20120571 Ver 1_401 Application_20120612

June 2012
Cyndi Karoly
NC Division of Water Quality
Parkview Building
2321 Ciabtree Road
Raleigh NC 27604 2260
RE Lake Norman Seawall
Dea► Cyndi
201 2067 1
858 Williamson Road
Mooresville NC 28117
[phone] [phone] (FAX)
www rowboatcomuany com
(f, � a RJJ,
Oue fii m is processing this application on behalf of Jeff Templeton to stabilize approximately 106
linear feet of shoreline by installing and engineered block Seawall a1:20947 Island Forest Drive
on Lake Norman in Mecklenbuig County North Carolina
A copy of the NCDWQ application PCN form Duke Power Company application pertment
d►awings and a location map are enclosed for your use
To access the project Take aright on Bethel Chuich Road from Catawba Avenue in Cornelius
NC Take a right on Pmehurst Drive Take a right on Island Forest Drive Picject site will be
located on your left
We look forward to hearing from you at the earliest time possible
Smceiely
THE ROWBOAT COMPANY, INC
C %fit
Michael Degnei
Senioi Designee
Enclosed Five (5) Copies
Check #7432 $240 00
JUN 7 2012

The following is an abbreviated application form for those applying for a 401 Water Quality
Certification to impact FERC (Federal Energy Regulatory Commission) regulated lake shore or
bottom under the U S Arm} Corps of Engineers Permit GP30 This Application cannot be used
for wetland or stream impacts Please provide five (5) copies of this application and supporting
information as well as a non refundable application fee to the Division of Water Quality of $240 00
for impacts to lake bottom of less than 1 acre and $570 00 for impacts to lake bottom of greater or
equal to 1 acre
Applications should be sent to
Division of Water Quality 401 Oversight/Express Review Permitting
1650 Mail Service Center
Raleigh, NC 27699 1650
Applicant Information
Owner /Applicant Information
Named c.,o Ale 76/1
Mailing Address 290 sI.A t "j^ /e-
emf17 c /us 41' 6 Z$a 3.1
Telephone Number '6VX — LIZ — Q 1 7 4 Fax Number
E mail Address
2 Agent Information (A signed and dated copy of the Agent Authorization letter must be attached
if the Agent has signatory authority for the owner /applicant )
Name
v
Company Affiliation 70',.,/404.f d�d�/� J�e�4 e-
v
Mailing Address SS7 414"�6 Z-a
Telephone Number Fax Number ` k-1 - 65'7 — j� 7?
E mail Address /P1.4 ea ate/' Cs� /'a�r/haaf C ®.�'!�a/lv Ga►.�l
II Project Information
Attach a vicinity map clearly showing the location of the property with respect to local landmarks such
as towns rivers and roads Also provide a detailed site plan showing property boundaries and
development plans in relation to surrounding properties You may use the diagram below to make a
hand sketch of your project Also see the example below for guidance Both the vicinity map and site
plan must include a scale and north arrow The footprints of all buildings impervious surfaces or other
facilities must be included

I Location
County �eG %L°%%%4i r Nearest Town LO,14e l u.5
Subdivision name or site address (include phase /lot number) d Fe- le- T"
Directions to site please include road numbers landmarks etc (This is not necessary if an adequate
vicinity map is included) �i'v�? Ca`Farr/hcL �z � ? !�ti 74
e I Cti 4 ZJ -7✓ „,f Z, d f e.4 '?-xe 4,4,sf r-
aw . 56 t,4j
2 Describe the existing land use or condition of the site at the time of this application
3 Property size (acres) _ G ul, A ,.e.s
4 Nearest body of water (stream/nver /sound/ocean/lake) G� /rs �e/.✓re
5 Descnber the purpose of the proposed
pr oposed wor k _ Y002 lace— 's f- -n t4.0.4 e
q*af iS /74
ly' A A- 40,41 � �dG /f !.flit r�
6 List the type of equipment to be used to construct the project 14f exCa ✓�¢a�”
7 Amount of impact (including all excavation backfill np rap retaining walls etc ) below the
normal pool lake level in square feet or acres
.Zi aed* 7-" oAV4 X/ Om �l,.GAYA
8 a Amount of impact (including all clearing back fill excavation np rap retaining walls etc )
above the normal pool lake level and 50 feet land ward in square feet or acres
sQ ,fir 7&.1".i,
W ll 5c a 4ec¢ed
8 b Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance) 44 4" ¢ yrr
i0 e d s wi Y-le- e s e17,1 tF-lt� g .a s s awe a s c,/ �� 6c �.nl✓a c +�e�
v i
Applicant/Agent s*'Signature " Date
(Agent s signature is valid only if an authorization letter from the applicant is provided )

C, Office Use Only
t t 7 Corps action ID no
DWQ project no
Form Version 1 3 Dec 10 2008
Pre-Construction Notification PCN Form
A Information
—Applicant
1 Processing
1 a Type(s) of approval sought from the
Corps
Section 404 Permit ❑ Section 10 Permit
1 b SHsth ationwide Permit (NWP) number or General Permit (GP) number
1c HNWP or GP number been verified by the Corps?
❑ Yes ❑ No
1d Type(s) of approval sought from the DWQ (check all that apply)
❑ 401 Water Quality Certification — Regular 'P Non 404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
le Is this notification solely for the record
For the record only for DWQ 401
For the record only for Corps Permit
because written approval is not required?
Certification
❑ Yes El No
❑ Yes ❑ No
1f Is payment into a mitigation bank or in lieu fee program proposed for mitigation
of impacts9 If so attach the letter
❑ Yes No
acceptance from mitigation bank or in lieu
fee program
1 g Is the project located in any of NC s twenty coastal counties If yes answer 1 h
❑ Yes A No
below
1 h Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes No
Page 1 of 10
PCN Form — Version 1 3 December 10 2008 Version

4
Applicant Information (if different from owner)
4a
Applicant is
Agent ❑ Other specify
4b
Name
r. i e eat ie
4c
Business name
(if applicable)evrtf�fc�u`�
4d
Street address
Ld�eG /r�z�?
4e
City state zip
Ae,5 te -1
4f
Telephone no
Za f — & ,y _. 3`
4g
Fax no
4h
Email address
de 40 i— � � lI IL" �
5
Agent/Consultant Information (if applicable)
5a
Name
5b
Business name
(if applicable)
5c
Street address
5d
City state zip
5e
Telephone no
5f
Fax no
5g
Email address
Page 2 of 10
PCN Form — Version 1 3 December 10 2008 Version

B Project Information and Prior Project History
1 Property Identification
1a Property identification no (tax PIN or parcel ID)
lb Site coordinates (in decimal degrees)
1c Property size
2 Surface Waters
Latitude
(DD DDDDDD)
acres 0, 1—
2a Name of nearest body of water (stream river etc ) to // /
proposed protect Z,,
2b Water Quality Classification of nearest receiving water
2c River basin �+
3 Project Description
Longitude TCO
( DD DDDDDD)
3a Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application
x'�,u-r2L u',kedr ? 5e,,2./ f/ 54-&y 1 z '12S 94-' 15 afi ,, f17 e-
3b List the total estimated acreage of all existing wetlands on the property
® cam' tzc./PS
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
3d Explain the purpose of the proposed project
.ems Orrr g <1
3e Describe the overall project in detail i c uding the type of equipment to be used
r,
74fi L' °YwL S[e a Lf1A s 6&441 4, 40-416 taek T4e
4 Jurisdictional Det rminations
4a Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past? ❑ Yes ❑ No ,Unknown
Comments
4b if the Corps made the jurisdictional determination what type
of determination was made? ❑ Preliminary ❑ Final
4c If yes who delineated the jurisdictional areas? Agency /Consultant Company
Name (if known) Other
4d If yes list the dates of the Corps jurisdictional determinations or State determinations and attach documentation
5 Project History
5a Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past9 ❑Yes No ❑ Unknown
5b If yes explain in detail according to help file instructions
6 Future Project Plans
6a Is this a phased project? ❑ Yes No
6b If yes explain
Page 3 of 10
PCN Form — Version 1 3 December 10 2008 Version

Page 4 of 10
PCN Form — Version 1 3 December 10 2008 Version
C Proposed Impacts Inventory
1 Impacts Summary
1a Which sections were completed below for your project (check all that app)y)
❑ Wetlands ❑ Streams tributaries Buffers
9Open Waters ❑ Pond Construction
2 Wetland Impacts
If there are wetland impacts proposed on the site then complete this question for each wetland area impacted
2a
2c
2d
2e
2f
Wetland impa
Type of jurisdiction
number —
L2b
of impact
Type of wetland
Forested
(Corps 404 10
Area of impact
Permanent (P)
(if known)
DWQ — non 404 others
(acres)
Temporary T
W1 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g Total wetland impacts
2h Comments
3 Strearn Impacts
If there are perennial or int rmittent stream impacts (including temporary impacts) proposed on the site then complete this
question for all stream sites impacted
3a
3b
3c
3d
3e
3f
3g
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number
Permanent (P) or
(PER) or
intermittent
(Corps 404 10
DWQ — non 404
stream
width
length
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
S1 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S2 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S3 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S4 ❑ POT
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h Total stream and tributary impacts
31 Comments
Page 4 of 10
PCN Form — Version 1 3 December 10 2008 Version

Page 5 of 10 v �`� w j C04Sttruc ate ,7 la PCN Form —Version 1 3 December 10 2008 Versioon `` I/
4 Open Water Impacts
If there are proposed impacts to lakes ponds estuaries tributaries sounds the Atlantic Ocean or any other open water of
the U S then individually list all open water impacts below
4a
4b
4c
4d
4e
Open water
Name of waterbody
impact number —
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P) or
Temporary T
01 T
I a i% A'IVa 1
C /
We rlit? c7`�nY7 ► Z�+i7� Lam/!
� � �t E�
G9�,`�
02 ❑P ❑T
03 ❑P ❑T
04 ❑P ❑T
4f Total open water impacts
4g Comments cJ - l � Ae, ` � � �� le �/% r�5 � fig .5
5 Pond or Lake Construction
If pond or lake construction proposed then complete the chart below
5a
5b
5c
5d
5e
Pond ID
Proposed use or purpose
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
number
of pond
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
517 Total
5g Comments
5h Is a dam high hazard permit required?
❑ Yes ❑ No If yes permit ID no
ted pond surface area (acres)
pond watershed (acres)
ff
d of construction
6 Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer then complete the chart below if yes then individually list all buffer impacts
below If any impacts require mitigation then you MUST fill out Section D of this form
6a
❑ Neuse ❑ Tar Pamlico ❑ Other
Project is to which protected basin?
❑ Catawba ❑ Randleman
6b
6e
6f
6g
Buffer impact
number —
Permanent (P) o
Ic
:6d
Stream name
Buffer
mitigation
Zone 1 impact
(square feet)
Zone 2 impact
(square feet)
Tem orar T
required?
B1 ❑ P MT �5'�4t✓
/-
�a..
❑Yes iSx
!�d
No
Sc��
B2 ❑ P ❑ T
❑ Yes
❑ No
B3 ❑P ❑T
❑Yes
E] No
6h Total buffer impacts
61 Comments
Page 5 of 10 v �`� w j C04Sttruc ate ,7 la PCN Form —Version 1 3 December 10 2008 Versioon `` I/

D Impact Justification and Mitigation
1 Avoidance and Minimization
1a Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
1 b Specifically describe measures taken to'avoid or minimize the proposed impacts through construction techniques
2 Compensatory Mitigation for Impacts to Waters of the U S or Waters of the State
2a
Does the project require Compensatory Mitigation for
impacts to Waters of the U S or Waters of the State?
❑ Yes No
2b If es mitigation is required by (check all that apply)
❑ DWQ ❑ Corps
2c
if yes which mitigation option will be used for this
project?
❑ Mitigation bank
❑ Payment to in lieu fee program
❑ Permittee Responsible Mitigation
3
Complete if Using a Mitigation Bank
3a
Name of Mitigation Bank
3b
Credits Purchased (attach receipt and letter)
Type
Quantity
3c Comments
4
Complete if Making a Payment to in lieu Fee Program
4a Approval letter from in lieu fee program is attached
❑ Yes
4b
Stream mitigation requested
linear feet
4c
If using stream mitigation stream temperature
❑ warm ❑ cool ❑cold
4d
Buffer mitigation requested (DWQ only)
square feet
4e
Riparian wetland mitigation requested
acres
4f
Non riparian wetland mitigation requested
acres
4g
Coastal (tidal) wetland mitigation requested
acres
4h
Comments
5
Complete if Using a Permittee Responsible Mitigation Plan
5a
if using a permittee responsible mitigation plan provide a description of the proposed mitigation plan
Page 6 of 10
PCN Form — Version 1 3 December 10 2008 Version

6 Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation
❑ Yes YN No
6b If yes then identify the square feet of impact to each zone of the riparian buffer that requires mitigation Calculate the
amount of mitigation required
Zone
6c
Reason for impact
6d
Total impact
(square feet)
Multiplier
6e
Required mitigation
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1 5
6f Total buffer mitigation required
6g If buffer mitigation is required discuss what type of mitigation is proposed (e g payment to private mitigation bank
permittee responsible riparian buffer restoration payment into an approved in lieu fee fund)
�6h Comments
Page 7 of 10
PCN Form — Version 1 3 December 10 2008 Version

E Stormwater Management and Diffuse Flow Plan (required by DWQ)
1 Diffuse Flow Plan
1a Does the project include or is it adjacent to protected riparian buffers identified
Yes ❑ No
within one of the NC Riparian Buffer Protection Rules?
lb If yes then is a diffuse flow plan included? If no explain why
Comments (y
e91" r1 % Soc l t4
Yes � No
2 Stormwater Management Plan
2a What is the overall percent imperviousness of this project?
© %
2b Does this project require a Stormwater Management Plan?
❑ Yes X No
2c If this project DOES NOT require a Stormwater Management Plan explain why lei A,2 zap,,
2d If this project DOES require a Stormwater Management Plan then provide a brief narrative description of the plan
❑ Certified Local Government
2e Who will be responsible for the review of the Stormwater Management Plan?
❑ DWQ Stormwater Program
❑ DWQ 401 Unit
3 Certified Local Government Stormwater Review /(f
3a In which local governments jurisdiction is this project?
❑ Phase II
3b Which of the following locally implemented stormwater management programs
❑ NSW
❑ USMP
apply (check all that apply)
❑ Water Supply Watershed
❑ Other
3c Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached'?
4 DWQ Stormwater Program Review N�`f
❑ Coastal counties
❑ HQW
4a Which of the following state implemented stormwater management programs apply
❑ ORW
(check all that apply)
❑ Session Law 2006 246
❑ Other
4b Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes ❑ No
5 DWQ 401 Unit Stormwater Review Ak
5a Does the Stormwater Management Plan meet the appropriate requirements?
❑ Yes ❑ No
5b Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No
Page 8 of 10
PCN Form — Version 1 3 December 10 2008 Version
.t-

F
Supplementary Information
1
Environmental Documentation (DWQ Requirement)
la
Does the protect involve an expenditure of public (federal /state /local) funds or the
❑ Yes
ANo
use of public (federal /state) land?
1 b
If you answered yes to the above does the protect require preparation of an
environmental document pursuant to the requirements of the National or State
❑ Yes
❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c
If you answered yes to the above has the document review been finalized by the
State Clearing House? (If so attach a copy of the NEPA or SEPA final approval
❑ Yes
❑ No
letter )
Comments
2
Violations (DWQ Requirement)
2a
Is the site in violation of DWQ Wetland Rules (15A NCAC 2H 0500) Isolated
Wetland Rules (15A NCAC 2H 1300) DWQ Surface Water or Wetland Standards
❑ Yes
No
or Riparian Buffer Rules (15A NCAC 2B 0200)?
2b
Is this an after the fact permit application?
❑ Yes
No
2c
If you answered yes to one or both of the above questions provide an explanation of the violation(s)
3
Cumulative Impacts (DWQ Requirement)
3a
Will this protect (based on past and reasonably anticipated future impacts) result in
❑ Yes
KNo
additional development which could impact nearby downstream water quality?
3b
If you answered yes to the above submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy If you answered no provide a short narrative description
4
Sewage Disposal (DWQ Requirement)
A-
4a Clearly detail the ultimate treatment methods and disposition (non discharge or discharge) of wastewater generated from
the proposed protect or available capacity of the subject facility
Page 9 of 10
PCN Form — Version 1 3 December 10 2008 Version

5 Endangered Species and Designated Critical Habitat (Corps Requirement)
5a Will this project occur in or near an area with federally protected species or
❑ Yes No
habitat?
5b Have you checked with the USFWS concerning Endangered Species Act
❑ Yes No
impacts?
F-1 Raleigh
5c If yes indicate the USFWS Field Office you have contacted
❑ Asheville
5d What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
6 Essential Fish Habitat (Corps Requirement)
6a Will this project occur in or near an area designated as essential fish habitat?
❑ Yes No
6b What data sources did you use to determine whether your site would impact Essential Fish Habitat?
"'Duke, &r3, 4 e ln, .tilkP-5
7 Historic or Prehistoric Cultural Resources (Corps Requirement)
7a Will this project occur in or near an area that the state federal or tribal
governments have designated as having historic or cultural preservation
❑ Yes No
status (e g National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b What data sources did you use to determine whether your site would impact historic or archeological resources?
1
C,fa"/ /,,, d,qd [a 7 /,��tn
8 Flood Zone Designation (Corps Requirement)
8a Will this project occur in a FEMA designated 100 year floodplain?
Yes ❑ No
8b If yes explain how project meets FEMA requirements 5kv,Ie
8c What source(s) did you use to make the floodplain determination ?Jda c2 /,ed C�� Surynrlu��
Pe,
41-1
Applicant/Agent s Printed Name
Date
li nt/Agent s Slgnatur
(Agents signatu a is valid only if an authorization letter from the applicant
is provided )
Page 10 of 10
PCN Form — Version 1 3 December 10 2008 Version

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Rowboat Dock
YM MAO DATE 05/9/12 & Dredge �
APPROVED DATE
er
Con id and Am q t Very fie t
PROJECT WNACER DATE 658 WHOM30 R d
ROW 0519112 t4 26 '
(7D) 663 3478
SCALE [phone] FAX
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YM MAO DATE 05/9/12 & Dredge �
APPROVED DATE
er
Con id and Am q t Very fie t
PROJECT WNACER DATE 658 WHOM30 R d
ROW 0519112 t4 26 '
(7D) 663 3478
SCALE [phone] FAX
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YM MAO DATE 05/9/12 & Dredge �
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PROJECT WNACER DATE 658 WHOM30 R d
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(7D) 663 3478
SCALE [phone] FAX
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B)ITEM DlTERGI L ,4�CE iAL4� \AGETv=1, NT EC12 Q
F 0 BOX ?o(16
':HARLOT= TeC 2810s -LOEI6
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A,PPLIC�T1ON FOR P'ERNUT TO S7 A-F31 = S'11G t,LEIL EK TV OR. TH CA -ROLIINT A
Pleas° tvp or print and f11 in all blanks If mf'o -mauon z., not appacable so -achcate bi pla -mg a N/4 in blank
°LEASE SUBMIT APPLICATION AND APPPOPRfATE DUKE ENEPC" FILINC FEE PAYABLE TO DUKE
ENEPGY TO ABOVE ADDRESS
L kpphcant Iniormatron
A Name 1e, v 6 rr; a la 4,/7
B kLmlmg Address © �dyc 3�rC�
Zl z `�(� 7
C Telephone Z - (v S — '71 O /
IL Location of Proposed Project
A Lake A
B Street Address y6 aril ti �o /ab
C County
D City/Town/Commumty or Landmark Caiyl g /,rls
E Section Lot# Subdivision
F Dnw ons to property by road /G�'a�a
u0_.P.( (:�iu /ri� �r_{YOnSyia,� f Lir�/r�t ID a i/�wL
G Latitude and Longitude for the project site SEE ATTACHED MAP
Please submit a map showing the coordinates or a detailed map (USGS quad map city
map etc ) showing the exact location of the project site (NOTE Latitude/Longitude
coordinates can be found on internet site mm, mapblast corn )
II Description of Project
A_ Length of wall /490 ze�i "
B Material yst� ry7 "1, re a
C Distance from property brie /shoreline © egg
IV Intended Use of P'ro'em Area
A Private X-
B Commercial
V Applicant s Signature r ) ,r' r Date ? ( L
PLE4,S'E NOTE THE F®LLGff1ZNG
A COPY OF THE COMPLETED APPLICATION WITH A ROAD MAP SHOWaIG LOCATION OF THE
PROPERTY MUST BE SUBMITTED TO US ARI%n CORPS OF ENGINEERS 151 PATTON AVE
ROOM 208 ASHEVII LE NO 28801 3006
A COPY OF THE DU= ENERGY APPLICATION FOR PERMIT TO STABILIZE THE SHORELINE IN
NORTH CAROLINA AND SEVr'-1. T (7) COPIES OF THE CONIPLETED "NC DIVISION OF WATER
QUALITY PRE - CONSTRUCTION NOTIFICATION APPLICATION" MUST BE SUBMIT= WITH
THE DIVISION OF WATER QUALITY APPLICATION FEE TO
NC DIVISION OF WATER QUALITY
ATIHNTION CYNDI KAROL Y
PARKV= BLDG 2321 CRABTREE ROAD
RALEIGH, NC 27604-2260
(019) 7D3 1786
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D,-t

DUKE ENERGI DIRECTIONS BY ROAD FORT
La e Use Permit kpplieant-, and contractors Ea-- of lccatii g th, niopDsea piojecL ' to cail haN e a L)12
i 'npact oij l,eCmit piocessin` tjnie Please complete +leis or,1 and return it alo-ig «ith our completed
peirnit application to
Applicants Name
Street Address (at lake)
Lake Name
Subdivision Narne
Property Section
Clt} CornehuS
State North Cad ohna
Telephone
DUKE ENERGY
C/O L kKE AIANACEl'e'1ENT EC 12 Q
P 0 BOX 1006
CHARLOTTE, NC 28201 1006
1 800 443 4133
3effi ev Templeton
Type of Permit Requested
Circle
20947 Island Forest Drive
Prn ate Facility
Commerical Facthty
Lake Norman
Ezcai atcon
Stabilization
Island Forest
Conveyance
Miscellaneous Uses
Lot 4
Count} Meellenburg
Zip 28031
Directions (fiom majoi load of highway)
Flom Catawba Aienue Tut right on Bethel Chutch Ro id Turn right otito Pinehuist Diive
Turn Right onto Island Foi est Dr i` e P1 oject is looted on ) our left
Desci ipti\ e Sti uctui e on Pi opert} (i e brick gai age NN bite fence mobile home etc )
Smile famil} iesidence NA ith brick on the bottom half of the house and painted wood siding
Note Please i e the beck of th form if desired to dra u a mp to the s to
GPAL /LAKEMCMT /LMPPM /DiRECTI01\S DOC Eff c D i 11115198

D O N A L L E N & A S S O C I A T E S P A
L) S Since 1971
Cornmorcial * Residential " Mortgage Survoy. Muitl —Forr ily
Construction Stakinq * Subdivi Ion Design * Topographical
111 -3 Rocewfay Drive * Mooresville * NC * 28117
(704) 664 -7079 (704) 664 -8041 Fox
I certify that this map was drawn under my supervision from On actual
survey made under my supervision rocorded In deed book-24355 __ pf�ge_ 10sn,,,_ rn,� /or
plat book_ _ 12 page__�.Ll that the ratio of precision Is 1 11) 0001 1' �pAi�14r,ap
was prepared in accordance with, the General Statutes of North Carolina CFxbl#y9
my hand and seal on the day of _ ^ JULY__ A D 20__129 a aA1.
CURVE TABLE
CURVE
RADIUS
LENGTH
BEARING
CHORD
C1
,ao o0
50 3e
S 5327-30 E
4626
C2
5000
27 00
S 124540 E
21 87
C3
5000
40 02
S 73 42 0o W
3896
C4
—
'5000
6457
S 53,3443 W
60 15
1
Ca
277 46
27 56
S 53 36 55 E
2755.
R
0'� GON5�.11P
f0�v
�a
N�FMPN
VO
CA�t a �R
10 1.v
hv I
DONALD RAY A EIS, RV04'h sLA°
1
l
ti
/s
LINE TABLE _
LINE
BEARING
LENGTH
L1
N 14 47 23 W
5625
PD f2 AV
EI
d JSN 9
10 �o,►'s �/ Deb
04
CP
soRaS o1
P ��4oW r
IAC���O
�a
SgO��Pl1q
OR�CI pIP`'r`'R0
J �
� T
,GOT 39
DOMIXQUE
ROMAGiVOLO
71951386
O w
SITE ga�
CORNELIUS
14WY 73
Pp ,10 �� `�0 gxlT 26
IET10N RD
VICINITY MAP NO SCALE
q4 RF6AR
FOUND
�d
SCALE _ 1 _ _ 40
ACQUIRED BY
IL
LOT 40
7 26 AC
Cu
o �
N COQ
n
f\ fn
fiJ Ib
N Ip E , E
3/4 GOLID
IRON FOUND
47�
NOTES
1) THIS PROPERTY MAY DE SUIOJECT TO
ANY EASEMENT AND /OR RIGHTS -OF -WAY
OF RECORD
7) AREA COMPUTED BY THE COORDINATE
p METHOD
3) EXI -TING 790 & 761 CONTOUR ELEV-
ATICN $ASED ON LAKE NORMAN 1AKE
LEVEL AT COWANS FORD DAM (READING
ON 7- 19 -09) EI PvATION 757 90
4) OVERHEAD POWER
NO GRID MONUMENT FOUND WITHIN
2003 FEET
I
I
N \�
q tr
Cj
EIP
61 -
r
1
15IANb FOREST
DRIVE
(PAVED)
CF
0 20 40 100
I L- I I
SCALE IN FEET
PHYSICALSURVEY
OF
20947 I$I AND FOREST DRIVE
LOT-2 0 ISLAND FOREST
LEMLEY TWBP MECKLENBURG C0 N C
JEFFREY TEMPI -ETON
EIP
--r
LEGEND
P P = POWER POLE
E I P - 1 -1/2 PIPE FOUND
C P e COMPUTED POINT
R/W - RIGHT -OF -WAY
mi.o BOOK 749 PG 18
FILE ISLAND FOREST -40
OC FILE
TAX MAP NO 00111402

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Real Estate Lookup
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Parcel Information
Parcel ID
Account
Parent Previous
00111402
INDIVIDUAL
Owner(s)
Sale Price Stamps Qualify Vll DeedBook Type
Legal Ref
Owner Name
Mailing Address
City /State
TEMPLETON JEFFREY B
20947 ISLAND FOPEST DR
COPNELIUS NC 28031
Legal Information
Nov 32006 879000 1758 00000 IMP 21317 180 WARRANTY D
21317 180
Legal Municipality
Annexed
Special District Fire District Acreage
L40 M12 341 CORNELIUS
6/30/1995 12 00 00 AM
FIRE SERVICE B CORNELIUS 0
Total Parcel Assessment & Exemptions
Building Land Features Total
Exemption Year Approved Review Date Amount
245200 560000 22900 828100
Sales Information
Sale Price Stamps Qualify Vll DeedBook Type
Legal Ref
Grantor
Aug 21 2009 605000 1210 00000 GOV T/ BANK IMP 25025 489 SPEC WARRNTY
25025 -489
WELLS FARGO BANK NA
Jan 7 2009 753500 1507 00000 FORECLOSURE IMP 24356 105 TRUSTEE DEED
24356 105
CHROMIK STEVE
Nov 32006 879000 1758 00000 IMP 21317 180 WARRANTY D
21317 180
STONESTREET JOHN M
Sep 28 1998 0 OTHER IMP 09940 316 DEED STAMPS
09940 316
STONESTREET JOHN M
Land Use
Use Units Type Neighborhood
Assessment
R122 1 00 WF A101
560000
Building Information
Bldg Description Type Year Built Property Location
1 Single Fam PES 1975 20947 ISLAND FOREST DR CORNELIUS
Bldg Story Units Total SgFt Heated Foundation Ext Wall
Grade Value
1 1 STOPY 1 4796 2897 CRAWL SPACE CEDAR RDWD FACE BRICK
GOOD 03 245200
Bldg Heat Fuel FirePlace AC Fixtures Bedrooms
Full Baths
314 Baths 112 Baths
1 AIR DUCTED GAS 1 FP3 AC CENTRAL 4
4
1
Sub Areas
Bldg Description
Size
1 BASE (FIRST FLOOR)
1857
1 GARAGE FINISHED
462
1 PORCH OPEN FINISHED
30
1 PORCH OPEN FINISHED
360
1 BASEMENT FINISHED
10,10
1 UTILITY UNFINISHED
300
1 PORCH OPEN FINISHED
280
1 BASEMENT UNFINISHED
467
Depreciation
Bldg Physical Functional Economic
Special
Override
1 AV 16 00 /
Dotes
Tax Year Notes
Note Date
2011 Informal Review Request Peceived
04/13/201
Special Features & Yard Items
Bldg Built Type Quantity
Units
Value
1 2009 PIER 1
5X50
4400
Page 1 of?
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