20220236 Ver 1_Shoreline Stabilization_20220210

Submission Form
I. Applicant Information [I5A 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]
Please provide an email address for payment and requests for more information here.
Jeffrey Sutherland
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
444 Nonnandy Road
Address Line 2
City
Mooresville
Postal / Zip Code
28117-8433
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: *
Company Affiliation:
Email: *
Phone Number:*
Donna P Hrko
State / Province / Region
NC
Country
us
Lancaster Custom Dock and Lift Systems, Inc.
[e-mail]
[phone]
(xxx)xxx-xxxx

Mailing Address: * Street Address
1156 Perth Road
Address Line 2
City
State / Province / Region
Troutman
NC
Postal / Zip Code
Country
28166-8640
US
A signed and dated copy of the Agent Authorization letter:
Sutherland Signed Agent Authorization
144.77KB
Form.pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: * Sutherland Dredge and Seawall
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
444 Normandy Road
Address Line 2
City
Mooresville
Postal / Zip Code
28117-8433
Latitude: * 35.613104
State / Province / Region
NC
Country
US
Longitude: *-80.902734
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*
Sutherland Detailed Site Plan and Duke
6.33MB
Dredge Application.pdf
Please use the diagram at the link below:
https://edocs.deq.nc.gov/WaterResources/0/edoc/616616/ShoreIine%20Layout.docx
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale of some sort- a yard
stick, shovel handle, etc.)
Spain Shoreline Photos.pdf 622.51KB
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:* CLT Corp. Sect.#11 Lot#119 444 Normandy Road, Mooresville, NC
28117
Include phase/lot number
Directions to site: *
From I-77 NB, Exit 36, Left onto NC-150 WB, Right onto Perth Road,
Left onto Normandy Road. Property is on the right.
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 1.35 Acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Dredge area for boating access.Dispose of excavated materials on site as
shown in aerial photograph. Remove existing timber seawall. Construct
redi-rock seawall and install Class B Rip Rap at base 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.)
4,377 sq
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):
o $240.00 for impacts to lake (below normal water level) of less than 1 acre
o $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:
o I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the best
of my knowledge and belief

o I, the project proponent, hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time.
o I agree that submission of this Shoreline Stabilization online form is a "transaction" subject to Chapter 66, Article 40 of
the NC General Statutes (the "Uniform Electronic Transactions Act');
o I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act');
a 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: 2/10/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20220236 Version: *
Select Reviewer:*
Select Reviewing Office:
Has payment been received?*
What amount is owed?*
Doug Perez:eads\djperez
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: 119 PLAN NO: PARCEL ID: 4638434590
STREET ADDRESS:
444 Normandy Road
Mooresville, NC 28117
Please print:
Property Owner: Jeffrey Sutherland
Property Owner:
The undersigned, registered property owners of the above noted property, do herebyauthorize
Donna P. Hrko
(Contractor/Agent)
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):
Telephone: 704- n-6873
We hereby certify the above information submitted in this application is true and accurate tothe
best of our knowledge.
th d Signature Authorized Signature
4-2022
Date
Date

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
LINVIRONMENTAL QUALITY
FORM: SSGP 02-2017
Please approximately sketch the following inforrnatlon on this plan and provide dimensions for
each item:
a. All proposed vegetation clearing
b. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
c. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
d. Location of any proposed structures such as buildings, retaining walls, docks, etc.
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
Full Pond/ Normal water Level
����=
5hvrellne
Plan View
FORM: SSGP 02-2017
La ke
(At Full Pond/ Normal Water Level)
4�
�A'� G
{
f N,5D = ctinMyim4�o,
Lorridor
J
Full Pond/ Normal Water Level
` 1�io'reTne "'
2 ft-. 150 ft.
additlonal clearing
. If necessary
Lake
(At Fuc Pond/ Pfurmal Water Level}
Existing clock
,A 30 ftx7R
3 fix 150 fr
eebw Full pond! HLVL
� ww
Riprap 4tt150 ft
. .. .. Rg Rhow Full pond/NWL
AMPLE
Ijel-pjtj�\Ivai
Page 1 of 3
Plan View

CATAIYBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: 1. i A r County: r
Owner: 7� 'PSI .��t ]�-1r= In W,
Print IV Sign u
Contractor agent: ��,v n L_av] rr, c_v_
Print
azure
The approval is for the purpose and design described in your application. Impacts not indicated in the
application is a violation of the Buffer Rule. Site specific work should be provided in the application. [15A
NCAC 02H .0506 and 15A NCAC 02B .0243(8)1
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)1
Beaches, impervious patios, impervious walkways, etc. are not allowed in the buffer unless specifically
approved by the Division. There are limitation on size for decks. [15A NCAC 02B .0243(4) and (6)]
Work to be conducted from land must indicate an access and indicate any trees that are to be removed. The
work corridor should be described. The approved access corridor shall be restored. Staging, spoil, construction
material must be outside the buffer. [15A NCAC 02H .0502 and 15A NCAC 02B .0243 (4), (6), (8)1
Stormwater cannot be piped or channeled for direct discharge to the lake. All constructed stormwater
discharges must be at the natural elevation and discharged prior to entering the buffer directed as diffuse or
sheet flow at non -erosive velocities to the lake. [15A NCAC 02B .0243(5), (6)]
Acknowledgement of Notification
I, t r- hereby state that I have been informed of the Catawba
Riparian Buffer 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 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 plan(s) and specification(s), and other supporting
materials.
Signature (owner): Date: Z — 1-20, �

DREDGE SPOIL DISPOSAL FORM
Project Name address: �r
ff�� j r aunty: d eat
Location dddress: T44 �1 f�.r..Y]r�s „� .,1, . _ mc}Y'eSV t J* e
Parcel ##:
Parcel/lot size
❑islpasal area required (sq ft and/or acreage)
Ack�i ement of otlfr [ ion '1
1, CJ
and rules raga ing sediment and erosion can 1 and wateram aware haualithe
site
�Andu adhere to all state regulations
till + �� permission for
Name of Individual and Company
to dispose of their dredge material at the above stated location
Owner: L cic) I! 4)nr r1.)n
Date: /_ 1 / % / 5sgnay6re
Along with form, please provide:
Aerial of Parcel/lot (County GIS)
Photo of proposed spoil site
Identified proposed spoll site

tm,A-1ierkav�d
Z�)117

1/24122, 2:22 PM Property Data
Iredell County
Property Data
Parcel Number: 4f 38434590.000
Inquiry Date: 1/24/2022
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.
Property Map
Owner/Property Info
Tax Account Number: 80059689
Old Parcel Number: 1702PO4000A119
Owner Name: SUTHERLAND JEFFREY + M ELISSA
Mailing Address: 455 NORMANDY RD MOORESVILLE NC 28117
Property Location: NORMANDY RD
Lot Number: 119
Legal Description: CRESCENT LAND+TIMBER CORP 511 PB14-40
Municipal Information
Township Code: 17
City Code: oo
Neighborhood Code: 17111
Value Information rrent Y_UL.paperty&cord Card (PRC)
Building Value: 46570
Other Building Features: 21070
Land Value: 260000
Tax Assessed Value: 327640
Deferred: Null
Land Infonnatior, - &egj5LqL of De!d�_Online 5 ar
web 3. mo bi le 311. cc m/ I redel I Repo Wrepc rt. aspx? P i N =4 6384 34596.000
q
112

24122, 2:22 PM
Date Recorded
20181211
Tax Information
Exemption
Null
Property Data
Document Type
Deed Book Deed Page
Plat Book & Page Land Area Land Type Zoning
W❑
2593 651
14-40 1 LT R20
Tax Code i
Tax Code 2
Tax Code 3 Tax Code 4 Tax Code 5
C ADVLTAX
Null
FR05ADVLTAx Null Null
Current Zoning
Contact Into.
Iredeil County
704,878.3118
Harmony
704.878.3118
Love Valley
704.878,3118
City of Statesville
704.878.3575
Town of Troutman
704.526.7600
Town of Mooresville
704.662,7040
Village of Davidson
704.892,7591
QP
web3.mobile311.comlired el1Repo rtlreport.aspx?PIN=4638434590.6ad 212

1124122, 2:21 PM
4VICONNEUGIS
WEB ROSTINO
. 638M 4i �24
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.6 A. T-<
it
ConnectGIS Feature Report
fredell
Printed January 24, 2022
See Below for Disclaimer
Addres5es
lt�i • Infrastructure
NonResidential Use
3 `-848' Residential Use
tiws
Streets
Interstate
Y
Ramp
US H,,y
r f
State I"l ri J
r.N.i�1`'
— Main Road
Local Road
Residential
•
■
Private
Inactk-e
s
Parcels Hooks
�1638�3-a��
5
-,:}I Parcels
k Parcel Labels
City Limits
a� Lake Normar
Iredell Courrylire
NC Cour- les
} N
4638 43-623U
1W
I
1 : 100 Feet
he maps prepared for this website are generated from recorded deeds, plats, and other public records. Users of these maps are hereby notified that the inform ati
rovided herein should be verified- fredell County assumes no legal responsibilities for any of the information contained on this site. Users are advised that the use
ny of this information is at their own risk- All maps on this site were prepared using a 10005f- Grid based upon the North Carolina State Plane Coordinate System frc
ie 1983 North American Datum. The delinquent real property tax overlay is updated monthly, The information presented is not intended to be used or relied upon
fficial notice of tax liens- For additional information req ardi ng delin uent taxes contact the Iredell County Tax Coflector's Office.
q
https:lliredell-connectgis-oomIOownloadF!le.ashx?i=_ags_mapO37cc631252442a08l ffd45023ag6d 12x.htm&t=print ill

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 / Organization List.
Each agency / organization must be provided at least 30 days prior notification, Evidence must
be provided (e.g., response letter or Certified Mail receipt) in the complete application to show
each agency / organization was given the opportunity to review the proposal.
Consultation letters must be dated within the two years preceding Duke Energy's receipt of the
application. All permits must be valid at time of application and have a term longer than the
projected schedule for completing the permitted project.
What to Ex ect During Agency Review and Comment:
■ You will typically receive a letter from each agency / organization either documenting its
concurrence with your proposal, requiring additional information; recommending
modifications, or offering no comment. You must address each agency's / organization's
comments with a follow-up letter and in your final application as described in part IV.
■ If you do not receive any documentation from an agency 1 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 l5 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 11,22.21
Excavation Program

at the top of the follow-up letter and include it in the application along with proof of the
agency's 1 organ ization 5 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 Arn v Corps of Engineers (Corps): {** Note — The Corps may have
additional fonns 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 Penn it (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 (I )
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
WaterResources- (Note —NCDEQ may have additional forms to submit for your proposal
and an additional fee) If the proposal meets the requirements of the Clean Water Act Sect.
401 Water Quality Certification, you will typically receive a letter from the NCDEQ Division
of Water Resources documenting Sect. 401 Certification and providing any additional
instructions. You may also receive a letter requiring additional information or
recommending modifications. You must receive written documentation from NCDEQ
noting any required Sect. 401 Certification has been received before Duke Energy can
process your application.
From the North Carolina Wildlife Resources Commission (NCWRC): If you do not receive
any documentation from the NCWRC within 30 days of their receipt of your application, you
may proceed with the application process without submitting a follow-up request,
recognizing however if comments come in later in the application process, you will be
required to address them.
From the South Carolina Department of Health and Environmental Control (SCDHEC):
(Note — SCDHEC may have additional forms to submit for your proposal and an additional
fee.) The SCDHEC conducts a joint application process with the USACOE in S.C. If the
proposal meets any applicable requirements of the Clean Water Act Sect. 401 Water Quality
Certification, you will typically receive a letter from SCDHEC documenting Sect. 401
Certification and providing any additional instructions. You may also receive a letter from
USACOE requiring additional information for the agencies participating in the joint
application process. You must receive written documentation from SCDHEC noting Sect.
401 Certification has been received if required before Duke Energy can process your
application.
• Froin 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.
DLike Energy Page 2 of 13 ,e„ 1 trn;,1
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 i l r'22:21
Excavation Program

Duke EnergV Excavation Permit Application Form
FOR DUKE ENERGY USE ONLY
Duke File No.
Application Fee $ Security Deposits
Check # Date Reev'd Initials
Date of Dake Energy Lake Services, applicant andlor contractor on -site inspections [late 1 Zd ZZh,itials—Iml—
bate Final Protection/Avoidance Area Markings Field - Verified
Approved to Start Work By *
Initials
ir•rrn» 0,19n1
Date Completion Required Date of Any Approved Extension Initials
Date Passed Closeout inspection*
Initials
Date
Anv Stop Work Orders or SMG Violations'? (check one) []Yes DNo (If Yes, explain in PART V]
Date Deposit Refunded Initials Date Penn it Database Updated Initials
s 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 a p piication.
Part I. Applicant Information (Please Print)
Name --3-e ,rTelephone TCA -5D0-
Email address: tj A+ V)e�r ko Y)A G) r, w" n , 1 1' r% t^/\
Laie-Address
� I �
Mailing Address fif'dierent)
Contractor Company f ti 1 t j Y1 C.
Contractor Contact Person L N r ac p � r � Telephone
Contractor Email Address: r- QC V j�j k] D[ lr}'j Q l 1. r o yy1
LAKE LOT INFORMATION N 543459C)
Lake&Krmuli County LnedL City r State Ill.. Tax Map No. 14-4Q
Subdivision "Te�br
Lot 1 Section No. � Lot Size Acres
`
Duke Energy Page 4 of 13 rev 11,22L)1
Cxcavation Program

Duke Enerev Excavation Permit Application Form
Security Deposit Refund Information
The security deposit will be refunded after the excavation pen -nit has expired if no violations of
the approval occurred. The applicant will receive the security depost refund at the mailing
address in Pail 1 unless an alternative recipient is identified.
Send the security deposit to an alternative recipient? (check one) XYes QNo (If Yes,
include name and mailing address below.
Name: }eY `J -ry ]`ll 'bD[ l'tj Tax ID: l `-i-
L.X ernes, I r, C_ .
Mailing Address:
7'r out v" n C 1 toty
Are there any Co -Applicants*? (check one) ❑Yes Wo (If Yes, include names, street
addresses or lot numbers, pier numbers, phone numbers., and e►nail addresses in Part V -
Additional information)
* Co -Applicants exist when the proposed work is being done under a single application, will be
perfonned 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: I►►Walling 1/1& portion of the application by a Lake Representative in 110 way
constitutes approval or endnent approval of the excavation or any other lake use pern►itti►►g
activity.
Date of on -site inspection 1 Z C, 7-'-
Initials (Duke Energy) 4r2V_[1
(applicant/contractor) C
Duke Energy Page 5 of 13 rev 11/2121
Excavation Program

Duke Energy Excavation Permit A > tlication Form
Part II. Description of Project
A. Basic lnfonnation
1. Type of excavation: (check one) ❑ New excavation 0maintenance excavation
2
Purpose of excavation: (check one)
❑ Water Intake Channel
❑ Other (specify):
;arkoat Access Channel
❑ Wastewater Discharge Channel
3. Lake user category: (check one) Orivate ❑Residential Marina
❑Commercial Marina ❑Public
❑Dther (sped):
4. Max. Excavation Area Dimensions (ft): Length Width tQ7 Depth F ,
(Note: include additional area dimensions if necessa)y so response to #5 helow equals max. area
dimensions in 44)
5. Volume of Excavated Material (TOTAL for the project): 305 Cubic yards
6. Type of material removed applicant determines by field sajjtple it prac
7. Excavation Site area:_ Acre (s) Disposal Site area: Acre
(s)
8. Total Disturbed Area (including equiprnent.staging area): ��� Acre (s)
9. Does the project meet the requirements of the applicable General Permit? (check one)
lv'es ❑No
10. Do you claim title to the disposal area? (check one) Yes ❑No
It. Do you claim title to the equipment staging area? (check one) RrYes []No
12. Are there any water -treatment facilities within 50 feet of the proposed excavation area?
(check one) ❑Yes ON
(If Yes, spec):
13. How will the excavated material be entrapped and the erosion controlled? (e.g. see attached
erosion control plan and disposal area design):
"e e rnot�c►r •� 1 s w ; �h lb� r ea.c� ex CoC�0.�or. 1-roct o n-Io d a� p
tLkC a+ bore rmv-n p °X'-►�ns�o r} to ovti Arta o�'properA �
11A- en ' a hay b0,es will ba ' lled� gYe-4C - eros;on
Duke Energy Page 6 of 13 rev l
Excavation Program

Duke Energy -Excavation Permit AiRplication Form
14. T e(s) of excavation equipment to be used:
5h [) Y-+ reach
dL, .M p truLl1S 110b CA+
16-- XCaVC1+0 ff
1a r-3e s,
15. WiIl waters or wetlands be crossed in transporting equipment to or frorn the site?
(check one) K'es ONo
(If yes, explain)
c3,re,� NP
C Prr,en+ is }ran r+ed V +ct 04 ' lctyl+
tee.° + �m L U)CCA,s�-r �rn b0c I -lxt i a.+�ea
ec+ $i c, o n 1-�uie Nor r7
16. Will return water re-enter the reservoir? (Check one) ❑Yes ONo fV1A
,IfYes, s eci aint(s) of re-entry and show on Excavation Area Drawinul
17. Is there an existing facility (e.g. pier) that access is being maintained to by conducting the
excavation? P"'es ONo
(If Yes, provide the existin ermit numher. If No, include a .scaled drawing of'the proposed
facility). Permit # 5
18. Total planned duration of the work (Include first equipment mobilization, excavation
through final mitigation measures complete);
START — & / FINISH Z /
(Month) (Year) (Month) (Year)
Duke Energy Page 7 of 13 rev 11;22/21
Excavation Program

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Duke Energy Exca-vation Permit A lication Form
C. Applicant's Siltnatures
Comments. -
Applicant Name (print) r- r
Applicant Signature* -Dale
zz
Co -Applicant Name (print)
Co -Applicant Signature* Date
Co -Applicant Name (print)
Co -Applicant Signature* Date
Co -Applicant Nance (print)
Co -Applicant Signature* Date
Co -Applicant Name (print)
Co -Applicant Signature's 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 1 I r22:2021
Excavation P rograin

Duke Energy 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 ❑rawing: 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 nurnbers (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 (I) acre in North Carolina, including excavated,
equipment staging, and disposal areas, you must submit an erosion control Dlan. For
Projects larger than two (2) acres in South Carolina, including excavated, equipment staging
and disposal areas, you must submit an erosion control p ]an. For projects < two (2) acres in
South Carolina, you must submit a completed standard reportiiig 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 listed in the order
Duke Energy Page i 1 of 13 rev I I1'22/2021
Excavation Program

Duke Enemy Excavation Permit ARylication Form
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. Sample Agency 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 pen -nits, 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 o1' 13 rev 1 P212021
Excavation Program

Duke Energy Excavation Permit Application Form
application and have a term longer than the projected schedule for completing the permitted
project.
Part V. Additional Information
Provide relevant additional information. Reference previous parts as applicable. Include the
FERC-required Environmental Assessment if you were directed to do so during the initial site
visit. If there are co -applicants, this is where their information would be provided {see Part I},
Duke Ener&v Page 13 of 13 re„ i i„ /2021
Excavation Program

Excise Tax: $1,000.00
Tax Parcel I❑ No.:
on the day of
GENERAL WARRANTY DEED
20 By:
Verifled by: Iredell
Type: CONSOLIDATED REAL PROPERTY
Recorded: 12/11/2018 4:09:26 PM
Fee Amt: $1,026.00 Page 1 of 2
Revenue Tax: $1,000.00
Iredell County, NC
Ronald N. Wyatt Register of Deeds
BK 2593 PG 651 - 652
County
MaillBox to: Grantee
This instrument was prepared by: Kevin C. Donaldson, Jones, Childers, Donaldson & Webb, PLLC, 149 Welton
Way, Mooresville, NC 28117
Brief description for the Index: Lot 119 of Section 11 of Crescent Land & Timber Corp.
THIS DEED, made this the 11th day of December, 2018, by and between
GRANTOR: Lester James Watts and wife Edith S. Watts
whose mailing address is 8916 Mooresville Road, Concord, NC 28027
(herein referred to collectively as Grantor) and
GRANTEE: Jeffrev Sutherland and wife Melissa Sutherland
whose mailing address is 455 Normand Road, Mooresville, NC 28117
(herein referred to collectively as Grantee) and
WITNESSETH:
For valuable consideration from Grantee to Grantor, the receipt and sufficiency of which is hereby acknowledged,
Grantor hereby gives, grants, bargains, sells and conveys unto Grantee in fee simple, subject to the Exceptions and
Reservations hereinafter provided, if any, the following described property located in the Township of Davidson, County
of Iredell, State of North Carolina, more particularly described as follows:
BEING Lot 119 in Section 11, as shown on map recorded in Map Book 14 at Page 40 in the office of the Register
of Deeds for Iredell County AND BEING a part of the property conveyed to Crescent Land & Timber Corp. by
deed of Duke Power Company recorded in Book 481, Page 91 in the Office of the Register of Deeds for Iredell
County.
Said property having been previously conveyed to Grantor by instrument(s) recorded in Book 606, Page 279, and being
reflected on Plat(s) recorded in Map/Plat Book 14, Page 40.
All or a portion of the property herein conveyed does not include the primary residence of a Grantor.
Revised December 17, 2009
submitted electronically by "]ones, Childers, ❑onaldson & Webb, PLLC"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Iredell county Register of Deeds.

TO HAVE AND TO HOLD unto Grantee, together with all privileges and appurtenances thereunto belonging, in fee
simple, subject to the Exceptions and Reservations hereinafter and hereinabove provided, if any.
And Grantor hereby warrants that Grantor is seized of the premises in fee and has the right to convey same in fee simple,
that title is marketable and is free and clear of encumbrances other than as set forth herein, and that Grantorwill forever
warrant and defend the title against the lawful claims of all persons or entities whomsoever.
This conveyance is made subject to the following Exceptions and Reservations:
1. ANY AND ALL EASEMENTS, RIGHTS OF WAY AND RESTRICTIONS OF RECORD.
2. ANY AND ALL ZONING AND PLANNING ORDINANCES.
All references to Grantor and Grantee as used herein shall include the parties as well as their heirs, successors and
assigns, and shall include the singular, plural, masculine, feminine or neuter as required by context.
I WITNESS WHEREOF, the Grantor has duly executed the foregoing as of the day and year first above written.
(SEAL)
r Jam tts
dith S. Watts (SEAL)
(OfficiallNotariaf Seal)
State of North Carolina
County of Iredell
I certify that the following persons, who are known to me or proved to me on
the basis of satisfactory evidence to be the persons described, personally
appeared before me this day; acknowledging to me that he voluntarily signed
the foregoing document for the purpose stated herein and in the capacityIN
indicated herein: Lester James Watts and Edith S. Watts.
WITNESS my hand and official seal, this Y day of December, 2018. s �0TAI?,
Notary I�UbIIC•rfl/rl�I�rrrCO;l�i►IU„1,,�`,��`
Printed Name: Amanda N. Bowers
My Commission Expires: May 10, 2019
Revised December 17, 2009

ViCIN I�j'Y SLAP NOTES:
1) PROPERTY IAAY 9E SUBJECT TO RECDRDED OR
HOT OEOBBSSEERVED NA ED 0T IOR R5EES MC)TvE OR �ENAAWM
2) OWNER TO VERIFY AND
L SETBACKS AND ZONING
REGULATIONS PRIOR TO ANY PLANNING OR
CONSTRUCf1ON.
yr 3) ALL DISTANCES ARE HORIZONTAL CROUND DISTANCES
4J ALL�AREAS 9H N NEREEOH WERE DUERAaNED 19Y
COOROWATE 5J POWS OFOTHIS PROP R7Y pO LIE WHIN A
SPECIAL Fi60Q HAZRRQ AREA AS DETER4NED 9Y
THE PEDEFAL EMERGENCY NVWAOEAIENT AGENCY.
vom INFOIi7LATEONI
IAFP 37104636003
EFF DATE: 3/18/20o6
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A�SAR
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I HERESY CERi1Fr THAT THIS PLAT REPRESENTS AN
ACTUAL FIELD SURVEY AND JAEFTS. THE REOUIRO MS
OF THE STANDAWS OF PRAMCE FOR LAND SURVE17NG
IN NORTH CAROLM (21 NCAC 58.18O0),
THE RAM OF PRECISION MEEDS 1;10.000.
L7 4154
PROFESSf ND URV LA:hr R LICENSE NO.
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ALL OF LOT 1I9 or CREscEw u o & nugER oMp.
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DATE OCTOBER 25, 202I
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REFER.T'CES: D& 2M3-551 & P0: 14-49

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YII;LR iTl LMAF I NTES:
N0` 10 �"i1 I ) PROPERTY MAY BE SUBJECT '0 RECORDED OR
UNRECORDED RIGHTS OF WAYS OR :ASEMEKTS
NOT OBSERVED AND Oft EESTRICTWE COVENANTS- OWNER TO V6R[LY ALL SETBACKS AND ZONING
REGULATMONS PRIOR TO ANY PLANNING OR
3) ALL CON�iST NCES ARE HORIZONTAL GROUND DISIMJCES
�� UNLESS OTHERWISE NOTED-
4) ALL AREAS SHOWN HEREON WERE DETERMINED BY
COORDINATE COMPUTA110N.
,�• 5] PORTIONS OF THIS PROPERTY DO LIE wRHIN A
,F SPECIAL RCO-3 HAZAIRD AREA AS DETERMINED BY
C THE FEDERAL. EMERGENCY AAWrLIENT AGENCY.
HIBIE fHMMUTiON:
MAP 9: 3710463800d
EFFE - DATE: Z/TB/2008
ZONE: % Y AE
1 T 1 3949 E7a7
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00
L HEREBY CERTIFY THAT THIS PLAT REPRESENTS AN
ACTVAL FIELD SURVEY AND 1d= THE REOVIREMUM
OF YHE STANDARDS OF PRACTICE FOR LAND SVRVEI'INC
RI NORT14 CAROUNA (21 NCAC 58.1B00).
THE RATIO OF PRECISION EXCEEDS 1:10.000,
�4e 4164
PROFESSIONAL LAND SURVEYOR LICENSE NO.
DRAM sy gRW
BOLP40ARY SuNty FOR
DWC ALE NAME: i9Tg9-Cl1 R9
PROJECT NO• RES&-
JEFFREY & MELISSA
HARRIS LAND SURVEYING, PLLC
FIRM LRCENBE P-1295
IM F
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PRa'ERiY ALIPRE55:
sea XKWIMMDr RD
MLCIRESVfLLE, NC 28r17
SUTHERLAND
CAVIDSON TOWN9NnP, IREOELL COUNTY. NC
R
4050 aAv1s RD
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SCAiCr 1�-40'
ALL OF LOT 119 OF CRESCENT LAND k TWDCR CARP.
RAKF 1mnleul PEOnC&11 H Lars. sc TON 11
REFERENCES: DID; 2593-651 k P9: 14-40
828-970-7288
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ConneotGIS Feature Report
2/10/22, 10:13 AM
AWCONNECTGIS
Nrfg HVSTINO
Iredell
Printed February 10, 2022
See Below for disclaimer
Addresses
�+�`� ti , • Infrastructure
NonResidential Use
1� Residential Else
■ -4, ¢i. Streets
% Interstate
Al ": � • Ramp
US Hwy
�. State Hvey
I. y1 �►
plain Road
■. f ti +. Local Road
Residential
Private
Inactive
Darcels Hooks
Parcels
1 N,t ❑
.• City Limits
� r �'. Lake Norman
s'
r �t
r Iredell Countyline
I -• NC Counties
�
Total Length, 255.11 Feet ecA_
3625.71 Sq- Feet
or.08 Acres
�i or Sq. Miles
S 1 : 61 Feet
he maps prepared for this website are generated from recorded deeds, plats, and other public, records. Users of these maps are hereby notified that the informatior
irovided 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 o1
ny of this information is at their own risk. All maps on this site were prepared using a 1000H " Grid based upon the North Carolina State Plane Coordinate System from
he 1983 North American Datum. The delinquent real property tax overlay is updated monthly. The information presented is not intended to be used or relied upon as
,fficlal notice of tax Ilens. For additional information rep ardi nq delinquent taxes, contact the Iredell County Tax CcIlector's Off Ira.
QP
https:I/ired el1.cannectgis. comlDownbad File. ash x?i=_ags_map1563d2c33cf247cabadb5fefFc926acix.htm&t=print 1 +1

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Excavation Project User's Agreement Letter
(Please fill in the blanks. Please Print)
Date
TO: Duke Energy
c/o Lake Services - EC 12Q
526 S. Church Street
Charlotte, NC 28202
RE: E cavatian For (Subdi�ar�L
io�ad Lot #'s or Qther Project Name)
r� 5u he.�lnn��r�r�ap
(Lake/CountylCity) 1 r i l r�
(Applicant's full name) an or conditions hereby agrees to comply with all
recommendations, requirements of Duke Energy, General Permit(s) (if
applicable) and other federal, state and local agency requirements pertaining to the application to
excavate for the purpose of a
In addition, I/we have read and agree to comply with Duke Energy's current Shoreline
Management Plan (SMP) or other applicable guidelines, much of which is repeated herein, and
understand that written authorization must be obtained from Duke Energy prior to beginning any
activity within the Federal Energy Regulatory Commission (FERC) project boundary or on Duke
Energy property associated with a reservoir, collectively referred to as Project Boundary. The
excavation will be completed as described in the approved application and within eighteen (18)
months from the date of written approval by Duke Energy, unless specifically noted otherwise in
the application or unless I/we obtain approval for a single, time extension (maximum of one year)
in writing from Duke Energy. I/we understand that if the SMP or other applicable guidelines or
rules change during any extension period, Ilwe will be expected to comply with the new
requirements to the maximum extent practicable. I/we also recognize that failure to complete the
excavation within this build -out period will require the filing of a new application within the then -
current SMP or other applicable guidelines and the new application must include any applicable
fees and security deposits.
Ilwe attest to be the owner(s) or lease holder(s) of the land immediately adjoining the Project
Boundary where the excavation activity is to take place, or if not the owner or lease holder, Ilwe
have included proof of title to the property and written authorization from the owner(s) or lease
holder(s) to carry out the proposal within the Project Boundary adjacent to their land.
I/we attest to be the owner(s) or lease holder(s) of the land that will be used for equipment
staging and disposal of excavated material or if not the owner or lease holder, I/we have included
proof of title to the property and written authorization from the owner(s) or lease holder(s) to
carry out the work on their land.
Duo Energy Page I Rev: 4W2020

I/we understand that all excavation work must be done directly in front of my/our property and as
specified in Duke Energy's approval. I/we also understand that access channels must run
Perpendicular to the shoreline while within the third of the cove area that is nearest mylour
property.
I/we understand that for proposed excavations, Ilwe must notify the appropriate local, state and
federal agencies in advance of the activity by sending them a completed copy of Duke Energy's
Excavation Permit Application Form and other required information. I/we understand that
written authorization and/or other permits may be required by some of these agencies and such
required authorizations must be obtained before I/we submit the final application to Duke
Energy.
At FERC-licensed reservoirs, I/we understand that except for maintenance excavations, any
excavation exceeding 2000 cubic yards of material removed ox any excavation or shoreline
stabilization work needed to support an application that requires FERC review does itself require
specific review and approval by the FERC before Duke Energy can issue any approvals.
I/we agree that unless specifically approved otherwise in the application, explosives will not be
used as part of this excavation activity.
I/we understand that every reasonable effort must be made to minimize any adverse impact on
fish, wildlife and other natural resources.
Ilwe understand that applicants in South Carolina proposing excavations that are not covered
under the General Permit, or are greater than 150 cubic yards, must receive prior written
authorization from the South Carolina Department of Health and Environmental Control
(SCDHEQ or the US Army Corps of Engineers (as applicable) before submitting the completed
application to Duke Energy.
Ilwe agree that excavation activities will not occur during the months of March, April, May and
June because of the potential impacts to fish spawning areas.
Ilwe understand that trees and vegetation growing within or adjoining the lake play an important
role in its overall environmental condition, and the ecological benefit the vegetation has on fish
and wildlife habitat directly supports a sound and healthy lake environment. I/we also understand
that unauthorized removal of shoreline vegetation (e.g. button bushes, willows, cattails, etc.)
and/or disturbance of the shoreline buffer may result in suspension or denial of lake use
permitting requests, forfeiture of security deposits and require re-establishment of vegetation at
mylour expense, particularly if the disturbance is found to be in violation of state or local
ordinances or impacts FERC project buffers.
I/we agree all excavated material will be placed in upland areas, landward of the Project
Boundary, and confined to prevent erosion and sedimentation back into the lake or nearby
streams.
Duke HmrBY Page 2 Rer. 41&2020

Ilive agree to adequately stabilize all excavated material and all disturbed shoreline to prevent
erosion and runoff into the lake.
I/we understand that the double handling of excavated material will not be allowed; therefore, all
excavated material must be placed above the Project Boundary in one handling.
I/we have designed the hydraulic excavation process (if any will be used) so that return water re-
enters the lake in the same general vicinity and cove as the excavation, to the maximum extent
practicable.
Ilwe agree that the proposed excavation will not be for the purpose of creating additional
shoreline, will not alter the Project Boundary or the full pond contour, and will not impact
threatened or endangered species, historic properties, or environmentally -important areas, unless
special public entity provisions were made in the application.
Ilwe recognize that it is mylour responsibility to clearly locate in the field and label on mylour
work area drawings any areas that require specific protection or avoidance during this excavation
work. Examples of these protection/avoidance areas include but are not limited to, any
Environmental Areas, Natural Areas or Impact Minimization Zones as identified by Duke
Energy; jurisdictional wetlands; historic properties; rare or threatened species; and buried gas,
water, sewer, electric or communications lines. Ilwe agree to provide mylour contractor with a
COPY of these work area drawings showing these areas to stress the necessary protection
measures.
Ilwe agree that if any archaeological resources (e.g. pottery shards, Indian artifacts, etc.) are
discovered during the excavation, work shall be halted immediately. Ilwe will then notify Duke
Energy and the State Historic Preservation Office to determine what measures, if any, Ilwe must
pursue to protect or salvage the archaeological resources.
I/we agree that any excavation from within the Project Boundary will not exceed the volume as
outlined in the application and will remove and disturb only what is absolutely necessary to
achieve the project's stated purpose.
Ihve agree to be fully responsible for the permitted lake use and Ilwe understand that this
responsibility is considered to transfer automatically along with ownership and leases of the
adjoining tract.
I/we understand Duke Energy representatives may issue Stop Work Directives for violations of
the SMP or other applicable guidelines and other consequences may result from such violations,
including but not limited to suspension or cancellation of approved permits, increases in fees,
modification or removal of non -complying structures and restoration of disturbed areas at mylour
own expense or loss of any consideration for future lake use permits. Ilwe agree to immediately
comply with any Stop Work Directives, to fully cooperate with Duke Energy and other agencies
as necessary, and to perform the necessary remedial actions within the specified time frame.
DU4. Energy Page 3 Rem: V62020

I/we agree to develop any required mitigation plans and to complete any required mitigation
activities at mylour own expense within the specified time frames. I/we recognize that the
excavation work is not considered complete and deposits will not be refunded until the
mitigation requirements (if any) have been satisfactorily fulfilled.
I/we a ee to noti Duke Ener b hone when the excavation is initiated and to ensure that
during the excavation period, I/we will post Duke Energy's a royal letter in a clear Ovate roof
bagat the iob site and visible from the water's ed e.
I/we agree to notify Duke Energy in writing when the excavation is completed (including any
required mitigation measures) and that the excavation was completed per the approved
application, so a close-out inspection can be performed.
I/we recognize security deposits will not be refunded if any violations of the SMP, other
applicable guidelines, or this user's agreement occur.
Ave understand there will be no change in hydro project operations as a result of the excavation
and/or utilization of the excavated area.
I/we agree to maintain the work area in a safe condition and to fully indemnify and save Duke
Energy harmless from any and all claims, liability, loss or damage that may arise from this
excavation project.
Ilwe understand that this user's agreement does not, in any way, constitute the transfer of any
rights in real property and that mylour use and enjoyment of FERC project and Duke Energy
lands and waters shall not hinder the general public's lawful use and enjoyment of the same.
Sincerely,
Applicant's ame (Print) Applicant's Signature
Co -Applicant's Name (Print)
Co -Applicant's Name (Print)
Co -Applicant's Name (Print)
Co -Applicant's Name (Print)
Co -Applicant's Signature
Co -Applicant's Signature
Co -Applicant's Signature
Co -Applicant's Signature
Duke EmW Page 4 Rm V612020

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