20201641 Ver 1_Shoreline Stabilization_20201203

Submission Form
Pre -Filing Meeting Information
Before submitting this form please ensure you have submitted the Pre -Filing Meeting Request Form as we will not be able
to accept your application without this important first step. The Pre -Filing Meeting Request Form is used in accordance
with 40 C.F.R. Section 121.4(a) "At least 30 days prior to submitting a certification request, the project proponent shall
request a pre -filing meeting with the certifying agency" and in accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5)
all certification requests shall include documentation that a pre -filing meeting request was submitted to the certifying
authority at least 30 days prior to submitting the certification request. Click here to read more information on when this
form is needed prior to application submission or here to viewthe form.
Attach documentation of Pre -Filing Meeting Request here:
Spain Trust DWR Pre -Filing Meeting Request
51.33KB
Form.pdf
Pre -fling Meeting or Request Date 10/30/2020
ID# 20201641 Version 1
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:*
[e-mail]
Rease provide an er ail address for payment and requests for more infornation here.
Spain Trust (Jeff Spain Trustee)
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
8397 Norman Estates Drive
Address Line 2
City
Denver
Fbstal / Zip Code
28037-7667
State / Rovince / Fbgion
NC
Country
US

Is there an agent working on the r Yes
project?* r No
Agent/Consultant Information
Name:* DonnaP. Hrko
Company Affiliation: * Lancaster Custom Dock and Lift Systems, Inc.
Email:* donna. lancasterdocks@gmaiLcorn
Phone Number:* [phone]
(XXX)XXX-XXXX
Address:* Street Address
1156 Perth Road
Address Line 2
City
State / Province / Region
Troutman
NC
Fbstal / Zip Code
Country
28166
US
Asigned and dated copy of the Agent Authorization letter:*
Spain Signed Agent Authorization Form
154.42KB
NCDENR.pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Spain Dredge
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.
f Upload File
r Lookup address
Property Address Lookup:*
Latitude:* 35.475581
Street Address
2529 Ranger Island Road
Address Line 2
City
Denver
Fbstal / Zip Code
28037-8672
State / Province / Pegion
NC
Country
US
Longitude:*-80.959032
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*
Spain Trust Dredge Application Packet.pdf 5.62MB

Please use the diagram at the link below:
https://edocs.deq.nc.gov/WaterResources/0/edoc/616616/Shoreline%20Layout.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.)*
Spain Aerial Photo of Shorchne.JPG 107.92KB
Spain Shoreline Photo 1.JPG 128.78KB
Spain Shoreline Photo 2.JPG 130.5KB
Spain Shoreline Photo 4.JPG 144.31KB
4. Location of the property (where work is to be conducted)
Nearest Town:* Denver
County:* Lincoln
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address:* 2529 Ranger Island Road Denver, NC 28037
Include phase/lot nunber
Directions to site:*
From NC- 16 NB, Right onto Optimist Club Road, Left onto Triangle
Circle Road, Proceed Straight across NC-16 Business onto Unity Church
Road, Continue on Unity Church Road, Right onto Ranger Island Road.
Property is on the right near the end of the road.
Rease include road names 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. Property Size .804 +/- Acres
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. Construct a new fixed pier and dock.
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 w alls, etc.)
2304 sf
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 sf construction
corridor
square feet
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet
landward to be impacted:*

(nunber 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):
o $240.00 for impacts to lake (below normal water level) of less than 1 acre
o $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:
o I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the
best of my knowledge and belief
o I, the project proponent, hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time.
o I agree that submission of this Shoreline Stabilization online form is a "transaction" subject to Chapter 66, Article 40 of
the NC General Statutes (the "Uniform Electronic Transactions Act');
o 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');
0 1 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 the Shoreline Stabilization online form.
Full Name:* DonnaP. Hrko
Signature:}7

Initial Review
Is this accepted into the review
process?*
Project Number:* 20201641
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

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO:
STREET ADDRESS:
2529 Ranger Island Road
Denver, NC 28037
Please print:
PLAN NO:
Property Owner: Spain Trust (Jeff Spain Trustee)
Property Owner:
PARCEL ID: 4613-63-8711
The undersigned, registered property owners of the above noted property, do herebyauthorize
Donna P. Hrko
(Contractor/Agent)
of Lancaster's Custom Dock and Lift Systems, Inc.
(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):
8397 Norman Estates Drive
Denver, NC 28037
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate tothe
best of our knowledge.
Aut orized re Authorized Signature
Jeff pain u tee
Date 11-16-2020 Date

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ID#* 20201641
Version* 1
Regional Office * Mooresville Regional Office - [phone]
Reviewer List* Alan Johnson
Pre -Filing Meeting Request submitted 10/30/2020
Contact Name* Donna P. Hrko
Contact Email Address* donna. [e-mail]
Project Name* Spain Dredge
Project Owner* Spain Trust (Jeffrey Spain Trustee)
Project County* Lincoln
Owner Address: Street Address
2529 Ranger Island Road
Address Line 2
aty State / Province / Pegion
Denver NC
Postal / Zip axle Country
28037 us
Is this a transportation project?* r Yes r No
Type(s) of approval sought from the DWR:
* 401 Water Quality Certification - F 401 Water Quality Certification -
Regular Express
* Individual Permit F Modification
W Shoreline Stabilization
Does this project have an existing project ID#?*
C Yes (-- No
Do you know the name of the staff member you would like to request a meeting with?
Please give a brief project description below.*
Dredge for boat slip access.
Please give a couple of dates you are available for a meeting.

Please attach the documentation you would like to have the meeting about.
pdf only
By digitally signing below, I certify that I have read and understood that per the Federal Clean Water Act Section
401 Certification Rule the following statements:
This form completes the requirement of the Pre -Filing Meeting Request in the Clean Water Act Section 401 Certification
Rule.
1 understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request.
1 also understand that DWR is not required to respond or grant the meeting request.
Your project's thirty -day clock started upon receipt of this application. You will receive notification regarding meeting location
and time if a meeting is necessary. You will receive notification when the thirty -day clock has expired, and you can submit an
application.
Signature
Submittal Date 10/30/2020

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: IV % r e. Lb y h n unty: L.1 ✓]
I a4axd..4ie�A1G 7
Owner: v-
Print
Contractor/agent;
Print
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 02B .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
1, " e_T 11 n hereby state that I have been informed of the Catawba
Riparian Buffer R e Any tvork conducted 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 a roved plan(s) and specification(s), and other supporting
materials. k N %
v -
Signature (owner): Date: 1

,4 State of North Carolina
Department of Environment and Natural Resources , a.Division of Water Resources
Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
ENVIRONMLN 7 A L QUALITY 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
Full Pond/ Normal Water
Shoreline
Plan View
FORM: SSGP 02-2017
Full Pond/ Normal Water
n ore7ne
2 ft.. 150 ft
uddiGonaf dearing
H neteuary
E
Plan View
La ke
(At Full Pond/ Normal Water Level)
Lake
i,aFull Pond/No lware,1­11
Riprap
,36 `� red e--,
A/2 la� a f D J/Po
lope,� �v1
Ve-
�
Co 5-fruc�ed
Existing Dock
/31) NXYR
3 Ft a I50 ft
BLi.. hull pond! NWL
7 —4ha�150fr
7
�Ah— hip pond/ N WL
AMPLE
t3cvrtD vim!
Page 1 of 3

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 U-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 Ex ect 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 final 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 far 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.
Duke Energy Page 2 of 13 rev 10/1l2019
Excavation Program

Step 4: Final Application & Submittal to Doke 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.
Duke Energy Page 3 of 13
Excavation Program

Duke Ener2y Excavation Permit Analication Form
FOR DUKE ENERGY USE ONLY
Duke File No.
Application Fee S Security Deposit S Check # Date Recv'd initials
Date of Duke Energy Lake Services, applicant and/or contractor on -site inspections Date i l Initials
Date Final Protection/Avoidance Area Markings Field - Verified Initials
Approved to Start Work By * : Date
(Print) (sign)
Date Completion Required Date of Any Approved Extension Initials
Date Passed Closeout Inspection* Initials
Any Stop Work Orders or SMG Violations*? (check one) ❑Yes ❑No (If Yes, explain in PART V)
Date Deposit Refunded Initials Date Permit Database Updated Initials
* Forward copy of approved application (all pages, plus any attachments that Duke Energy changed) hack 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 1. Applicant Information (Please Print)
Name SQ; y��rt,�S� ley yl Telephone
Email address: Suits, 4'�40 [v�11 myy:v
Lake Addres Mailin Address (if different) �
oil 3�3 77 r`YY? J� 5 1),,
eriyPr_ N ? n37 v C
Contractor Company I D 1Cgs-�e5 i _u S6-n K L L+6 V,6LCVM Ir?G .
Contractor Contact Person
Contractor Email Address:
IAy-hto Telephone 3o4 -(OZC(-6oQ&
a
LAKE LOT INFORMATION
Lake NNkrnanawounty L-ooco In City r- State MGTax Map No.
Subdivision r
Lot / Section No. —
Lot Sizc•J�CAAcres
Duke Energy Page 4 of 13 rev 1D/1/2019
Excavation Program

Duke Energy Excavation Permit Application Form
Are there any Co -Applicants*? (check one) ❑Yes dio (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 ILv
Initials (Duke Energy) (applicant/contractor)
V
Duke Energy Page 5 of 13
Excavation Program

Duke Energy Excavation Permit Application Form
Part 11. Description of Project
A. Basic Information
1. Type of excavation: (check one) JdNew excavation ❑ Maintenance excavation
2. Purpose of excavation: (check one)
❑ Water Intake Channel
❑ Other (specify):
jd'Boat Access Channel
❑ Wastewater Discharge Channel
3. Lake user category: (check one) ;3f rivate ❑Residential Marina
[]Commercial Marina ❑Public
❑Other (specify):
4. Max. Excavation Area Dimensions (ft): Length Width 3(o_ Depth
(Note: include additional area dimensions if necessary so response to #5 below equals max. area
dimensions in 44)
5. Volume of Excavated Material (TOTAL for the project): ;?40 Cubic yards
6. Type of material removed (applicant determines byf:eld sample ifpractieal):
7. Excavation Site area: . 05 Acre (s) Disposal Site area: Acre(s)
8. Total Disturbed Area (including equipment staging area): , Q 7 Acre (s)
9. Does tbaDroiect meet the requirements of the applicable General Permit? (check one)
1 es Jo
10, Do you claim title to the disposal area? (check one) Byes No
11. Do you claim title to the equipment staging area? (check one) O es �o
12. Are there any water -treatment facilities within 50 feet of the proposed excavation area?
(check one) Yes Vo
(If Yes, specify):
13. How will the excavated material be entrapped and the erosion controlled? (e.g. see attached
erosion contr l plan disposal area desi n): 1)w e m ,r►cL1 S -W t�- lov1 re'-xch
ex�CUgtor. \Os-e,yY }�A 5 i �, V pe D es o�' ^ucl1s
1Mogred 6L+ S 1 tin e, . L€acl , ct i Q. s o� �=�
C�1'7 5
O�+n is ,,1 rec�. ��1 r, cLb let
SpO1C �� � �n S Cl � � [.l..C..� y.. dC► r�C.+'
Mn IQ 6 w III be. I�ded ►f �1 l non durnp`h" s
tinau.l ~�-o onsl, � dl s�osa �,��
Duke Energy Page 6 of 13 rev 10/12014
Excavation Program

Duke Enerey Excavation Permit Application Form
14. Type(s) of excavation equipment to be used: e[-ch exC0.v a� Dr,
Shoves+ recLcYi eKcaj +nY-, e5, dump +rud1 s
15. Will waters or wetlands be crossed in transporting equipment to or from the site?
(check one) fa'�'es ❑No
(If yes, explain) AI I dr j r1 E+ U i vY1en 4� 16 PMyl 5POr � v t a
�1oot}i n IO.V1+ - r s I4e,
}� 1ooq+ -I-o p o� cc
G.CYO 5 Ll�.� e NO rti'1'1
16. Will return water re-enter the reservoir? (Check one) ❑Yes ❑No 12 /A
(If Yes, sped points) of re-entry and show on Excavation Area Drawing)
17. Is there an existing facility e . pier) t access is being maintained to by cpnd�cting the
excavation? ❑Yes �io ! Y e W �A -�j be GpY7 g-tj^!, Cz
(If Yes, provide the existing permit number. 1 No, include a caled drawing of the proposed
facility). Permit # 'be c�1 e� Cnqq 1 rt erg v1 >r'Q W 5
Lr ace I +ics � from �P>� ca4ion
19. Total planned duration of the work (Include first equipment mobilization, excavation
through final mitigation measures complete):
START () / I ?, FINISH
(Month) ear) (Month) (Year)
Duke Energy Page 7 of 13 rev 10/112019
Excavation Program

Duke Enemy Excavation Permit Application Form
Part 11. (Continued)
B. Protection 1 Avoidance Area Description
Complete the following table including all land areas within and immediately adjoining the disturbed area:
Protection/Avoidance Areas
Approx
Identification
Method M
Avoid (A) or Mitip-ate (M)
Acre
Field ID
Work Area Dwl. [A
(check all that apply)
a. Marshland, swamp, ponds, beneficial
aquatic vegetation or other potential wetlands
w I� 1
/ V [A
circle all that apply)
b. Buffer Zones (specify width & source
of requirement)
r 8 W iti kw ct—Cr p lib
A�
10
n [ dr s 1015CL e
vU I IOe le-1\1
b
c. Environmental Areas as identified by
/ /A
Duke Energy'
V
d. Natural Areas as identified by Duke
Energy
N/jj
�-t
e. Historic properties (spec)
"/A
f. Rare or threatened species (specify)
Duke Energy Page S of 13 rev 10/1/2019
Excavation Program

Duke Ener v Excavation Permit Application Form
Protection/Avoidance Areas
(check all that apply)
Approx
Identification
Melhod (*)
Avoid A or Mitigate M
Acre
Field 11)
Work Area U2 . !!
iin
g. Buried gas, water, sewer,
communications or electric lines circle
�/ A
h. Impact Minimization Zones as
identified by Duke Energy
q
L Other areas requiring specific
avoidance, protection or mitigation (spec)
/V/
* 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 13 rev 10/1/2019
Excavation Program

Duke Enemy Excavation Permit Application Form
C. A licant's Signatures
Comments:
Applicant
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 13 rev I0l1/2019
Excavation Program

Duke Enerav Excavation Permit Application Form
Part III. Additional Information
XDeed 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.]
t 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
IK 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
Duke Energy Page 1 l of 13 rev 10/1/2019
Excavation Program

Duke Eneray 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-1. Sample Agency Comment and Response Table
Agency Comment Applicant Response
Agency 1
The activity is approved as proposed. NA
A enc 2
The on -site well provides drinking water to the
Contacted Mr. Smith on 1/1/20xx. No
public. Please contact Mr. Smith to discuss the
further action needed.
proposed changes and potential issues
associated with your proposal.
You must contact us immediately if
Applicant will contact Agency 2 if
endangered species are located during the
endangered species are located during
course of construction.
construction
Agency 3
Requested agency comments on I/I/20xx and
NA
again on 2/1/20xx. No response as of
2/ 16/20xx.
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
Date of
Issuance
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
Duke Energy Page 12 of 13 rev 1011/2019
Excavation Program

Duke Enerey 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 1).
Duke Energy Page 13 of 13 rev 10/1/2019
Excavation Program

BK 2949 PG 796 - 797 (2) DOC# 615720
This Document eRecorded: 09/11/2020 11.07-56 AM
Fee: $26.00 DocType: DEED Tax: $1,460.00
Lincoln County, North Carolina
Danny R. Hester, Register of Deeds
NORTH CAROLINA GENERAL WARRANTY DEED
Excise Tax: $1,460.00
Parcel Identifier No, 31836
Mail/Box to; Sandra L. Knox, PC 19410 Jetton Rd, Suite 130, Cornelius, NC 28031
This instrument was prepared by: Sandra L. Knox PC 19410 Jetton Rd. Suite 130 Cornelius NC 28031
Brief description for the index! Metes and Bounds Ranger island Road
Title Insurance Issued By; LM Title
THIS DEED made this I I'll day of Septernt)er, 2020, by and between
GRANTOR GRANTEE
,lack Raymond Welch (unmarried) Jeffrey E. Spain, trustee, and
Melanie L. Spain, trustee
of the Spain Trust dated February 11, 2019
731 Killian Farm Road 8397 Norman Estates Drive
Stanley, NC 28164 Denver, NC 29037
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.
WIThEESSF,TH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt ofwhich is hereby acknowledged, has and by
these presents does grant, bargain, sell and convey unto the Grantee in tee simple, all that cartain lot, parcel of land or condominium unit
situated in the City of Denver, Lincoln County, North Carolina and more particularly described as follows:
BEGINNING at a #4 pin set in the centerline of the apparent 60" right-of-way for Ranger Island Road, said point being the southwest
corner of the property of TMSMJ Properties (now or formerly, see Deed Book 1885 at Page 518, Lincoln County Public Registry),
said point also being shown as the northwest corner of the "New 30' Easement" identified on a plat recorded in Plat Book 18 at Page
146 in said Registry; and running thence from said point of BEGINNING S 31-41-13 W 13.68 feet to a spike; thence S 01-22-25 W
198.21 feet to a #4 pin; thence S 31-38-53 W 63.96 feet to a pinched pipe; thence N 67-16-5 I W 36.56 feet to a point; thence N 33-50-
03 W 70 11 feet to a point; thence N 30-2 t-21 W 139.27 feet to a 2" pipe; thence N 4I-34-58 E I06.5 feet to a I" pipe; thence
continuing N 41-34-58 E 36,77 feet to a paint in the centerline of Ranger Island Road; thence with the centerline of hanger Island
Road S 69-28-50 E 100,20 feet to the point and place of BEGINNING, containing 0.804 acres or 35012 square feet, more or less, as
shown on a survey entitled "Physical Survey for Jeff and Melanie Spain" dated September 8, 2020, by Dedmon Surveys.
Sandra Paulette Welch died testate May 7, 2015. See Estate File No. 15-E-353, Lincoln County Clerk of Court.
The property hereinabove described was acquired by Grantor by instrument recorded in Book 463 page 526 and Book 2436 page 334.
Submitted electronically by "Sandra L. Knox P.C."
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Lincoln county Register of Deeds.

urX LZJ-PU F% _-j r V 1 vvvrr U I .j r Ac-u
All or a portion of the property herein conveyed _ _ includes or X does not include the primary residence of a Grantor.
A reap showing the above described property is recorded in Plat Book 463 page 526 & Deed Book 2436 Pg 334,
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 sane 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: All easements, restrictions and conditions of record, any matters
that would be revealed by a current and accurate survey of the property, and the lien for ad valorem real properly taxes not yet due and
payable.
IN WITNESS WHEREOF, the Grantor has duly executed the foregoing as of the day and year first above written.
(Entity Name) ck aym' o Welch
By:
MnUType Name & Title -
fay:
Print/Type Name & Title:
(SEAL}
By: SEAL,
Print/Type Name & Title:
State of North Carolina - County of�Q� lJl
1, the undersigned Notary Public of the County of and State aforesaid, certify that .lack Raymond Welch
personally appeared before me this day and acknowledged the due execution of the foregoing irstrumenf for the purposes therein expressed.
Witness my hand and Notarial stamp or seal this IL day of Se-Vtel`Y*iDe-4—, 20M
-I
My Commission Expires:?,
(Affix Soai)
2

NOTE S:
ZONED R—SF
PROPLRTY MAYOL FA)WECI TO RECORDED OR
SETBACKS: FRONT/LAKE 40'
VNRECORDED RIGHTS OF WAYS OR EASEMENTS
SIDES 10'
NOT OBSERVED
• 10' DRAINSCE k UTILITY EASEMENT MAY E)TST M.ONG ALL LOT LINES.
ROADFRONT 3D'
• OWNEN TO VER— ALL SFEIACKS AND ZONING
RECULA7IONS PRIDR TO ANY PLANNNQ OR
50' LAKEFRONT BUFFER
OONSTRUCTI I,
• DIMENSIONS OF ALL IMrROVEMENT5 SHOWN ON
THIS PLAT SHOULD NOT DL S(ALYD OR RELIED
UPON FOR OESIGN OR CONSTRUCI)QY WITHO,IT
A FEW V09FEATMU OF ALL DIMENSIONS.
• DIGITAL COPIES OF THIS ALE ARE FOR REFERENCE
DNLY AND MAY NOT BE USED FOR DE90M WDFK
• ALL LNUERCROUtO URJTIES ARE NOT SH M1 HEREON.
• 1O. ORWU E a UnurY EASEMENT MAY EXIST ALONG Al LOT LIMM
JU5TIN CAREY
BUMBARONER
2640-627
Course Bearing Distance
1.
Li 1 5 31-41 13 W 1 13.1i8
Y PIPE
LEGEND
R\w RIGHT-OF-WAY
E\P EDGE OF PAVEMENT
C\L CENTERLINE
POE PERMANENT DRAINAGE EASEMENT
X vnuTY POLE
LIGHT POLE
s SANITARY SEWER UNE
_06FERHEAD UTILITY LINE
++++++I++ii GUY WIRE
-T - UNDERGROUND TELECOMMUNICATIONS LINE
—a — CAS UNE
—W —WATER LINE
—• — FIBER OPTIC CABLE LINE
CP = COMPUTED POINT
DEDMON SURVEYS
APPROX. FLOOD LINE
FNORMAN���
NN NICKS, Im OR v—.
� . E
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�2937-498
PWH D PIPE
`AP � I' PIS
PHYSICAL SURVEY
FOR
JEFF & MELANIE
v
SPAIN
PARCEL 016121347
2529 RANGER ISLAND RD - DENVER. NC
CATAWBA SPR TOWNSHIP - LINCOLN COUNTY
SCALE: 1' = 50'
DEDMON SURVEYS
CHUCK POOVEY, PLS #3762
ROBERT DEDMON, PLS #3899
3704 NC HIGHWAY #16 NORTH
P.O. BOX 494 - DENVER, NC 28037
PHONE: [phone]
FAX: 7D4/48312170
Z. L-376 —
fnCCVIN
Z il; IliitlTl�
I. DAMD C. POOVEY, CERTIFY THAT THIS PLAT WAS
DRAWN FROM AN ACIVAL SURVEY MADE UNDER MY
SUPERVISION (DO 24M. PC 334)(DB 463. PS
526; THAT THE RATIO OF PRECISION AS
CGLLCLILATED EXCEEDS I:IODDD; THAT THIS FLAT
WAS PREPARED IN A=RDAFICE WITH CS 47-30
AS MANDED. W1111ESS. MY OWMAL SIGMAnJIRE,
REDISIRATIONN�U�MBBER .I/NDSEAL THIS 0 DAY OF
SEPT" AD :Q2^'1 c � 1
L-37B1{+J�L-37B1
PROFESSIONAL D S LICENSE NO,
SURV. BY: HL I DRAWN: CP I JOBI RISJACK
I v1muff Kw
UNITY CH
QO �p
SITE

_ 4� n I Y IJI.St
NOTES:
• PROPERTY MAY BE $UW CT TO RECORDED OR
UNRECORDED RM4M OF WAYS OR EASEMENTS
NOT OBSERVED
+ 10' OW4 GE a UTRAY EASEYENf MAY IDW ALOEIG ALL LOT LINES.
• OWNER TO VERIFY ALL SETBACKS AND ZONING
RM"TTONS PRIOR TO ANY PUNNING OR
• DIMENSIONS OF ALL IMPROVEMENTS SHOWN ON
THIS PUT SHOULD NOT BE Scum OR RELIED
UPON FOR DMON OR oONSTRUCRON WITHOUT
A FIELD VERIRCAT1ON OF ALL DRAENSIONS.
• DIGITAL COPIES OF THIS FHE ARE FOR REFFiEMCT
ONLY AND MAY NOT 6E USED FOR DMON WOWK.
• ALL UNDERGROUND UIlURES ARE NOT SHOWN HEREON.
• 10' DRARYLOE 8 11TRIlY EASEMENT NAY ET05T ALONG ALL LOT LNES.
C011rs! I B-Ofi-g Distance
L1 I S 31'4113 W 13-fi8
LEGEND
R\W RIGHT-OF-WAY
�P EDGE OF PAYEMEM
C\L CENTERLINE
PDE PERMANENT DRAWAGE EASEMENT
X UTILITY POLE
X LIGHT POLE:
-S -SANITARY SEWER UNE
« � OVERHUD UnLITY UNE
i++tFFFH+FF GUY MARE
—T - UNDERGROUND TELECOMMUNICATK)NS UHE
-o - GAS LINE-
-W -WATER LINE
-• - FIBER GPTIC CABLE UNE
Cp = COMPUTED POINT
DEDMON SURVEYS
ZONED R-SF
SETBACKS: FRONT/LAKE 40'
SIDES 10'
ROADFRONT 30'
50' LAKEFRONT BUFFER
JUSTIN 8L CAREY
BUMBARDNER
2W-627
A
Y PIPE
�NGO I
so •� .
PERoft-
R/1P_ .. SB.R e4 y
1' PIPE
lcw/
PHYSICAL SURVEY
FOR
JEFF & MELANIE
n SPAIN
v PARCEL #M21347
N 2529 RANGER ISLAND RD - DENVER, NC
r1s1 SPIKE
�lNF /J ♦ ` I � ' �
_ x i
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74. EI I f�D�b,/a�Gl7DYlCra
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4/ co� lat
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ORER ANG
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"
+
I
N I
0
vppqKI
I \
I \
I \\
I \
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CATAWBA SPR TOWNSHIP - UNCOLN COUNTY
SCALE: 1' - 50'
DEDMON SURVEYS
CHUCK POOVEY, PLS#3752
ROBERT DEDMON, PLS #3899
3704 INC HIGHWAY #16 NORTH
P.O. BOX 494 - DENVER, NC 28037
PHON ET 7D4/48314906
FAX: [phone]f2170
SEAL
L-342
AFL CC
I. DAVID C. PUOVEY. CVMFY THAT THIS PLAT WAS
DRAWN FROM AN ACR AL SURVEY MADE UNDER MY
SUPERI7SON (DB 2436. PG 334)(08 463. PG
526: THAT THE RATIO OF PRECISION AS
CALCUulEO DOMMS 1:10000: THAT THIS PLAT
WAS PREPARED N ACCORDANCE WITH GS 47-30
AS AMENDED. WITNESS MY OFWANAL SIGNATURE,
RE(OVMMN NUMBER AND SEAL THIS 8 DAY OF
SEPT" �° PC•-�
L-3792
PROFESSIONAL LAND WRYEYW -- LICENSE ND.
/• SURV. 6Y: HL I DRAWN: CP JOM RISVACK
J �e�
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DUKE ENERGY DIRECTIONS BY ROAD FORM
Lake Use Permit Applicants and Contractors: Ease of locating the propo
site canhavea big impact on permitting processing time. Please complete this fi
return it along with your completed application to:
DUKE ENERGY
CIO LAKE SERVICES — EC 12 Q
526 SOUTH CHURCH STREET
CHARLOTTE, NC 28202
Applicant's Name: _ Spain Trust (Jeff Spain Trustee)
Street Address (at lake): 2529 Ranger Island Road
Lake Name: Norman
Subdivision Name:
Property Section: Lot 4:
City: Denver County: Lincoln
State: NC Zip: 28037
Telephone: [phone]
Directions (from major road or highway):
From NC-16 NB, Right onto Optimist Club Road, Left onto Triangle Circle
Road, Proceed straight across NC-16 Bus onto Unity Church Road, Continue on
Unity Church Road Right onto Ranger Island Road, Property is on the right near
end of road.
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,

November 30, 2020 1:5,781
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