20211580 Ver 1_Shoreline Stabilization_20211102

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 view the form.
Attach documentation of Pre -Filing Meeting Request here:
Campbell Pre -filing Meeting Request
244.95KB
Form.pdf
Pre -fling Meeting or Request Date 8/27/2021
ID# Version
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* [e-mail]
Please provide an email address for payment and requests for more information here.
Owner Information:
Name: *
Margaret L Campbell
Email: *
[e-mail]
Phone Number:*
[phone]
(xxx)xxx-xxxx
Mailing Address:*
Street Address
616 Charming Circle Northwest
Address Line 2
City
State / Province / Region
Troutman
NC
Postal / Zip Code
Country
28166-7645
United States

Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: * Donna P. Hrko
Company Affiliation: * Lancaster Custom Dock and Lift Systems, Inc.
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address: * Street Address
1156 Perth Road
Address Line 2
City
State / Province / Region
Troutman
North Carolina
Postal / Zip Code
Country
28166
United States
A signed and dated copy of the Agent Authorization letter: *
Campbell Signed Agent Authorization
148.681CB
Form.pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
.............................................................................................................................................................................................
Project Name: * Campbell Dredge and Shoreline Refresh
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.*
Upload File
• Look up address
Property Address Lookup:* Street Address
136 Claiborne Drive
Address Line 2
City
Mooresville
Postal / Zip Code
28117-9201
Latitude: * 35.511441
State / Province / Region
NC
Country
US
Longitude: *-80.951594
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*
Campbell Site Plan Etc..pdf 6.16MB

Please use the diagram at the link below:
https:Hedocs.deq.nc.gov/WaterResources/O/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.)*
Campbell 136 Photos.pdf 1.76MB
4. Location of the property (where work is to be conducted)
Nearest Town: * Mooresville
County: * Iredell
Lake/ river/ ocean adjacent to Nonnan
property:
Subdivisions name or site address:* Crescent Land + Timber Corp. Section 6 Lot 237
Include phase/lot number
Directions to site: *
From I-77 NB, Exit 35, Left onto Brawley School Road, Turn Right onto
Tuscarora Trail, Right onto Binns Road and continue to intersection of
Claiborne Drive. Property is on the left at the end of the road.
Please include road names and numbers, landmarks 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 .637 acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Dredge for new dock boating access. Shoreline refresh for stabilization
and erosion control.
8. How will the work be done?* From Land
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.)
5486 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:* Donna P. Hrko
Signature:/
Submittal Date: 10/31/2021

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20211580 Version: *
Select Reviewer:*
Select Reviewing Office:
Has payment been received?*
What amount is owed?*
Alan Johnson: eads\adjohnson I
Mooresville Regional Office - [phone]
No Payment Needed
Fee Received
• Need Fee - send electronic notification
• $240.00
$570.00

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO: 237 PLAN NO: PARCEL
ID:4614962707
STREET ADDRESS:
136 Claiborne Drive
Mooresville, NC 28117
Please print:
Property Owner: Margaret Campbell
Property Owner:
The undersigned, registered property owners of the above noted property, do herebyauthorize
Donna P. Hrko
(ContractorlAgent)
of Lancaster 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):
616 Channing Circle NW
Concord, NC 28027
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate tothe
best of our knowledge.
&ON 1, � W4. ca I Vol F ON 04 � WE
Auth - . )&Wure
10/25/21
Date
Authorized Signature
Date

' r-o_
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Water Resources 15A NCAC 02H .0500 —Water Quality Certification, Shoreline Stabilization
ENVIRONMENTAL QUALITY FORM: 55GP 02-2017
Please approximately sketch the following information ❑n 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 Level
Shoreline
Plan View
FORM: 5SGP 02-2017
Lake
(At Full Pond/ NNgrnal Water Level) k
ie
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(At FuII comVNcmW were le eq Existing Dock
/30 ftx7 fi
3 ft z 150 ft
Full Fonds Normal Water Level
Below full Bond/ NWL
r--1r10re�nMM
— SNx 155n
Riprap
Ab" fill porKV NwL
2 ft. x 350 ft
addltlonal Geaeing
If necmery
E AMP E
Plan view
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Iredel! County
Property Data
Parcel Number: 4614962707.000
Inquiry Date. 1012-7/2021
Disclaimer: While every effort is made to keep information provided over the Internet accurate and up-to-date, the County does not certify
the authenticity or accuracy of such information. No warranties, express or implied, are provided for the records and/or mapping data
herein, or for their use or interpretation by the User.
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Tax Account Number: 77392715
Old Parcel Number: 001 382 52A
Owner Name: CAMPBELL PAUL T+MARGARET L
Mailing Address: 616 CHANNING CIR NW CONCORD NC 28027
Property Location: CLAIBORNE DR
Lot Number: 237
Legal Description: CLT S6 M17-625 MECK-NECK PB34-29 REV PB60-119
Municipal Information
Township Code: 17
City Code: Null
Neighborhood Code: 17o1s
Value Information - Current Year Property Record r [PRC},
Building Value: sossso
Other Building Features: 39210
Land Value: 57ocoo
Tax Assessed Value: 1117790
Deferred: o

Land Information - Regs�t�r of De ,s,4nline Search
Date Recorded Document Type Deed Book
19980101 WD 9498
Tax Information
Deed Page Plat Book & Page Land Area Land Type Zoning
379 60-119 0.637 AC R-20
Exemption Tax Code 1 Tax Code 2 Tax Cade 3 Tax Code 4 Tax Code 5
(dull C ADVLTAX Null FR06ADVLTAX Null Null
Current Zonina Contact Info.
Iredell County
704.578.3118
Harmony
704.878.3118
Love Valley
7D4.878.3118
City of Statesville
704.878.3575
Town of Troutman
704,528.7600
Town of Mooresville
704.662.7D40
Village of Davidson
704.892.7591

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: � %& n J County:
Owner: _ Jbi-r-lr w cm-k- Larmn1%P I L .�i it w-j A' �W-o
Pri
Contractor/agent.
Print
e
The approval is for the purpose and design described in Mur 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 1SA 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 and 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. 115A 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 D2B .0243(S), (6)]
Acknowledgement of Notification
I, hereby state that I have been informed of the Catawba
Riparian BLYer Rule. Any work 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 w I I I be
taken such that the construction will be built within substantial compliance and intent of the 401 Water
quality Certification and Buffer Rules, the approved plan(s) and specificat ion(s), and other supporting
materials.
Signature (owner):

DREDGE SPOIL DISPOSAL FORM
ea" c1ed�.
Project Name/address: I
County: r f
�i n Adore l � �17 rV�' .9..Q 7
Location Address: � � �7, �i JP r' ! 1►r-s �1' LVr3 � ■ I"fIY� rim ti,. 11.01
Parcel M
Parcel/lot size 2, !
Disposal area required (sq ft and/or acreage)
Acknowledg meat f Notification f
1. � T , am aware that the site must adhere to all state regulations
and rules regArding sediment and erosion control and water quality. And give permission for
Name of Individual and Company
to dispose of their dredge material at the above stated location
Owner: , I ILdae'A!�� JJZ.
Print 15igna ure
Date: 1
Along with form, please provide:
Aerial of parce1/1ot (County G15)
Photo of proposed spoil site
Identified proposed spoil site

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Iredell County
Property Data
Disclaimer: While every effort is made to keep information provided over the Internet accurate and up-to-date, the County does not certify
the authenticity or accuracy of such inform atian, No warranties, express or implied, are provided for the records and/or mapping data
herein, or for their use or interpretation by the User.
'vvt1Pr�Prnpern,r Tnf•
Tax Account Number: 77374349
Did Parcel Number: 1702N04000A001
Owner Name: BIG ❑ADDYS OF LAKE NORMAN
Mailing Address: 1162 RIVER hWY MOORESVILLE NC 28117
Property Location: ROBINSON RN
Lot Number: PT1
Legal Description: WEST LAKE VALLEY PBI1-52 BIG ❑ADDY5 ANNEX P645-79
Township Cade: 17
City Code: 03
Neighborhood Code: 03060
urr Year_Proqgfty Record Card (EK)
Rullding Value: 0
Other Building Features: 9380
Land Value: 207480
Tax Assessed Value: 216860
Deferred: a

CONN r-` $ { Iredell
•,ylp „��= Printed October 19.2021
- 1 1
See Below for Disclaimer
17W�,;in Addresses
•ii� f -��ll ■ Inc 5t rt
a rt, ire
NonResidential Use
• Residential Use
Sleets
Interstate
Ramp
IP•• •. i II11
US Hoy
State Hv y
Main Road
' Loral Road
Ag
Residential
Private
lnarti:'e
r
'C� Parcels Hooks
Parcels
'#�' • �'-.;-:,, ..,: Parcel Labels
S City Limits
f Lake Normar
11. •-
- .: I � ••' Imo'-•� s
Iredell CourtAire
e a .r�r lI � }] •
I I �■ r. 1.1 I I PIPhC Courtles
ll- l l f N
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t 1 t 75 Feet
fhe maps prepared for this website are generated from recorded deeds, plats, and other public records. Users of these maps are hereby notified that the informati
arovided herein should be verified. Iredell County assumes no legal responsibilities for any of the information contained on this site. Users are advised that the use
any of this Information is at their own risic All maps on this site were prepared using a 10oWG— Grid based upon the North Carolina State Plane Coordinate system fn
:he 1983 North American Datum. The delinquent real property tax overlay is updated Mnth ty. The information presented is not intended to be used or relied upon
afficial notice of tax [fens. For additional information regardin d elinq uerrt taxes, contact the Iredell County Tax Collectors Office.

Urxi Information - R�gi.sk�[. o ends _Online _ aarC
Date Reorded Document Type Deed Book teed Page Plat Book & Page Land Area Land Type Zoning
19910607 WD 823 933
45-79 2.73 AC CMX
Tax Information
Exemption Tax Code I Tax Code 2
Null C ADVLTAX C103ADVLTAX
Iredell County
Harmony
Love Valley
City of Statesville
Town of Troutman
Town of Mooresville
Village of Davidson
Tax Code 3 Tax Code 4 Tax Code 5
Null Null Null
704.878.3118
704,878.3118
704.878.3118
764.878.3575
704.528,7600
704,662,7040
704.892.7591

Duke Energy Lake Services
Guidance for Completing an Excavation Permit Application
Note: If you are proposing excavation in association with the permitting of a new
or expanded facility under the Marina or Conveyance Programs, you do not need
to complete this application. Instead, you should incorporate the excavation
request into the permit application for the marina/conveyance using the
appropriate application.
Step 1: Contact Duke Energy Lake Services
Complete "Part I" of the application and develop a drawing of the proposed excavation area.
Contact Duke Energy Lake Services to schedule a site visit. Lake Services will conduct a site
visit to determine if Duke Energy will accept an excavation permit application for the proposed
work. If the Lake Services representative determines the application process may proceed,
he/she will initial Part I of the application.
Step 2: Draft Application Development
Complete Parts 11-III.A-G and Part V of the Excavation Permit Application.
Step 3: Agency Consultation
Send the draft application developed during Step 2 to the agencies for review and comment on
the proposed activity. Refer to the Agency / Organization List available from Duke Energy to
determine which federal, state, regional, and local agencies and organizations require
consultation or review.
Note: Duke Energy reserves the right to require consultation with additional organizations
beyond those included in the Agency / Organization List.
Each agency / organization must be provided at least 30 days prior notification. Evidence must
be provided (e.&, response Ietter 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 10/1f2019
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 for your proposal and an additional
fee.) The SCDHEC conducts a joint application process with the USACOE in S.C. If the
proposal meets any applicable requirements of the Clean Water Act Sect. 401 Water Quality
Certification, you will typically receive a letter from SCDHEC documenting Sect. 401
Certification and providing any additional instructions. You may also receive a letter from
USACDE 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 (SCM-4): 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/P2019
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 101112019
Excavation Program

Duke Energy Excavation Permit Application Form
FOR DUKE ENERGY USE ONLY
Duke File No,
Application Fee $ Security Deposit $ Check # Date Reev'd Initials
Date of Duke Energy lake Services, applicant and/or contractor on -site inspections Date 1 1- _Qials
Date Final Protection/Avoidance Area Markings Field - Verified
Approved to Start Work lay
Date Completion Required
Date Passed Closeout Inspection*
{prrno
Date of Any Approved Extension
Initials
Initials
Date
♦:Sign]
Initials
Any Stop Work Orders or 5MC 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) back to applicant
with Approval Getter and highlight any changes. File copies of Approval and Close-out Checklists and any Stop Work
Orders with application.
Part I. Applicant Information (Please Print)
Name re� 1 l Telephone 74. 7-44',i 71.3
Email address: Miarllafp-+ L--. t n-mtlhP.1 Gn f't Y1Il�'i ti . �'T�►rY�
Lake Addr s Maiiin ddress (rf diffe ent)
4DDre, v, e;Za 117
Contractor Company r
Contractor Contact Person Unn 0 r Telephone —ArA-
Contractor Email Address:
r d cr' 16S
21.
LAKE LOT INFORMATION
Pty
Lake "f irrounty ke3elL City tare IAL'Fttx Map ' jt - 270T
Subdivision gcc LCAyiA Lot / Section No. Z57, Lot Size437Acres
-3' —r, glbe,r- tDr p .
Duke Energy Page 4 of I3 rev 10/1/2019
Excavation Program

Duke Energy Excavation Permit Application Form
Are there any Co -Applicants*? (check one) ❑Yes P�io (If Yes, include names, street
addresses or lot numbers, pier numbers, phone numbers. and email addresses in Part V —
Additional Info rrnatio n )
* 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 I lease holders of Project -front properties within a single development. There can be no
more than 4 co -applicants in addition to the Iead 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
(3 L f
Initials (Duke Energy) J V
(applicanticontractor)��
Duke Energy Page S of 13 rev 141112014
Excavation Program

Duke Energy Excavation Permit Application Form
Part II. Description of Protect
A. Basic Information
1. Type of excavation: (check one) WNew excavation ❑ Maintenance excavation
Purpose of excavation: (check one)
❑ Water Intake Channel
❑ Other (spec):
,Boat Access Channel
❑ Wastewater Discharge Channel
Lake user category: (check one) ,IFrivate ❑Residential Marina
❑Commercial Marina ❑Public
❑ether (specify):
4. Max. Excavation Area Dimensions (ft): Length .J L�, Width _&� Depth JD
(Note: include additional area dimensions if necessary so response to #S below equals max. area
dimensions in #4)
5. Volume of Excavated Material (TOTAL for the project): 9peCubic yards
6. Type of material removed (applicant determines by field sample if practical):
7. Excavation Site area:Acre (s) Disposal Site area: Acres)
8. Total Disturbed Area (including equipment staging area): , r 19 Acre (s)
9. Does toject meet the requirements of the applicable General Permit? (check one)
ties qo
10. Do you claim title to the disposal area? (check one) OYes 1Vo
11. Do you claim title to the equipment staging area? (check one) IKS vo
12. Are there any water-treatmen facilities within 50 feet of the proposed excavation area?
(check one) Yes QY
(If Yes, specify):
13. How will the excavated material be entrapped and the erosion controlled? (e.g. see attached
psion control plan and d4posal area desi }:-]f fi e, w 1kh ,©n treaty ItA dOL -pIr
14��.rna.xt�l� L►r3 �oppe.�-14otr is 1 0.1G1 har e.. Qjp
to P
Duke Energy Page 6 of 13 rev to/ 112Q19
Excavation Program

Duke Enerey Excavation Permit App lication Form
14. Type(s) of excavation equipment to be used: Lov�G� rgat,h P-XCg-4cC6y-, ��v r�- re[�.t,]•1
e.XCcLYa�', 1D0.rbtt, L1 uVXPtr ,t,L,
15. Will waters or wetlands be crossed in transporting equipment to or from the site?
(check ones) des ONO
(I yes, explain)
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16. WilI return water re-enter the reservoir? (Check one) J Y-es ❑No Z/A
(If Yes, sped point(s) of re-entry and show an Excavation Area Drawing)
17. Is there an existing facility (e.g. pier) that access is being maintained to by conducting the
excavation? OYes 040 * 7--xie4 doc.lh-b Joe r e vq b,4 e$L re � la Lej .
(If Yes, provide the existing permit number. I 'No, include a scaled drawing oft e propose I,
forility). per it # 14evi] 6cr-P) W 1 R or- `con b� uc4-6d , SCe. C46L�C�
]-INC�e. V46 V, IF, e5 CbVLsiru,L+ion ctppJtCcL` i6n 4 drawivi s
18. Total planned duration of the work (Include first equipment mobilization, excav�ion
through final mitigation measures complete):
START J n / 31 FINISH __ZZL 1
(Month) (Year) (Month) (Year)
Duke Energy Page 7 of 13 rev 10/1/2019
Excavation Program

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Duke Energy Excavation Permit Application Form
C. Applicant's Signatures
Comments:
Applicant Name (pri.
Applicant Signature
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Ca -Applicant Name (print)
Co -Applicant Signature*
Date
Date
Date
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 IO/V2019
Excavation Program

Duke Enerav Excavation Permit Application Form
Part III. Additional Information
A. 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.
B. 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.]
C. Disposal Area Drawing: An accurate drawing of the proposed design for the disposal area.
The drawing must snow 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 Iocation (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) acne 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
D. 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 Iisted in the order
Duke Energy Page 1 I of 13 rev 1011 r2019
Excavation Program

Dube )Ene Excavation Permit ADOlication Forth
shown in the Agency/organization List. Consultation letters must be dated within the two years
preceding Duke Energy's receipt of the application.
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. Sam le en Permits and Certifications Table
Agency Permit/Certification Name Date of Date of
Issuance Expiration
Agency 1 Surface Water Withdrawal Permit
Agency 2 1 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 1411I2619
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 I01112014
Excavation Program

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DUKE ENERGY DIRECTIONS BY ROAD FORM
Lake Use Permit Applicants and Contractors: Ease of locating the proposed project
site canhave 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 Name: Margaret Campbell
Street Address (at lake): 136 Claiborne Drive Mooresville NC 28117
Lake Name: Norman
Subdivision Name: Crescent Land + Timber Corp,
Property Section: 6 Lot #:237
City: Mooresville County: Iredell
State: NC Zip: 28117
Telephone: [phone]
Directions (from major road or highway):
From I-77 NB, Exit 35, Turn Left onto Brawley School Road, Turn
right onto Tuskarora Trail, Right onto Binns Road, Road intersects
Claiborne Drive at the property, Property is on the left at the end of
the 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.

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Address or Place GC]
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136 Claiborne Drive, Mooresville, NC 28117
0 35.51942i},-80.951597
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Decimal Degrees Latitude: 35.511420
Decimal Degrees Longitude:-80.951587
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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
site can have a big impact on permitting processing tune. Please complete this form and
return it along with your completed application to:
DUKE ENERGY
CIO LADE SERVICES — EC 12 Q
526 SOUTH CHURCH STREET
CHARLOTTE, NC 28202
Applicant's Name: Lancaster Custom Dack Dis asal Site
Street Address (at lake); 1 ] 62 River Hi hwa Mooresville NC 28117
Lake Name: Norman -
Subdivision Name: B' d 's of Lake Norman
Property Section: Lot #:
City: oo a villg County: _ igdell
State:
Zip- 28117
Telephone: 704-3 61
Directions (from major road or highway): From I-77 NB, Exit 36, Left onto NC-
150 WB, Disposal Area is on the right behind Big Daddy's Restaurant
Complex.
Descriptive Structure(s) on Property (i.e. brick garage, white fence, mobile
home, etc,)
*Note: Please use the back of this form if desired to draw us a map to the site.

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1162 River Highway Mooresville, NC 28117
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D8Cirnat Degraes Latituda' 35,604043
Decimal Degrees Longitwde:-80.010286
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Contact Name's Donna P. Hrko
Contact Email Address* donna. la [e-mail]
Project Owner* Paul and Margaret Campbell
Project Name * Cambel€ Dredge and Shoreline Refresh
Project County* Iredell
Owne r Add re ss: * street Address
136 Claiborne Drive
Address Line 2
CKY State 1 F}ovrree 1 Fbgion
Mooresville NC
Postal ! Zip Code C-ntry
28117 USA
Is this a transportation project?* e- Yes f- No
Type(s) of approval sought from the DWR:
r 401 Water Quality Certification - i` 401 Water Quality Certification -
Regular Express
f Individual Permit F- Modification
W Shoreline Stabilization
Does this project have an existing project ID#7*
(' Yes r- No
Do you know the narne of the staff member you would like to request a meeting with?
Please give a brief project description below and include location information.
Refresh approximately 326 If of shoreline with Class A Hammer Rock
for stabilization and erosion control. install 8' wide fieldstone steps at
point of property. Dredge approximately 980 cubic yards of material
for boating access to dock. Work will be performed from land and
water.
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.
• I understand by signing this form that I cannot submit my application until 30 calendar days after this pre-f ling
meeting request.
• I 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 *
4 � �)e Iffr1r1 e 151-11i ?/F141-
Submittal pate 8/27/2021