20210717 Ver 1_Shoreline Stabilization_20210624

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:
Mack DWR Pre -Filing Meeting Request
51.54KB
Form.pdf
Pre -fling Meeting or Request Date 4/8/2021
ID# 20210717 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.
Robert P. Mack
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
156 Waterford Drive
Address Line 2
City
Troutman
Rbstal / Zip Code
28166-7645
State / Frovince / Region
NC
Country
United States

Is there an agent working on the F Yes
project?* r No
Agent/Consultant Information
Name: * Donna P. Hrko
Company Affiliation:* Lancaster Custom Dock and Lift Systems, Inc.
Email:* donna. lancasterdocks@gmaiL corn
Phone Number:* [phone]
(XXX)XXX-XXXX
Address:* Street Address
1156 Perth Road
Address Line 2
City
State / Province / Region
Troutman
North Carolina
Fbstal / Zip Code
Country
28166
United States
Asigned and dated copy of the Agent Authorization letter:*
Mack Signed Agent Authorization Form.pdf 141.94KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Mack Dock and Dredge
If your project has a formal name please use this. If your project does not hake a formal name, please identify your project by
the ovvner 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 Lookup address
Property Address Lookup:* Street Address
156 Waterford Drive
Address Line 2
city
Mooresville
Fbstal / Zip Code
28117-8915
Latitude:* 35.547174
State / Province / Pegion
NC
Country
US
Longitude:*-80.911139
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*
Mack Dredge NCDENR Site Plan and Review
5.65MB
Packet.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.)*
Mack Photos.pdf
1.44MB
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:* Pine Isle, Phase 1, Lot 32 156 Waterford Drive Mooresville, NC 28117
Include phase/lot number
Directions to site:*
From 1-77 SB, Exit 35, Turn Right onto Brawley School Road, Turn Left
onto Isle of Pines Road. Turn Right onto Waterford Drive. Property is on
the right.
Pease include road narres and nunters, landnarks 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 .67 acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Dredge approximately 260 cubic yards of material for boating access.
Excavation work will be primarily be preformed by water with a
construction corridor for delivery of materials and staging for dock
construction.
8. How will the work be done?* I7 From Land
rJ 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.)
2543 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:*
(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):
0 $240.00 for impacts to lake (below normal water level) of less than 1 acre
0 $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:* 20210717
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: 32 PLAN NO: PARCEL ID: 4635196512
STREET ADDRESS:
156 Waterford Drive
Mooresville, NC 28117
Please print:
Property Owner:
Property Owner:
Robert Mack
The undersigned, registered property owners of the above noted property, do herebyauthorize
Donna P. Hrko of Lancaster Custom Dock and Lift Systems, Inc.
(Contra dor/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.
J L�_
Authorized Signature U Authorized Signature
Date 5/58/2021
Date

Project
Owner:
caffir lctor/agel
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 07-H .0506 and 15A NCAC 02B .0243(g)]
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. USA NCAC 028 .0243(5)1
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 (s)]
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)]
Storrnwater 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 028 ,0243(5), (6)]
Acfnowwgement of Natiftcaeic n
I' hereby state that i have been informed of the Catawba
Riparian Buffer Rule. Any rk conducted in the buffer, not specifically stated in the application and approved
by the Division of plater Resources (DWR), is a violation and subject to enforcement. Due diligence will be
taken such that the construction will be built within substantial compliance and intent of the 401 Water
Quality Certification and Buffer Rules, the approved plans) and specification(,$), and other supporting
materials.
i I
Signature (owner): Date: 5

;. State of North Carolina
Department of Environment and Natural Resources f . a Division of Water Resources
Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
ENVIRONMENTAL 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/ Norrnal Water Level
�
Shoreline
Plan View
Full Pond/ Normal Water Levet
' - 3t oreTne - -
Lake
�a
(At Full Ponds Normal Water Level) �4�je,,,
G,� k
Lake
{At Full Pond/tdormal Water L-1 Existing Dock
/ 30 ft x 7 ft
31txmft
` Below full pvnEINWL
�. . r
SRwx 150k
�Ab—full pond/ NWL
NO NN'
Plan View
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 II-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 I 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 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 1 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 10/1r2019
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.
Duke Energy Page 3 of 13 rev 10/1,2019
Excavation Program

Duke Enery-y Excavation Permit Ann ication 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 d ZZ zlInitiais,,
Date Final Protection/Avoidance Area Markings Field - Verified
Approved to Start Work Sy * :
Date Completion Required
Date Passed Closeout Inspection's
(Print)
Date of Any Approved Extension
Initials
Initials
Date
(sign)
Initials
Any Stop Work Orders or SMG Violations"? (check one) ❑Yes ❑No Qj' }'es, 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 1. Applicant Information (Please Prise)
Name �Q )pe_r- + i ' 1QC_Telephone '_70 1-7
Email address:
r
Lake Address
lap p A Ct2r-&-d I)r t \l e+
L lw resv'l lle. NC_ Z?)1 l-7 -
Contractor Company
Contractor Contact Person
Contractor Email Address:
Vie,
Mailing Address (f different)
U
)�)OV) nCt P kr V�1 ❑ Telephone 3o4 - (oZ� - &o_ (a
Ann lno,.Ian rnS4err1nc146 a�)aMa1 l,Com
LAKE LOT INFORMATION 4 (035 kc 5 ! Z
■■t� �lN�
Lake I o ry�lGt n County l r e.�e] i City r State Tax Map jNo. 93
SubdivisionLot 1 Section lvo.'3. 1 Lot size •Acres
Duke Energy Page 4 of 13 rev 10/1/2019
Excavation Program

Duke EnerSy Excavation Permit Application Form
Are there any Co -Applicants*? (check one) ❑Yes No (If Yes, include names, street
addresses or lot numbers, pier'numbers, phone num ers.. 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 tit is 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 4 'Z z -z i
Initials (Duke Energy) W_11 (applicant/contractor)
Duke Energy Page 5 of 13 rev 10/1/2019
Excavation Program

Duke Energy Excavation Permit Application Form
Part II. Description of Project
A. Basic Information
1. Type of excavation: (check one) IlNew excavation ❑ Maintenance excavation
2
3
Purpose of excavation: (check one)
❑ Water Intake Channel
❑ Other (spec):
Lake user category: (check one)
❑Commercial Marina
❑Other (specify):
1d Boat Access Channel
❑ Wastewater Discharge Channel
Wrivate 13 Residential Marina
❑Public
4. Max. Excavation Area Dimensions (ft): Length 4 Width 5CP.5 Depth 1
(Note: include additional area dimensions if necessary so response to #5 belmi- equals max. area
dimensions in 94)
5. Volume of Excavated Material (TOTAL for the project): z�0 Cubic yards
6. Type of material removed (applicant determines byfeld sample ifpractical):
7. Excavation Site area: . 0 5 Acre (s) Disposal Site area: - OZ 5 Acre(s)
8. Total Disturbed Area (including equipment staging area): . O�,5 Acre (s)
9. Does theproject meet the requirements of the applicable General Permit`? (check one)
ties Jo
10. Do you claim title to the disposal area? (check one) ❑Yes No
11. Do you claim title to the equipment staging area? (check one) 2"fes %io
12. Are there any water-treatm. facilities within 50 feet of the proposed excavation area?
(check one) Yes Jv
(If Yes, specify):
13. How will the excavated material be entrapped and the erosion controlled? (e.g. see attached
erosion control plan and disposal area design): breMul
v V1P.�h Ib reach cymA J0.+nY-z
�1ct�e rna�-erial in 110?peg- bar es.0.\Ma bc�r�j e D91Cad
c-)VnJ-o duvlip trLLcV)s e(vid �spo �-+ to d� s$n� (
Duke Energy Page 6 of 13 rev 10/1/2019
Excavation Program

Duke Energy Excavation Permit Application Form
14. Type(s) of excavation equipment to he used: �_D v) )�p q� 11 j o Ir 4
" teaC_Vj CxCCkqa J-o r, bar e s , d vAP truc 1Y s
15. Will waters or wetlands be crossed in transporting equipment to or from the site?
(check one) CTYes ❑No
(I yes, explain)
11 died=I'le�uIpmepi+- y5 ir'cans �ri-eiviGLPoCL4;np1a,,,4- wcfk �U
boq+r1 Ca sue- us�aem �oc V) 5i-a51 n q v-e� � � � c.&, �
pro eL+ siAe dry L.a V1 a Nov -Mari �
16. al return water re-enter the reservoir? (Check one) ❑Yes ONo */A
(If Yes, sped points} 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? ❑Yes Rio
(If Yes, provide the existingpermit number. If No1, include a scaled drawingg of the pro msed
facility). Permit # new cla cV1 -gyp e C.ont'Tr'u.6 A.
ee he d raw; ����,,��, pr:mxa r. racy lI es
1$. Total planned duration of the work {T°nc�i5d rrs�f eq°u me r�ro�Fliva§nnexcavation
through final mitigation measures complete}:
START 0q 1 & FINISH 1 z
(Month) (Year) (Month) (Year)
Duke Energy Page 7 of 13 rev 1011 f2D 19
Excavation Program

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Duke Enerzy Excavation Permit Application Form
C. Applicant's Signatures
Comments:
Applicant Name (print) ?k)be-y--�
Applicant Signature* i -"� Date
Co -Applicant Name (print)
Co -Applicant Signature* Date
Co -Applicant dame (print)
Co -Applicant Signature* Date
Co -Applicant :dame (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 ! 0111Z019
Excavation Program

Duke Energy Excavation Permit Application Form
Part III. Additional Information
!r. 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.]
JC-' 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
Duke Energy Page 11 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 -I. Sample Agency Comment and Response Table
Agency Comment Applicant Response
Agency 1
The activit is approved as proposed. NA
Agency 2
The on -site well provides drinking water to the
Contacted Mr. Smith on 111120xx. 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
,4gency 3
Requested agency comments on 111120xx and
NA
again on 211120xx. No response as of
2116120xx.
_4jVencv 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
Date of
Date of
Agency
Permit/Certification Name
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 continents followed by
additional correspondence in chronological order. All permits must be valid at time of
Duke Energy Page 12 of 13 rev l DI1r2D 19
Excavation Program

Duke Energy Excavation Permit Annlication Form
application and have a term longer than the projected schedule for completing the permitted
project.
Part V. Additional Inforlmation
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 ❑f 13 rev 101112019
Excavation Program

Excise Tax: NTC
Type: CONSOLIDATED REAL PROPERTY
Recorded: 8l912019 12-05:58 PM
Fee Annt: $26.00 Page 1 of 3
Revenue Tax: $0.00
Iredell County, INC
Ronald N. Wyatt Register of Deeds
BIB 2636 PG 2321 - 2323
Recording Time, Back and Page
Tax Lot No. 4635-19-6512.000 Parcel Identifier No. 2G-23A-32
Verified by County on the day of , 20
bV
Mail after retarding to: Lauren T. Millovitsch, Creamer Millovitseb, PLLC
130 Harbour Place Drive, Suite 270, Davidson, NC 28036
This instrument was prepared by: Lauren T. MilIovitsch, Esq. (NO TITLE EXAMINATION REQUESTED OR
PERFORMED)
Brief Description for the index Lot 32 Pine Isle Phase I
NORTH CAROLINA GENERAL 'WARRANTY DEED
THIS DEED made this 9 day of t �s _, 2019, by and between
GRANTOR GRANTEE
SELLIAN A. MACK (formerly known as .TILL A. JILLIAN A. MACK and husband, ROBERT P.
HUL5E) and husband, ROBERT P. MACK '.MACK, as tenants by the entireties
156 Waterford Drive
Mooresville, NC 28117
156 Waterford Drive
Mooresville, NC 28117
Enter in apivapriate block For eadi p art : name. addirss. and, if W2rap riate, dheracter ofentii , e.�. vorpomtion or partnership
.
The designation Grantor and Grantee as used hereir. shall ine'Lude all parties, their heirs, successors, and assigns, and shall include
all 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, that certain lot or parcel of land lying and being in Iredell County,
North Carolina and more particularly described as follows:
BEING ALL OF Lot 32 as shown on map of PINE ISLE, PHASE f,
subdivision as platted, planned and recorded in Plat Book 22, Pages I24-127,
and specifically depicted on Page 127 in the Office of the Register of Deeds
for Iredell County.
Submitted electronically by "Creamer Millovitsch"
In compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the aredell county Register of Deeds.

The property hercinabove described was acquired by Jillian A. Mack, formerly known as Jill A,
Hulse, by instrument recorded in Book 1986, Page 569, Iredell County Registry.
It is the intent of the Grantor to establish ownership of the property described herein in the
form of a tenancy by the entireties by executing and recording this deed in accordance with
North Carolina law.
All or a portion of the property herein conveyed does include the primary residence of the
Grantor.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges mad
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, free and clear of all
encumbrances, and that Grantor will warrant and defend the title against the lawful claims of all
poisons whomsoever, other than the following exceptions:
1. Ad valorem taxes for the year 2019 and all subsequent years.
2. Easements, rights -of -way, conditions, restrictions, and other matters of public
record.
IN WITNESS WHEREOF, the Grantor has caused this instrument to be signed, sealed
and delivered as of the day and year first above written.
[SEPARATE SIGNATURE PAGES FOLLOW]
2

SEPARATE SIGNATURE PAGE TO
NORTFI CAROLINA GENERAL WARRANTY DEED
GRANTOR:
(SEAL)
3illi A ac nn rly know�asJil�IA. Hulse}
SEAL
Ro�eTt .Mack
STATE OF FORTH CAROLFNA - COUTNTY OF Ma CkUl� u rQ
1, T lr i C_GL_L . '?�,6h , a Notary Public of ,1 L County and the
State of North Carolina, certify that Ellian A. Mack and Robert P. Mack personally appeared
before me this day and acknowledged the due execution of the foregoing instrument for the
purposes therein expressed.
Witness my hand and Notarial
My Commission Expires: /.) 0 d i
[NOTARIAL SEAL]
ER 10A L. BEHMi
Notary Public,- North Carolina
lrsdO CO
�url�ty
►,�yCcN* Ri::Si:r t F..�cS,res Saj
j
stamp or seal this c? day of
Notary Public

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LCustom Dock & Lift
Systems, Inc.
NC General License Contractor # 49723
1156 Perth Road
Troutman, NC 28166
704-528-7400 Phone
704-528-3400 Fax
Robert Mack
156 Waterford DR
Mooresville, NC 28117
SUMMARY
4/22/21
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1) Dredge approximately 260 cubic yards with all required slopes at full pond.

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DUKE ENERGY DIRECTIONS BY ROAD FORM
Lake Use Permit Applicants and Contractors: Ease of locating the proposed project
sit e can have a big impact on permitting processing time. Please complete this form and
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'.`ame. Robert Mack
Street Address (at lake): 156 Waterford Drive Mooresville NC 28117
Lake Name: Norman
Subdivision Name: Pine Isle.
Property Section: Phase I Lot #: 32
City: Mooresville County: Iredell
State: NC Zip: 28117
Telephone: [phone]
Directions (from major road or highway):
From 1-77 NB, Exit 35, Turn Left onto Brawley School Road, Turn
Left onto Isle of Pines Road, Turn Right onto Waterford Drive,
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.

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DUKE ENERGY DIRECTIONS BY ROAD FORM
LANCASTER CUSTOM DUCKS DISPOSAL SITE
Lake Use Permit Applicants and Contractors: Ease of locating the proposed project
sit e c an have a 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
A pplicant's Name: Lancaster Custom Dock Disppsal Site
Street Address (at lake): 1162 River Hi hw1a3i Mooresville NC 28117
Lake Name: Norman
Subdivision Name: B r, Dadd 's of Lake Norman
Property Section:
Lot #:
City: Mooresville County: Iredell
State: N
Telephone: [phone]
Zip: 28117
Directions (from major road or highway): From I-77 NB, Exit 36, Left onto NC-
1 SO 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 farm if desired to draw us a map to the site.

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ID#* 20210717
Version* 1
Regional Office * Mooresville Regional Office - [phone]
Reviewer List* Alan Johnson
Pre -Filing Meeting Request submitted 4/8/2021
Contact Name* Donna P. Hrko
Contact Email Address* donna. [e-mail]
Project Name* Mack Dock and Dredge
Project Owner* Robert P. Mack
Project County* Iredell
Owner Address: Street Address
156 Waterford Drive
Address Line 2
aty
State / Rovince / Pegion
Mooresville
NC
Fbstal / Zip axle
Country
28117
us
Is this a transportation project?* r Yes (' 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 and include location information.*
Dredge appro)amately 260 cubic yards of material with required
slopes (10' feet depth at full pond) for watercraft 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 4/8/2021