20201078 Ver 1_Shoreline Stabilization_20200825

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/24/2020 8:39:07 PM (Submittal)
Approve by Montalvo, Sheri A 8/25/2020 8:53:19 AM (Non -DOT - Approver)
• The task was assigned to Montalvo, Sheri A 8/24/2020 8:39 PM

Submission Form
I. Applicant Information [15A NCAC 02H .0502(a)]
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all
mandatory questions are answered.
Primary Contact Email *
Owner Information:
Name:
*
Email:
*
Phone Number:*
Mailing Address:*
Is there an agent working on the
project?*
Agent/Consultant Information
.................................................................................................................
Name:
Company Affiliation:
Email:*
Phone Number:*
donna. [e-mail]
Rease provide an enail address for payment and requests for pore infornation here.
Stephanie D. Arnold
deebylake2l @gmail.com
[phone]
(xxx)xxx-xxxx
Street Address
110 Seneca Place
Address Line 2
city
Mooresville
Fbstal / Zip Code
28117-8456
r Yes
r No
Donna P fkko
State / Frovince / Region
NC
Country
US
Lancaster Custom Dock and Lift Systems, Inc.
[e-mail]
[phone]
(xxx)xxx-xxxx

Mailing Address:*
Street Address
1156 Perth Road
Address Line 2
city
Troutman
Fbstal / Zip Code
28166-8640
Asigned and dated copyof the Agent Authorization letter:*
Arnold Agent Authorization Form.pdf 180.03KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Arnold Dredge
State / Province / Fegion
NC
Country
US
If your project has a formal name please use this. If your project does not have a formal name, please identify your project by
the owner name and proposed activity (Jones Property Access Road, Smith Guest House, etc.) List in parentheses any
other names that have been used to identify the project in the past.
1. Provide 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.
r Upload File
r Look up address
Property Address Lookup:* Street Address
110 Seneca Place
Address Line 2
Latitude:* 35.628980
City State / Province / Flegion
Mooresville NC
Fbstal / Zip Code Country
28117-8456 US
Longitude:*-80.901481
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, and construction access corridors. You may use the
diagram under section 12.normal pool lake level/normal water level*
Arnold Shoreline Application and Duke Energy
6.16MB
Excavation Application.pdf
Please use the diagram at the link below:
https://edocs.deq.nc.gov/WaterResources/0/edoc/616616/Shoreline%2OLayout.docx
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale of some sort- a
yard stick, shovel handle, etc.)*
Arnold Shoreline Photos.pdf 335.01KB
4. Location of the property (where work is to be conducted)
Nearest Town:* Mooresville
County: * Iredell

Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address:* Crescent Land+ Timber Corp. Section 14 Lot 107 110 Seneca Place
Mooresville, NC 28117
Include phasellot number
Directions to site:*
From I-77 NB, Exit 36, Left onto NC-150 WB, Right onto Perth Road,
Left onto Stumpy Creek Road, Left onto Seneca Place, Property is on the
right.
Reese include road nacres and numbers, landrrarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
Residential
Residential, undeveloped, etc.
6. Pro pertySize .68
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Dredge area for boating access where new pier and dock will be
constructed.
8. How will the work be done? * I7 From Land
V From Water
9. Total amount of disturbance below the normal pool lake level/ normal water level:*
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
1380
square feet
10. Total amount of disturbance above the normal pool lake level/ normal water level and 50 feet
land -ward: *
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
500
square feet
11. 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)
None
Sketch:
Application Fee:
Once the application has been accepted. You will need to send a corresponding fee in with the appropriate DWR#. The
application fee is as follows (pursuant to G.S. 143-215.3D):
$240.00 for impacts to lake (below normal water level) of less than 1 acre
$570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:
• I have given true, accurate, and complete information on this form;
• I agree that submission of this form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the
"Uniform Electronic Transactions Act")
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act');
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written

signature; AND
o I intend to electronically sign and submit this form.
Full Name:* DonnaP. Hrko
Signature:

Initial Review
Is this accepted into the review
process?*
Project Number:* 20201078
Select Reviewer:*
Select Reviewing Office
Has payment been received?*
What amount is owed?*
rYes allo
Version:* 1
Alan Johnsomeads\adjohnsonl
Mooresville Regional Office - [phone]
r No Payment Needed
r Fee Received
r Need Fee - send electronic notification
r $240.00
f $570.00

Authorized Signature
AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO: 107 PLAN NO: PARCEL ID: 4638499286
STREET ADDRESS:
110 Seneca Place
Mooresville, NC 28117
Please print:
Property Owner: Stephanie D Arnold
Property Owner:
The undersigned, registered property owners of the above noted property, do herebyauthorize
Donna P Hrko , of Lancaster Custom Dock and Lift Systems, Inc.
(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 Owners Address (if different than property above):
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate tothe
best of our knowledge.
orized Signature
08/19/2020
Date Date
Artr Id
110 Seilecia V tgc.e.
l o o (esv ►Ile , Nci z81i--1
AY-no ►d
110 Seneca. Pt . Kpoy-e5 q, l le, N C 28117
Water Resources
ENVIRONMENTAL QUALITY
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 02-2017
Please approximately sketch the following information on this plan and provide dimensions for
each item:
a. All proposed vegetation clearing
b. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
c. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
d. Location of any proposed structures such as buildings, retaining walls, docks, etc.
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
E
Lake
At Full Pond/ Normal Water Level)
Full Pond/ Normal Water Level
nlicirernr
2 ft.x 150 ft.
additional clearing
• if necessary
Existing Dock
30 ft x 7 ft
3 ftx 150ft
Below full pond/ NWL
4 ft x 150ft
Above full pond/ NWL
Plan View
Page 1 of 3 KAMPL FORM: SSGP 02-2017
Lake
(At Full Pond/ Normal Water Lev Y..9
6\O
fl,CA
Ck°
Vei
Full Pond/ Normal Water Level
21111M INN
Shoreline
Plan View
Page 2 of 2 FORM: SSGP 02-2017
3 ft. below full pond water level 4 ft. above full pond water level
Existing bank
2 ft. additional clearing
if necessary
10 ft. bank
height
P E
Duke Energy Lake Services
Guidance for Completing an Excavation Permit Application
Note: If you are proposing excavation in association with the permitting of a new
or expanded facility under the Marina or Conveyance Programs, you do not need
to complete this application. Instead, you should incorporate the excavation
request into the permit application for the marina/conveyance using the
appropriate application.
Step 1: Contact Duke Energy Lake Services
Complete "Part I" of the application and develop a drawing of the proposed excavation area.
Contact Duke Energy Lake Services to schedule a site visit. Lake Services will conduct a site
visit to determine if Duke Energy will accept an excavation permit application for the proposed
work. If the Lake Services representative determines the application process may proceed,
he/she will initial Part I of the application.
Step 2: Draft Application Development
Complete Parts 11-III.A-G and Part V of the Excavation Permit Application.
Step 3: Agency Consultation
Send the draft application developed during Step 2 to the agencies for review and comment on
the proposed activity. Refer to the Agency / Organization List available from Duke Energy to
determine which federal, state, regional, and local agencies and organizations require
consultation or review.
Note: Duke Energy reserves the right to require consultation with additional organizations
beyond those included in the Agency / Organization List.
Each agency / organization must be provided at least 30 days prior notification. Evidence must
be provided (e.g., response letter or Certified Mail receipt) in the complete application to show
each agency / organization was given the opportunity to review the proposal.
Consultation letters must be dated within the two years preceding Duke Energy's receipt of the
application. All permits must be valid at time of application and have a term longer than the
projected schedule for completing the permitted project.
What to Expect During Agency Review and Comment:
• You will typically receive a letter from each agency / organization either documenting its
concurrence with your proposal, requiring additional information, recommending
modifications, or offering no comment. You must address each agency's / organization's
comments with a follow-up letter and in your fmal application as described in part IV.
• If you do not receive any documentation from an agency / organization within 30 days of its
receipt of your proposal, you must provide the agency / organization with a follow-up letter
requesting comment on your proposal within 15 days from the date of the follow-up letter. If
you still do not receive any response as a result of the second letter, type "NO RESPONSE"
Duke Energy Page 1 of 13 rev 10/1/2019
Excavation Program
at the top of the follow-up letter and include it in the application along with proof of the
agency's / organization's receipt of the letter (e.g., Certified Mail receipt). You may proceed
with the application process recognizing, however, that if its comments come later in the
application process, you will be required to address them.
• From the United States Army Corps of Engineers (Corps): (** Note — The Corps may have
additional forms to submit for your proposal and an additional fee.) If the excavation can be
done under the requirements of the General Permit (GP) or a Nationwide Permit (NWP), you
will typically receive a copy of the Corps' tear sheet documenting authorization and
providing any additional instructions. If the excavation isn't covered under the GP or a
NWP, you'll be required to obtain an individual 404 Dredge and Fill permit from the Corps.
You must receive written documentation from the Corps that your application either (1)
meets the requirements of the GP or a NWP or (2) the proper 404 Dredge and Fill permit has
been received before Duke Energy can process your application.
• From the North Carolina Department of Environmental Quality (NCDEQ), Division of
Water Resources: (Note —NCDEQ may have additional forms to submit for your proposal
and an additional fee.) If the proposal meets the requirements of the Clean Water Act Sect.
401 Water Quality Certification, you will typically receive a letter from the NCDEQ Division
of Water Resources documenting Sect. 401 Certification and providing any additional
instructions. You may also receive a letter requiring additional information or
recommending modifications. You must receive written documentation from NCDEQ
noting any required Sect. 401 Certification has been received before Duke Energy can
process your application.
• From the North Carolina Wildlife Resources Commission (NCWRC): If you do not receive
any documentation from the NCWRC within 30 days of their receipt of your application, you
may proceed with the application process without submitting a follow-up request,
recognizing however if comments come in later in the application process, you will be
required to address them
• From the South Carolina Department of Health and Environmental Control (SCDHEC):
(Note — SCDHEC may have additional forms to submit for your proposal and an additional
fee.) The SCDHEC conducts a joint application process with the USACOE in S.C. If the
proposal meets any applicable requirements of the Clean Water Act Sect. 401 Water Quality
Certification, you will typically receive a letter from SCDHEC documenting Sect. 401
Certification and providing any additional instructions. You may also receive a letter from
USACOE requiring additional information for the agencies participating in the joint
application process. You must receive written documentation from SCDHEC noting Sect.
401 Certification has been received if required before Duke Energy can process your
application.
• From the South Carolina Institute of Archaeology and Anthropology (SCIAA): The applicant
must wait 30 days after receiving the signed postal returned receipt. If a response from
SCIAA has not been received by this time you may proceed with the application process
without submitting a follow-up request, recognizing however if comments come in later in
the application review process, you will also be required to address them.
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Excavation Program
Step 4: Final Application & Submittal to Duke Energy
Following the consultation process, finalize the application. The final application submitted to
Duke Energy should incorporate all comments and recommendations provided by agencies and
organizations during the agency consultation process as well as copies of all permits received. In
addition to the final application include the following:
• One check payable to Duke Energy for the application fee and security deposit
• If applicable, a separate check payable to the appropriate Habitat Enhancement Program fund
• Signed Excavation Program Applicant's Agreement
Note: Co-applicants must also submit the application fees and applicable HEP fees with the
application.
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Excavation Program
Duke Enemy 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 zo Initials Ca l
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) q 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 Ske:Pharile t. A-v-101cl Telephone '104- (O77- (0-197
Email address: deeb\t lAIL)eZ 1 @Btrnck't Lam
Lake Add ess Mailing Address (i f different)
110 be-_necet Plac
N\oore5V1 LIP ) 1C ZB I 17
Contractor Company isknecel-e.rs etiskom 010014 1 5\13i-ems, rIG
Contractor Contact Person InniryA
Contractor Email Address: • on Q.
LAKE LOT INFORMATION
Lake NOnYlayrounty I re. deli City
Telephone :304. („zg-(on969
pi 4438 4cnzaco
State WC.;fax Map No. an,25854
SubdivisionertnCen+ Larici + Lot / Section No. I b7 /14 Lot Size .(0P)Acres
T1 nlb ex^ Carp
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Duke Energy Excavation Permit Application Form
Are there any Co-Applicants*? (check one) q Yes 2‹; (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 D B iS
Initials (Duke Energy) Ji2iLlit (applicant/contractor)

Duke Energy
Excavation Program
Page 5 of 13 rev 10/1/2019
Duke Energy Excavation Permit Application Form
Part IL Description of Project
A. Basic Information
1. Type of excavation: (check one)
2. Purpose of excavation: (check one)
q Water Intake Channel
q Other (specift):
1:3lew excavation q Maintenance excavation
lir‘oat Access Channel
q Wastewater Discharge Channel

3. Lake user category: (check one) IEKivate q Residential Marina
q Commercial Marina q Public
q Other (specify):
4. Max. Excavation Area Dimensions (ft): Length 4t49 Width ,...5() Depth /0
(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): l9 F3 Cubic yards
6. Type of material removed (applicant determines by field sample if practical): EJCk.r1C1
7. Excavation Site area: . 0 31 (.0 Acre (s) Disposal Site area: 03/ Acre(s)
8. Total Disturbed Area (including equipment staging area): , 04232) Acre (s)
9. Does the .roject meet the requirements of the applicable General Permit? (check one)
'4o
10. Do you claim title to the disposal area? (check one) q Yes
11. Do you claim title to the equipment staging area? (check one) arils To
12. Are there any water-treatmen facilities within 50 feet of the proposed excavation area?
(check one) Yes
(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 dqign): NA) ti+1 Ionq reactl
exeav a:41D LoacLmcciek-'qx 111+0 irtcciliS4tor hopper le3
and +Y-4-115 Por-t to ci16 posa.1 ay-ea. .
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Duke Energy Excavation Permit Application Form
14. Type(s) of excavation equipment to be used: Lo VIC\ Petro Excava+oe', 5110r+Readi
E—ACC01 abbr.) BO,rGeS j .0 Urn p tY..c._14N5
15. Will waters or etlands be crossed in transporting equi men or from he site?
(check one) es ONo Laiie. Le.ve 5 Per At
(~Ilyes, explain) -E-Ka..va_4iort eq 01 4.,y1.er) 1rr10121 1 st zed v ict Crainct plcv-i+.
La P) e Nor r) +t) 1 15tp
ed or7/0 ho per r-5-)77-i-- etrlFrit-d ki p)d • -e,_ryta-lers IS v 1 1( .1 _ -Or e fficd-er;cas w i 1 b .° 1
11.Will re
I oad it) 1-6, urn p:Tit-tc. 5
t es fEr
ted it -14qe asit.5 51 -Tc,
f`fgfitt IPSYS,Aierefirkeo ' ONo
(If Yes, specify point(s) 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? OYes Ono
(If Yes, provide the existing permit nurp¢er. If No, include a scaled drawing of the prppos4d
facility). Permit # New DOch ft) be Co qt-l -ruci-e al.
5 ee- A4kacl-led5-vlotivieereci Dam/6 4
18. Total planned duration of the work (Include first equipment mobt/ization, excavatiou • r ,eS through final miti„gatkn measures complete): Pri ,Icul-e ar-1 ii
START 0 Li 1 zn FINISH 69 / Z/ C_onsirttaion APP 1 ;dkn
(Month) (Year) (Month) (Year)
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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 Approx Identification Method (*) Avoid (A) or Mitigate (M)
(check all that apply) Acre Field ID Work Area Dwg. ID
a. Marshland, swamp, ponds, beneficial n/./A aquatic vegetation or other potential wetlands
(circle all that apply)
b. Buffer Zones (specify width & source Dreg41 wi tt be Ii5lied
1 ayt cl 4 ,yy
ith Lon ert
&await:in ctswill
be caded i n ho v5es , • fij - ;del.' , ,.,pr) _ 5dr,
of requirement)
c. Environmental Areas as identified by Al
Duke Energy
d. Natural Areas as identified by Duke AVA,
Energy
e. Historic properties (specify)
AYA
f. Rare or threatened species (specify)
N / 4
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Excavation Program
Duke Enemy Excavation Permit Application Form
Protection/Avoidance Areas Approx Identification Method (*) Avoid (A) or Mitigate (M)
(check all that apply) Acre Field ID Work Area Dwg. ID if211
Buried gas, water, sewer, A lg. /A communications or electric lines (circle)
h. Impact Minimization Zones as NiA identified by Duke Energy
i. Other areas requiring specific
AYA avoidance, protection or mitigation (specify)
* 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
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Excavation Program
Applicant Signature* Date e)-n-zo
Applicant Name (prin
Duke Energy Excavation Permit Application Form
C. Applicant's Signatures
Comments:
Co-Applicant Name (print)
Co-Applicant Signature*

Date

Co-Applicant Name (print)
Co-Applicant Signature*
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.
Date
Duke Energy Page 10 of 13
Excavation Program
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Duke Energy Excavation Permit Application Form
Part III. Additional Information
/Deed and Survey Plat: A copy of the deed and registered survey plat or other instrument
under which each applicant and co-applicant claims title to the affected property (the
shoreline adjoining the excavation area, equipment staging area, area crossed by any spoil
and return water lines, and the disposal area). If the applicant(s) is(are) not the owner(s) of
said property, then forward a copy of the deed and registered survey plat or other instrument
under which the owner(s) claim title plus written authorization from the owner(s) to carry
out the project on their land.
Excavation Area Drawing: An accurate drawing of the area to be excavated. The drawing
must show at a minimum, a North arrow; the boundaries and acreage of the proposed
excavation area and equipment staging areas; lake, county, city, cove, tributary, road and
subdivision names and lot numbers (as applicable); property corners for project front lots;
the full pond elevation contour and lines dividing the cove width into equal thirds (as
applicable); approximate volume in cubic yards of the material to be excavated; point(s) of
return water re-entry; the boundaries of any adjoining areas that are to be specifically
avoided or protected during the work and the location (address) of the disposal area for the
excavated material. [NOTE: A copy of this drawing must also be provided to the
excavation contractor to ensure restricted areas are not impacted.]
,$2<, Disposal Area Drawing: An accurate drawing of the proposed design for the disposal area.
The drawing must show at a minimum, a North arrow; the boundaries and acreage of the
proposed disposal area; lake, county, city, cove, tributary, road and subdivision names and
lot numbers (as applicable); the full pond elevation contour (unless disposal is well away
from the lake); the boundaries of any adjoining areas that are to be specifically avoided or
protected during the work; the location (address) of the excavation area from which the
material came and a statement of the disposal area's capacity with all dimensions labeled
that were used in the volume calculation. [NOTE: A copy of this drawing must also be
provided to the excavation contractor to ensure restricted areas are not impacted.]
Also note for projects larger than one (1) acre in North Carolina, including excavated,
equipment staging, and disposal areas, you must submit an erosion control plan. For
projects larger than two (2) acres in South Carolina, including excavated, equipment staging
and disposal areas, you must submit an erosion control plan. For projects < two (2) acres in
South Carolina, you must submit a completed standard reporting form for construction sites
disturbing two (2) acres or less to the South Carolina Dept. of Health and Environmental
Control (SCDHEC) - Stormwater Management
$ Vicinity Map and Driving Directions: A vicinity map and directions by road showing
directions to both the excavation area and disposal area. Include the latitude and longitude of
both the excavation area and the disposal area.
Part IV. Agency Reviews and Approvals
Begin this section with a summary table of all agencies consulted and applicant response to
agency comments as shown in the example table below. Agencies should be listed in the order
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Duke Energy Excavation Permit Application Form
shown in the Agency/Organization List. Consultation letters must be dated within the two years
preceding Duke Energy's receipt of the application.
Table IV-I. Sample Agency Comment and Response Table
Agency Comment I Applicant Response
Agency I
The activity is approved as proposed. I NA
Agency 2
The on-site well provides drinking water to the
public. Please contact Mr. Smith to discuss the
proposed changes and potential issues
associated with your proposal.
Contacted Mr. Smith on 1/1/20xx. No
further action needed.
You must contact us immediately if
endangered species are located during the
course of construction.
Applicant will contact Agency 2 if
endangered species are located during
construction
Agency 3
Requested agency comments on 1/1/20xx and
again on 2/1/20xx. No response as of
2/16/20xx.
NA
Agency 4
Section 401 Water Quality Certification Applicant will comply with the conditions of
the 401 Water Quality Certification
Following the table of agency comments and applicant responses, include a table of permits and
certifications issued by the reviewing agencies. As with the table of agency comments and
applicant responses, agencies should be listed in the same order as they are listed in the
Agency/Organization List.
Table IV-2. Sample Agency Permits and Certifications Table
Agency Permit/Certification Name Date of
Issuance
Date of
Expiration
Agency 1 Surface Water Withdrawal Permit
Agency 2 Section 401 Water Quality Certification
Following the two summary tables, include a copy of all correspondence to and from any local,
regional, state and federal agencies or other organizations with which you are required to consult,
including any required permits (e.g., Section 401 water quality certifications, Section 404
dredge/fill permits, building permits, etc.) or other approvals or comments which have been
obtained from these organizations regarding this activity. Include a copy of any local, regional,
state or federal regulations or guidelines that will be followed. All permitting issues must be
resolved and clearly documented. Correspondence should be organized in the order the agencies
are listed on the Agency/Organization list with the applicant's request for comments followed by
additional correspondence in chronological order. All permits must be valid at time of
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Excavation Program
Duke Energy Excavation Permit Application Form
application and have a term longer than the projected schedule for completing the permitted
project.
Part V. Additional Information
Provide relevant additional information. Reference previous parts as applicable. Include the
FERC-required Environmental Assessment if you were directed to do so during the initial site
visit. If there are co-applicants, this is where their information would be provided (see Part I).
Duke Energy
Page 13 of 13 rev 10/1/2019 Excavation Program
Excavation Project User's Agreement Letter
(Please fill in the blanks. Please Print)
Date b- Ic ZOZ0
TO: Duke Energy
c/o Lake Services - EC12Q
526 S. Church Street
Charlotte, NC 28202
RE: E avation For (Subdivi ion and Lot #'s or Other Project Name)
CreSee/14111/1 *7, e 'whey- e_orp. 440-107 - Arnold
(Lake/County/City) r / I rritz It I KOOre-5\jill-
(Applicant's full name) 5-1--ep haAle. hrnoi d hereby agrees to comply with all
recommendations, requirements and/or conditions of Duke Energy, General Permit(s) (if
applicable) and other federal, state and local agency requirements pertaining to the application to
excavate for the purpose of a \DOC& stip 3 cce3 .
In addition, I/we have read and agree to comply with Duke Energy's current Shoreline
Management Plan (SMP) or other applicable guidelines, much of which is repeated herein, and
understand that written authorization must be obtained from Duke Energy prior to beginning any
activity within the Federal Energy Regulatory Commission (FERC) project boundary or on Duke
Energy property associated with a reservoir, collectively referred to as Project Boundary. The
excavation will be completed as described in the approved application and within eighteen (18)
months from the date of written approval by Duke Energy, unless specifically noted otherwise in
the application or unless I/we obtain approval for a single, time extension (maximum of one year)
in writing from Duke Energy. I/we understand that if the SMP or other applicable guidelines or
rules change during any extension period, Uwe will be expected to comply with the new
requirements to the maximum extent practicable. I/we 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 or other applicable guidelines and the new application must include any applicable
fees and security deposits.
I/we attest to be the owner(s) or lease holder(s) of the land immediately adjoining the Project
Boundary where the excavation activity is to take place, or if not the owner or lease holder, I/we
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.
I/we 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, I/we 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 Rev: 4/6/2020 Page 1
I/we understand that all excavation work must be done directly in front of my/our property and as
specified in Duke Energy's approval. I/we 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.
I/we understand that for proposed excavations, I/we must notify the appropriate local, state and
federal agencies in advance of the activity by sending them a completed copy of Duke Energy's
Excavation Permit Application Form and other required information. I/we understand that
written authorization and/or other permits may be required by some of these agencies and such
required authorizations must be obtained before I/we submit the final application to Duke
Energy.
At FERC-licensed reservoirs, I/we 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 FERC review does itself require
specific review and approval by the FERC before Duke Energy can issue any approvals.
I/we agree that unless specifically approved otherwise in the application, explosives will not be
used as part of this excavation activity.
I/we understand that every reasonable effort must be made to minimize any adverse impact on
fish, wildlife and other natural resources.
I/we 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 Duke Energy.
I/we agree that excavation activities 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. I/we 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.
I/we agree 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.
Duke Energy Page 2
Rev: 4/6/2020
I/we 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.
I/we have designed the hydraulic excavation process (if any 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.
I/we 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.
I/we 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
Energy; jurisdictional wetlands; historic properties; rare or threatened species; and buried gas,
water, sewer, electric or communications lines. I/we agree to provide my/our contractor with a
copy of these work area drawings showing these areas to stress the necessary protection
measures.
I/we agree that if any archaeological resources (e.g. pottery shards, Indian artifacts, etc.) are
discovered during the excavation, work shall be halted immediately. I/we will then notify Duke
Energy and the State Historic Preservation Office to determine what measures, if any, I/we must
pursue to protect or salvage the archaeological resources.
I/we 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.
I/we agree to be fully responsible for the permitted lake use and I/we understand that this
responsibility is considered to transfer automatically along with ownership and leases of the
adjoining tract.
I/we understand Duke Energy representatives may issue Stop Work Directives for violations of
the SMP or other applicable guidelines 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. I/we agree to immediately
comply with any Stop Work Directives, to fully cooperate with Duke Energy and other agencies
as necessary, and to perform the necessary remedial actions within the specified time frame.
Duke Energ∎ Page 3
Rev 4/6/2020
I/we agree to develop any required mitigation plans and to complete any required mitigation
activities at my/our own expense within the specified time frames. I/we recognize that the
excavation work is not considered complete and deposits will not be refunded until the
mitigation requirements (if any) have been satisfactorily fulfilled.
I/we agree to notify Duke Energy by phone when the excavation is initiated and to ensure that
during the excavation period, I/we will post Duke Energy's approval letter in a clear waterproof
bag at the job site and visible from the water's edge.
I/we agree to notify Duke Energy in writing when the excavation is completed (including any
required mitigation measures) and that the excavation was completed per the approved
application, so a close-out inspection can be performed.
I/we recognize security deposits will not be refunded if any violations of the SMP, other
applicable guidelines, or this user's agreement occur.
I/we understand there will be no change in hydro project operations as a result of the excavation
and/or utilization of the excavated area.
I/we agree to maintain the work area in a safe condition and to fully indemnify and save Duke
Energy harmless from any and all claims, liability, loss or damage that may arise from this
excavation project.
I/we understand that this user's agreement does not, in any way, constitute the transfer of any
rights in real property and that my/our use and enjoyment of FERC project and Duke Energy
lands and waters shall not hinder the general public's lawful use and enjoyment of the same.
Sincerely,
54.eplictni e D Arnold
Applicant's Name (Print) Applicant's Signature
Co-Applicant's Name (Print) Co-Applicant's Signature
Co-Applicant's Name (Print) Co-Applicant's Signature
Co-Applicant's Name (Print) Co-Applicant's Signature
Co-Applicant's Name (Print) Co-Applicant's Signature
Duke Energy Page 4
Rev: 4/6/2020
THIS DEED made this 02/03/20, by and between
GRANTOR
Elizabete 0. Madeira and spouse,
Jose Benicio Madeira
410 Bemiss Court
Alpharetta, GA 30022
GRANTEE
Stephanie Dianna Arnold, Unmarried
Property Address:
110 Seneca Place
Mooresville, NC 28117
Mail/Box to: Grantee
Instrument prepared by: Ben S. Thomas, a licensed North Carolina attorney, 514 Williamson Road, Ste. 431, Mooresville, NC 28117
File# 2020010009
Title Insurance Company: Barrister's Title Services
Brief description for the Index: Lot 107 Cresant Land & Timber Corp.
Type: CONSOLIDATED REAL PROPERTY
Recorded: 2/3/2020 12:15:03 PM
Fee Amt: $1,966.00 Page 1 of 2
Revenue Tax: $1,940.00
Iredell County, NC
Ronald N. Wyatt Register of Deeds
BK 2674 PG 1801 - 1802
NORTH CAROLINA GENERAL WARRANTY DEED
Excise Tax: $1,940.00 Purchase Price: $970,000.00
Parcel Identifier No. 4638499286 Verified by County on the day of , 20
By:
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, sell 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 all of Lot 107 in Section 14 of Crescent Land & Timber Corp.as same is shown on map thereof recorded in Map Book 13,
Page 31, in the Iredell County Public Registry.
R .O.T.C. Page
NS
0,"firlefirt/MvaIL
Notary's Printed or Typed Name
Notary ublic
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 2502, Page 1403.
All or a portion of the property herein conveyed ____x_ includes or does not include the primary residence of a Grantor.
A map showing the above described property is recorded in Book 13, Page 31.
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:
I. 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,
_ "WI rAIO (SEAL) (SEAL)
Elizabete 0. Madeira Jos
(SEAL) (SEAL)
(SEAL) (SEAL)
State of North Carolina - County or City of lredell
I, the undersigned Notary Public of the County and State aforesaid, certify that Elizabete 0. Made' d spouse, Jose Benicio
Madeira personally appeared before me this day and acknowledged the due execution of the foregoin trument for the purposes
therein expressed. Witness my hand and Notarial stamp or seal this g day of 1---e , 20.24
011 11 ,,,,,,,,,,,,
„O‘' s. THO4f ,,,,,
(<;\ 46%
My Commission Expires: / NOTARY -s
(Affi x Seal) PUBLIC 4;
E tfl My Commission
° Expires AD..i w7v
State of North Carolina - County or City of Iretipti, ()I
I, the undersigned Notary Public of theVAtopci sItteresaid, certify that
b... ...u1 ''''''
Witness my hand and Notarial stamp or seal, this day of ,20 .
My Commission Expires:

Notary Public

(Affix Seal) Notary's Printed or Typed Name

•
IRON PIN
FOUND
N87'18'57°W
100.39'
LOT 106
P.B. 13 PG.
O -2 L3 (i)
L4
LOT 107
0.68 ACRE
50' REAR YARD
IRON PIN
FOUND L5
IRON PIN
FOUND
WE.L
I
25' SETBACK UNE
60' PUBLIC R/W
• ece, PO4
FOUND
LOT 108
P.B. 18 PG. 8C
I a
LINE TABLE
LENGTH BEARING
31.32 I S64',33'00"E
91.39 I S89 -26'00"E
I 35.00 S85 .04'00"E
25.32 S75'59'00 -EI
26.17 S85'06 .51 n Ej
LINE
LI
L2
L3
L4
L5
I CERTIFY THAT THIS MAP WAS DRAWN uNDER MY SUPERVISION FROM AN ACTUAL SURVEY MADE UNDER MY SUPERVISION
(MAP RECORDED IN BOOK 13, PAGE 31; THAT THE BOUNDARIES NOT SURVEYED ARE INDICATED AS DRAWN FROM
INFORMATION AS SHOWN ON PLAT; THAT THE RATIO OF PRECISION OR POSITIONAL ACCURACY IS 1:10,000+;
AND THAT THIS MAP MEETS THE REQUIREMENTS OF THE STANDARDS OF PRACTICE FOR LAND SURVEYING IN NORTH
CAROLINA (21 NCAC 56. 1600). THIS 12th DAY OF MARCH, 2019.
SIGNED
JOHN O. SKIDMORE I I, NCPLS L-3837
• AREA BY COORDINATE METHOD
• THIS IS A SURVEY OF AN EXISTING
PARCEL OR PARCELS OF LAND AND
DOES NOT CREATE A NEW STREET OR
CHANGE AN EXISTING STREET
• THIS MAP IS NOT INTENDED TO MEET
G.S. 47-30 AND IS NOT TC BE RECORDED
AS A PLAT
• SUBJECT PROPERTY MAY BE SUBJECT TO
RECORDED OR UNRECORDED EASEMENTS,
RIGHT OF WAYS, SETBACKS AND/OR
RESTRICTIVE COVENANTS NOT SHOWN HEREON
LAKE NORMAN
CAR
SEAL
L-3837
, .1,f1;00*,‘„Z
GRAPHIC SCALE
( IN FEET )
1 inch = 60 ft.
R/W = RIGHT. OF WAY
• = IRON PIN
0 = :RON PIPE
= COMPUTED POINT
= UTILITY POLE
CONCRETE MONUMENT
0 = SANITARY SEWER MANHOLE
Qp = STORM DRAIN MANHOLE
PROPERTY LINE
ADJOINER LINE
RIGHT OF WAY
SEWER EASEMENT
STORM DRAIN EASEMENT
— SETBACK UNE
MAP REVISED ON 3/12/2015 TO SHOW ADDITIONS TO THE HOUSE.
PHYSICAL SURVEY SURVEY DATE 11/9/2017 D.B. PG.
OVER
110 SENECA PLACE
LOT 107
RECREATION LOTS - SECTION 14
DAVIDSON TOWNSHIP, IREDELL COUNTY, NORTH CAROLINA
TAX No. 800465/0
MAP BOOK 13 PAGE 31
SKIDMORE SURVEYING, INC.
LICENSE NO. C-1876
`115 UNIONVILLE INDIAN TRAIL ROAD STE. B-11
INDIAN TRAIL, NC 28079
704-289-4855
DRAWN JOS
I
DRAVANG 17-339.DWG
Custom Dock & Lift
Systems, Inc.
Dredge Sketch
Dee Arnold
110 Seneca PL
Mooresville, NC 28117
1 1 1
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2
Dredge Disposal Area
1162 River Highway
Mooresville, NC 28117
lap
ksQ@A,
DUKE ENERGY DIRECTIONS BY ROAD FORM
Lake Use Permit Applicants and Contractors: Ease of locating the proposed project
site canhavea big impact on permitting processing time. Please complete this form and
return it along with your completed application to:
DUKE ENERGY
C/O LAKE SERVICES — EC 12 Q
526 SOUTH CHURCH STREET
CHARLOTTE, NC 28202
Applicant's Name: Stephanie D. Arnold
Street Address (at lake): 110 Seneca Place Mooresville, NC 28117
Lake Name: Norman
Subdivision Name: Crescent Land and Timber Corporation
Property Section: Section 14 Lot #: 107
City: Mooresville County: Iredell
State: NC Zip: 28117
Telephone: [phone]
Directions (from major road or highway): From 1-77 NB, Exit 36, Left onto NC-
150 WB, Right onto Perth Road, Left onto Stumpy Creek Road, Left onto
Seneca Place. Property is on the right.
Descriptive Structure(s) on Property (i.e. brick garage, white fence, mobile
home, etc.)
*Note: Please use the back of this form if desired to draw us a map to the site.
Arnold Dredge
Latitude: 35.629033
Longitude: -80.901504
Legend
110 Seneca PI
DUKE ENERGY DIRECTIONS BY ROAD FORM
LANCASTER CUSTOM DOCKS DISPOSAL SITE
Lake Use Permit Applicants and Contractors: Ease of locating the proposed project
site canhavea big impact on permitting processing time. Please complete this form and
return it along with your completed application to:
DUKE ENERGY
C/O LAKE SERVICES — EC 12 Q
526 SOUTH CHURCH STREET
CHARLOTTE, NC 28202
Applicant's Name: Lancaster Custom Dock Disposal Site
Street Address (at lake): 1162 River Highway Mooresville, NC 28117
Lake Name: Norman
Subdivision Name: Big Daddy's of Lake Norman
Property Section: Lot #: 2
City: Mooresville County: Iredell
State: NC Zip: 28117
Telephone: [phone]
Directions (from major road or highway): From 1-77 NB, Exit 36, Left onto NC-
150 WB, Disposal Area is on the right behind Big Daddy's Restaurant
Complex.
Descriptive Structure(s) on Property (i.e. brick garage, white fence, mobile
home, etc.)
*Note: Please use the back of this form if desired to draw us a map to the site.
Lancaster Docks Dredge Disposal Area
Latitude:35.604043
Longitude: -80.910286
Legend
1162 River Hwy
J Big Daddy's of Lake Norman