6/1 7
Excavation Program

Duke Eneru Excavation Permit Application Form
C. Applicant's Signatures
Comments:
ry 1 oores v'►11,e
Applicant Name (print)
Applicant
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

Excavation Project User's Agreement Letter
(Please fill in the blanks. Please Print)
Date o 21
TO: Duke Energy
c/o Lake Services - EC12Q
526 S. Church Street
Charlotte, NC 28202
RE: Excavation For (Subdivision and Lot #'s or Other Project Name)
-!in -A r e—L._., 'RA 1 _a. #* 1 iun
(Lake/County/City)'Normar► / Treclel l / YYlooresvl He.
(Applicant's full name) :R au roo nd 0) a AA hereby agrees to comply with all
recommendations, requirem— ents and/or condition' of Duke Energy Lake Services, General
Permit(s) (if applicable) and other federal, state and local agency requirements pertaining to the
application to excavate for the purpose of a n eW Cd 0 C Ili
In addition, Uwe have read and agree to comply with Duke's current Shoreline Management Plan
(SMP), much of which is repeated herein, and understand that written authorization must be
obtained from Duke Energy Lake Services prior to beginning any activity within the FERC
project boundary or on Duke Energy land. The excavation will be completed as described in the
approved application and within eighteen (18) months from the date of written approval by Lake
Services, unless specifically noted otherwise in the application or unless Uwe obtain approval for
a single, time extension (maximum of one year) in writing from Duke Energy Lake Services.
Uwe understand that if the SMP or other applicable rules change during any extension period,
Uwe will be expected to comply with the new requirements to the maximum extent practicable.
Uwe also recognize that failure to complete the excavation within this build -out period will
require the filing of a new application within the then -current SMP and the new application must
include any applicable fees and security deposits.
Uwe attest to be the owner(s) or lease holder(s) of the land immediately adjoining the project
boundary or Duke -owned peripheral strip where the excavation activity is to take place, or if not
the owner or lease holder, Uwe have included proof of title to the property and written
authorization from the owner(s) or lease holder(s) to carry out the proposal within the project
boundary adjacent to their land.
Uwe attest to be the owner(s) or lease holder(s) of the land that will be used for equipment
staging and disposal of excavated material or if not the owner or lease holder, Uwe have included
proof of title to the property and written authorization from the owner(s) or lease holder(s) to
carry out the work on their land.
Duke Energy Page 1 Rev:6(16/1)

Uwe understand that all excavation work must be done directly in front of my/our property and
within the third of the cove nearest my/our property or within any middle third of the cove that
Duke Energy owns, or Uwe have written authorization from the owner(s) or lease holder(s) to
carry out the proposal within the project boundary adjacent to/on their land. Uwe also understand
that access channels must run perpendicular to the shoreline while within the third of the cove
area that is nearest my/our property.
Uwe understand that for proposed excavations, Uwe must notify the appropriate local, state and
federal agencies in advance of the activity by sending them a completed copy of Duke's
Excavation Permit Application Form and other required information. Uwe understand that
written authorization and/or other permits may be required by some of these agencies and such
required authorizations must be obtained before Uwe submit the final application to Duke
Energy Lake Services.
Uwe understand that except for maintenance excavations, any excavation exceeding 2000 cubic
yards of material removed or any excavation or shoreline stabilization work needed to support an
application that requires Federal Energy Regulatory Commission (FERC) review does itself
require specific review and approval by the FERC before Duke Energy can issue any approvals.
Uwe agree that unless specifically approved otherwise in the application, explosives will not be
used as part of this excavation activity.
Uwe understand that every reasonable effort must be made to minimize any adverse impact on
fish, wildlife and other natural resources.
Uwe understand that applicants in South Carolina proposing excavations that are not covered
under the General Permit, or are greater than 150 cubic yards, must receive prior written
authorization from the South Carolina Department of Health and Environmental Control
(SCDHEC) or the US Army Corps of Engineers (as applicable) before submitting the completed
application to Lake Services.
Uwe agree that excavation activities in North Carolina and South Carolina will not occur during
the months of March, April, May and June because of the potential impacts to fish spawning
areas.
I/we understand that trees and vegetation growing within or adjoining the lake play an important
role in its overall environmental condition, and the ecological benefit the vegetation has on fish
and wildlife habitat directly supports a sound and healthy lake environment. Uwe also understand
that unauthorized removal of shoreline vegetation (e.g. button bushes, willows, cattails, etc.)
and/or disturbance of the shoreline buffer may result in suspension or denial of lake use
permitting requests, forfeiture of security deposits and require re-establishment of vegetation at
my/our expense, particularly if the disturbance is found to be in violation of state or local
ordinances or impacts FERC project buffers.
Duke Energy Page 2 Rev: 6/16117

Uwe agree that all excavated material will be placed in upland areas, landward of the project
boundary, and confined to prevent erosion and sedimentation back into the lake or nearby
streams.
Uwe agree to adequately stabilize all excavated material and all disturbed shoreline to prevent
erosion and runoff into the lake.
I/we understand that the double handling of excavated material will not be allowed; therefore, all
excavated material must be placed above the project boundary in one handling.
Uwe have designed the hydraulic excavation process (if arty will be used) so that return water re-
enters the lake in the same general vicinity and cove as the excavation, to the maximum extent
practicable.
Uwe agree that the proposed excavation will not be for the purpose of creating additional
shoreline, will not alter the project boundary or the full pond contour, and will not impact
threatened or endangered species, historic properties, or environmentally -important areas, unless
special public entity provisions were made in the application.
Uwe recognize that it is my/our responsibility to clearly locate in the field and label on my/our
work area drawings any areas that require specific protection or avoidance during this excavation
work. Examples of these protection/avoidance areas include but are not limited to, any
Environmental Areas, Natural Areas or Impact Minimization Zones as identified by Duke;
jurisdictional wetlands; historic properties; rare or threatened species; and buried gas, water,
sewer, electric or communications lines. Uwe agree to provide my/our contractor with a copy of
these work area drawings showing these areas to stress the necessary protection measures.
Uwe agree that if any archaeological resources (e.g. pottery shards, Indian artifacts, etc.) are
discovered during the excavation, work shall be halted immediately. Uwe will then notify Duke
Energy Lake Services and the State Historic Preservation Office to determine what measures, if
any, Uwe must pursue to protect or salvage the archaeological resources.
Uwe agree that any excavation from within the project boundary will not exceed the volume as
outlined in the application and will remove and disturb only what is absolutely necessary to
achieve the project's stated purpose.
Uwe agree to be fully responsible for the permitted lake use and Uwe understand that this
responsibility is considered to transfer automatically along with ownership and leases of the
adjoining tract.
Uwe understand Duke Energy representatives may issue Stop Work Directives for violations of
the SMP and other consequences may result from such violations, including but not limited to
suspension or cancellation of approved permits, increases in fees, modification or removal of
non -complying structures and restoration of disturbed areas at my/our own expense or loss of any
consideration for future lake use permits. Uwe agree to immediately comply with any Stop Work
Duke Energy Page 3 Rev: 6/16/I7

I/we understand Duke Energy representatives may issue Stop Work Directives for any
violation(s) of the SMG or engagement in prohibited acts or activities on Duke Energy property,
if any, as specifically identified in the SMG. I/we understand persons found to be in violation
will be subject to Duke Energy sanctions which can include, but are not necessarily limited to: 1)
restoration of the impacted area at the person's expense; 2) loss of consideration of any future
lake use permitting activities for up to five years for improper vegetation removal or until
vegetation is satisfactorily re-established (even if there is a change in property ownership); 3)
revocation of a previously issued permit and loss of consideration of any future lake use
permitting activities and/or reinstatement of the revoked permit; 4) increase in fees; 5)
modification or removal of non -complying facilities; and/or 6) further legal action being taken
by Duke Energy.
I/we agree that if any historic or archaeological resources are discovered during construction of
an approved activity the applicant must stop work immediately and contact Duke Energy. I/we
understand that in the event that anyone discovers a potential site of archaeological or historic
significance including any gravesite within the Project, the individual must immediately notify
Duke Energy.
1/we acknowledge Duke Energy has the right to charge reasonable user's fees for private use of
its property, if any, and the Project and failure to pay any applicable user's fees in a timely
manner can result in the suspension or cancellation of any previously approved lake use permit.
Uwe agree to notify Duke Energy when construction is completed and during the construction
period, I/we will post the Duke Energy approval (to be provided by Duke Energy) at the job site
visible from the water's edge.
G_U fn n 6 Maki
Applican ame
a a a Cn reen be U i�d
Lake Street Address
IM06T,esy ►11e , iSC_ a811`j
City/State/Zip Code
101A - L314 1 11 I
Preferred contact Phone Number
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Ismail Ad ss
Page 5 of 5
p_ cant Signature
41 Sri f'4 waoc Ceve_Or.
Home Mailing Address
l rcwV rY,lD U
City/State/Zip Code
`ley -U3Lq- 11-11
Home Phone Number
101z 1I_
Date
Rev U 2018

Type: CONSOLIDATED REAL PROPERTY
Recorded: 10/31/2019 3:34:37 PM
Fee Amt: $426.00 Pape 1 of 2
Revenue Tax: $400.00
Iredell County, NC
Ronald N. Wyatt Register of Deeds
BK 2655 PG 1225 -1226
NORTH CAROLINA GENERAL WARRANTY DEED
Excise Tax: $400.00 Purchase Price: $200 000.00
Parcel Identifier No. 4627776925 Verified by County on the _ day of , 20
By:
Mail/Box to: Grantee
Instrument prepared by: Ben S. Thomas, a licensed North Carolina attorney, 514 Williamson Road, Ste. 431, Mooresville, NC 28117
File# 2019100028
Title Insurance Company: Southern Homes Title Company, Inc.
Brief description for the Index: Lot 1140 Section 10
this I
GRANTOR
GRANTEE
Cynthia A. Lafoy, unmarried Raymond L. May, unmarried
4106 Wrentree Drive
Dallas, NC 28117 Property Address:
222 Greenbay Road
Mooresville, NC 28117
Mailing Address (if different):
147 Driftwood Avenue
Troutman, NC 28166
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and shall include
singular, plural, masculine, feminine or neuter as required by context.
WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby acknowledged, has
and by these presents does grant, bargain, sect and convey unto the Grantee in fee simple, all that certain lot or parcel of land situated in
Iredell County, North Carolina and more particularly described as follows:
Being Lake Lot No.1140 as shown on a plat of survey thereof prepared September 18,1986 and marked Dwg. No. C.F.10-1 a
copy of which Is recorded in book 18 at Page 91 in the Office of the Register of Deeds for Iredell County.
Page Count A
NS PO SI ROTC
Book 2655 Page: 1225 Page 1 of 2

Delinquent property taxes, if any, are to be paid by the closing attorney to the county Tax Collector upon disbursement of the
closing proceeds.
The property hereinabove described was acquired by Grantor by instrument recorded in Book 2266, Page 315.
All or a portion of the property herein conveyed ___. includes or x_ does not include the primary residence of a Grantor.
A map showing the above described property is recorded in Book IS, Page 91.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to the Grantee in
fee simple.
And the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee simple, has the right to convey the same in fee
simple, that title is marketable and free and clear of all encumbrances, and that Grantor will warrant and defend the title against the
lawful claims of all persons whomsoever, other than the following exceptions:
1. Any and all easements, rights of way and restrictions of record
2. Any and all zoning and planning ordinances.
3. Any discrepancies as an accurate survey of the premises might reveal.
4. Any and all other matters of record
IN WITNESS WHEREOF, the Grantor has duly executed the foregoing,
&Ak (SEAL)
Cynthia 6Xafoy
(SEAL)
(SEAL)
(SEAL)
(SEAL)
(SEAL)
State of North Carolina - County or City of Iredell
1, the undersigned Notary Public of the County and State aforesaid, certify that Cynthia A. Lafoy persm nally appeared before
me this day and acknowledged the due executjof the foregoing instrument for the purposes therein exp , Witness my hand and
Notarial stamp or seal this _1 day of (J L—T , 20i�
,,,�IeIH/I/p1� .
My Commission Expires: 3 — r —� 7- ;�* •TH s�F�y/'J 5 ittary Public
(Affix Seal) f 0 NOTARY '.� Notary's Printed or Typed Name
PUBLIC,_ I:
Book: 2855 Page: 1225 Page 2 of 2

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SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 1190 PLAN NO. PARCEL ID:
STREET ADDRESS:
Please print:
Property Owner:
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Tan, ce 5- , of e C 5�01)e i=
(Contractor / Agent) (Name of consulting firm
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
t76 woed LeVe— -Dr m-,� . 4
Telephone: 'IbL(" is
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
4Ah rized Signatur Authorized Signature
Date: l 0 I Z 3 I l Date: