20220511 Ver 1_Shoreline Stabilization_20220401

Shoreline Stabilization Application Form
NORTH CAROLINA
EnWnnmentufQu&lry
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
DRAFT -NOT FOR USE AT THIS TIME
Submission Form
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]
Please provide an email address for payment and requests for more information here.
Brian Zimmerman
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
235 Gainswood Drive
Address Line 2
City State / Province / Region
Mooresville NC
Postal / Zip Code Country
28117-9272 US
Is there an agent working on the project? * ® Yes
No
Agent/Consultant Information
Name: *
Company Affiliation: *
Email:*
Phone Number:*
Donna P. Hrko
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:*
Zimmerman Signed Agent Authorization
146.98KB
Form.pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: *
Zimmerman Dredge
If your project has a formal name please use this. If your project does not have a formal name, please identify your project
by the owner name and proposed activity (Jones Property Access Road, Smith Guest House, etc.) List in parentheses
any other names that have been used to identify the project in the past.
1. Provide a vicinity map (i.e. street map) clearly showing the location of the property with respect to
local landmarks such as towns, rivers, and roads. *
Upload File
Look up address
Property Address Lookup: *
Latitude: *
35.507704
Street Address
235 Gainswood Drive
Address Line 2
City State / Province / Region
Mooresville NC
Postal / Zip Code Country
28117-9272 US
Longitude: *-80.934382
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*
Zimmerman Detailed Site Information and
6.28MB
Duke Energy Application Packet.pdf
Please use the diagram at the link below:
https://edocs.deq.nc.gov/WaterResources/0/edoc/616616/Shoreline%20Layout.docx
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale of some sort- a yard
stick, shovel handle, etc.)
Zimmerman Photos.pdf 1.63MB
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: *
CL&T Lot 498 235 Gainswood Dr. Mooresville, NC 28117
Include phase/lot number
Directions to site: *
From I-77 NB, Exit 35, Left onto Brawley School Road. Proceed straight
and take second right at the traffic circle and continue straight. Turn Left
onto Gainswood Road. Property is on the left.
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 .77
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Maintenance dredge at existing dock for boating access.
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.)
3,446 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 const.
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.

a 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");
o I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
• I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name: * Donna P. Hrko
Signature:
Submittal Date: 3/31/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20220511 Version:* 1
Select Reviewer: * Doug Perez:eads\djperez
Select Reviewing Office: Mooresville Regional Office - [phone]
Has payment been received?* ( No Payment Needed
C Fee Received
C• Need Fee - send electronic notification
What amount is owed?*
C• $240.00
C $570.00

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO: 498 PLAN NO: PARCEL ID: 4624453374
STREET ADDRESS:
235 Gainswood Drive
Mooresville, NC 28117
Please print:
Property Owner: Brian Zimmerman
Property Owner:
The undersigned, registered property owners of the above noted property, do herebyauthorize
DONNA P HRKO , of LANCASTER'S CUSTOM DOCK & LIFT SYSTEMS,
INC.
(Contractor/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: CI —lb — S 15— ()Bag
We hereby certify the above information submitted in this application is true and accurate tothe
best of our knowledge.
Brian Zimmerman / -------
Authorized Signature Authorized Signature
3/1/2022
Date Date

12. 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
1 *-11 -Be u° e a 5 I o es 9 fffj
Lake
ZZCc'
6-5;x1Z;x��,
I5x4Z,x8,
Z3 xZZ x
Full Pond/ Normal Water Level
i ! E
Shoreline
Plan View
(At Full Pond/ Normaal4Iater Level)
J
oc-
FORM: SSGP 02-2017
Full Pond/ Normal Water Level
"horgixne
2 ft. x 150 ft.
additional dewing
• If necessary
E
Plan View
Lake
)At Full Pond/ Normal Water Level)
Existing Dock
30 ftz 7 ft
KAMPL
3ftx150ft
Below full pond/ NWL
aft x 150ft
Above full pond/ NWL
Page 3 of 4

--�C:eascuni L��1c Li Elie
PagolkikE
Sy94ViYnt, 9ti
NC General License Contractor # 49723
The "Customer"
Brian Zimmerman
235 Gainswood DR
Mooresville, NC 28117
978-815-0829
[e-mail]
The "Contractor"
Lancaster's Custom Dock & Lift Systems, Inc.
1156 Perth Road
Troutman, NC, 28166
[phone]
DESIGN SKETCH
- 5' DEEP
8' DEEP

DAS
ON ALLEN & ASSOCIATES, P. A.
"Since 1971"
Commercial * Residential * Mortgage Surveys * Multi —Family
Construction Staking • Subdivision Design • Topogrophicol
111—D Racewoy Drive * Mooresville * NC * 28117
(704) 664--7029 [phone] Fax
I. certify that this map was drawn under my supervision from an actual
survey made under my supervision recorded In deed book_ 6306 _, page 565 , and/or
plat book 34 , page_18 that the ratio of precision is 1':10,000, that this map
was prepared in accordance with the General Statutes of North Carolina.Chapter 89C.
4ttll uII�I
my hand and seal on the __ 26 , day of _ JUNE , A, D
WILLIASZf A41004 PL\
t a:
5.i o
, • 4i2:
i�,, ; ;+AM M `*���
VICINITY MAP'*NO SCALE
LAKE NORMAN
780' CONTOUR LINE PER UoiT
ACTUAL FIELD SURVEY I Pq.E
— Srj1.23 05 W --•
SOPit
LOT 499
DAVID E. STEPHENS
3954\288
NEIGHBORS ASPHALT
DRIVE ENCROACHES
U)
CURVE TABLE ---
Q1RVE RADRiS LENGTh BEARING
I. C1304.45' 1 57..4' ' N 6816'
C2 175.10' 1 33.83' 5 7' .- -
NOTES
1) THIS PROPERTY MAY BE S'Je.1c0T TO
ANT EASEMENT AND/OR RIGHTS -OF, -WAY
OF RECORD.
2) AREA COMPUTED BY THE COORDINATE
METt00.
3) E1051NG 760' & 761' CONTOUR ELEV-
ATION BASED ON LAKE NORMAN JJRE
LEVEL AT COWAN'S FORT) DAM (READING
ON 6/25/12) ELEVAIIlON: 758.21'
4) N0 GRID MONUMENT FOUND WREN
2000 FEET.
LOT
SCALE 1" = 50' _ DA
REBAR
FOUND
N
32 LOT 497
o c OLAN R. GOODNIGHT JR.
4. cu 2094\574
:W
I m1
GAINSWOOD RD.
(60' PUBLIC R\W)
! —
CHORD
W5CIMI
UNE TABLE
UNE BEARING LENGTH
11 N 6V49'18' E 32.41• _
0' 25' 50' 100'
SCALE IN FEET
PHYSICAL SURVEY
OF
235 GAIN W00D ROAD
498 CRESCENT LAND & UMBER CORP.. SECT. 6
VIDSON TWSP., IREDELL CO., N.C.
ACQUIRED BY: CLIFFORD & JENNIFER FISCUS
LEGEND
- P.P. = POWER POLE
= DUKE POWER TRAYS
EI.P. = EXISTING IRON FOUND
I.P.S. z REBAR SET
R/W - RICHT-CF-WAY
u
WELL
# ALP = UCNT PONE
FSID BOOK:
FILE CL&T LOT 4913
DC FILE:
TAX MAP N.O. 4824453374

3/23/22, 4:46 PM
Property Data
Iredell County
Property Data
Parcel Number: 4624453374.000
Inquiry Date: 3/23/2022
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: 77429453
Old Parcel Number: 001 353 09
Owner Name: ZIMMERMAN BRIAN T+ROGERIO BRASIL
Mailing Address: 235 GAINSWOOD DR MOORESVILLE NC 28117
Property Location: GAINSWOOD DR
Lot Number: 498
Legal Description: CRESCENT LAND+TIM M17-614 MECK-NECK REV PB61-34
Municipal Information
Township Code: 17
City Code: Null
Neighborhood Code: 17018
Value Information - Current Year Property Record Card (PRC)
Building Value: 1062380
Other Building Features: 132350
Land Value: 522500
Tax Assessed Value: 1717230
Deferred: Null
Land Information - Register of Deeds Online Search
web3.mobile311.com/IredellReport/report.aspx?PIN=4624453374.000
1/2

3/23/22, 4:46 PM Property Data
Date Recorded Document Type Deed Book Deed Page Plat Book & Page Land Area Land Type Zoning
20220118 WD 2888 2187 61-34 0.77 AC R20
Tax Information
Exemption Tax Code 1 Tax Code 2 Tax Code 3 Tax Code 4 Tax Code 5
Null C ADVLTAX Null FRO6ADVLTAX Null Null
Current Zoning Contact Info.
Iredell County 704.878.3118
Harmony 704.878.3118
Love Valley 704.878.3118
City of Statesville 704.878.3575
Town of Troutman 704.528.7600
Town of Mooresville 704.662.7040
Village of Davidson 704.892.7591
1
web3.mobile311.corn/IredellReport/report.aspx?PIN=4624453374.000 2/2

3/24/22, 9:54 AM
ConnectGlS Feature Report
1 : 75 Feet
Iredell
Printed March 24, 2022
See Below for Disclaimer
Addresses
• Infrastructure
' NonResidential Use
' Residential Use
Streets
— Interstate
Ramp
— US livoy
— State Hwy
Main Road
Local Road
Residential
Private
Inactive
Parcels Hooks
Parcels
Parcel Mailira Address
Parcel Labels
City Limits
Lake Norman
Iredell Countyline
NC Counties
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 information
provided 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 of
ny of this information is at their own risk. All maps on this site were prepared using a 10005€'" 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
fficial notice of tax liens. For additional information regarding delinquent taxes, contact the Iredell County Tax Collector's Office.
https://iredell.connectgis.com/DownloadFile.ashx?i=_ags_mapa20d2fa1 c9da40819c57ad54aa0a22bbx.htm&t=print 1/1

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: [ 1 vywn.ejrvikr
Owner:
i Ct \ Z:I comer rYlC( n
Print
Contractor/agent: ,1 1\-% YLan caA5
Print ignat
kte, N C ZSt
The approval is for the purpose and design described in yo`(r application. Impacts not indicated in the
application is a violation of the Buffer Rule. Site specific work should be provided in the application. [15A
NCAC 02H .0506 and 15A NCAC 02B .0243(8)]
Trees are not allowed to be removed from Zone 1 of the Buffer (within 30 ft of the full pond elevation), unless
approved. Exception, those trees that are severely undermined along the immediate shoreline can be
removed. Minimal shaping and sloping along the immediate shoreline is allowed. [15A NCAC 02B .0243(6)]
Benching 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. [15A NCAC 02H .0502 and 15A NCAC 02B .0243 (4), (6), (8)]
Stormwater cannot be piped or channeled for direct discharge to the lake. All constructed stormwater
discharges must be at the natural elevation and discharged prior to entering the buffer directed as diffuse or
sheet flow at non -erosive velocities to the lake. [15A NCAC 02B .0243(5), (6)]
Acknowledgement of Notification
I, r' ICor\ Malec ala,n , 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: 3

DREDGE SPOIL DISPOSAL FORM
Project Name/address:Zjvylrylervnoyt d 235%th6wond.Dr County: re,[ ,1
M oreSvt Ike, NC, Z8111
Location Address: 11 t2, (�jtVex" 1-1 j1yJCty V creSV t lle, NC L011
Parcel #: 4 (c 201 62 I
Parcel/lot size 2. 73 C&CCre 5
Disposal area required (sq ft and/or acreage)
. C'71 (C.r e 3
Acknowledgement of Notification
1, i r11-1 \trIca 'I -ex , 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
L.YICCI "h'r C 15)inm 7>ocih L,T+ 6y3fevf5, 1 v1G.
Name of Individual and Company
to dispose of their dredge material at the above stated location
Owner:
Print
Date: 3— ] — 221
Along with form, please provide:
Aerial of parcel/lot (County GIS)
Photo of proposed spoil site
Identified proposed spoil site
Signa ure

3/24/22, 12:03 PM
ConnectGlS Feature Report
•CONNECTGIS
WEB Hd5i1NG
Iredell County -'
4038-21-1111
4638-20-1821
Iredell
Printed March 24, 2022
See Below for Disclaimer
Addresses
A Infrastructure
NonResidential Use
Residential Use
Streets
— Interstate
Ramp
US Hwy
t — State Hwy
Main Road
Local Road
rr 111.38-2U-5852
E_ Residential
r Private
Inactive
' Parcels Hooks
P.r t t_
Rik
Parcels
tl ❑
Parcel Mailing Address
Parcel Labels
City Limits
Lake Norman
Iredell Countyline
NC Counties
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 information
provided 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 of
ny of this information is at their own risk. All maps on this site were prepared using a 10005€e" 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 a
•fficial notice of tax liens. For additional information re• ardin• delin• uent taxes, contact the Iredell Coun Tax Collector's Office.
Q
https://Iredell.connectgis.com/DownloadFile.ashx?i=_ags_map5f555286afaf4543beb4Of98c3477a6dx.htm&t=print 1/1

i

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 incoiporatc 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 1 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 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
bxc avation Program rev 11/22.71

at the top of the follow-up letter and include it in the application along with proof of the
agency's / organization's receipt of the letter (e.g., Certified Mail receipt). You may proceed
with the application process recognizing, however, that if its comments come later in the
application process, you will be required to address them.
• Front 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) 1 f 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 SCDI-IEC 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
Excavation Program�:•� 1 ir_� r

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
Excavation ProBr:U11
Page 3 of 13 rev 1 U33/21

Duke Energy Excavation Permit Application Form
LAKE LOT INFORMATION
Lake N ounty1re_Ae l
Subdivision(`.A I rp
Duke Energy
Excavation Program
rut( imicE ENERGY IISE ONLY
Duke File No.
Application Fee $ Security Deposit $
Check #— -- Date Rccv'd_-- — — Initials
Dale of Duke Energy Lake Services, applicant and/or contractor on -site inspections Dune 5 I �c61firials
——Jt'�llll
Date Final Protection/Avoidance Area Markings Field - Verified --`_ — — Initials
Approved to Start Work lay : --- --_� Date
(Print) (sign)
-- --- ---
Date Completion Required — Date ol'Any Approved Extension —._ Initials
Date Passed Closeout Inspection' _ Initials
Initials
Any Stop Work Orders or SMO Violations*? (check one) ❑Yes ONo (I% Yes, explain in PART V)
Date Deposit Refunded
Initials — Date Permit Database Updated _____ _-- Initials —_
fr 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 I. Applicant Information (P/ease Prim)
Name)r►rn r71 (rimer Y1Ci Y
Telephone
Email address: briny12IVi1 ZoI!l`�Qy 1C�I'. coal
L ke Address,
35m 115v,tcand Dr.
97P) - 815- ("Req
Mailing Address (ifdifferenl)
ivkoorecov; Ile, [AC Z8117
Contractor Company ncasi-er rus+o ink ci LI-R5 y6+ei'v ,
Contractor Contact Person "NorIc," 14r1))) Telephone o4- 6aZ9- ob9(p
Contractor Email Address: 11 n I. 1 h r• /• 1 l. 1
�1114(024453374
City I' Itesyl 1lState` C Tax Map No. (41-34
Lot / Section No. 1 S Lot Size •'l7Acres
Page 4 of 13 rev 11/2212I

Duke Energy Excavation Permit Application Form
Security Deposit Refund Information
The security deposit will be refunded after the excavation permit has expired if no violations of
the approval occurred. The applicant will receive the security depost refund at the mailing
address in Part 1 unless an alternative recipient is identified.
Send the security deposit to an alternative recipient? (check one) Jel'es ❑No (If Yes,
include name and mailing address helorw.
Name: Lan CA.c:,1 f Tax ID: 5(0 • Ic3(og44-
Mailing Address: 1 5(p ?ei.1-h
r Ou-I-►flCln i NC- Z U CD (D
Are there any Co -Applicants*? (check one) ❑Yes ,0'Ido (If Yes. include naives, street
addresses or lot numbers. pier numbers, phone numbers, and email acdresses in Part V —
Additional Information)
* Co -Applicants exist when the proposed work is being done under a single application, will be
performed by a single contractor as one continuous project, and is done to benefit multiple
owners / lease holders of Project -front properties within a single development. There can be no
more than 4 co -applicants in addition to the lead applicant on any application.
Do not continue the application until an on -site inspection has been conducted between a
Duke Energy Lake Representative and the applicant and/or the excavation contractor.
NOTE: Initialling this portion of the application by a Lake Representative in no way
constitutes approval or eminent approval of the excavation or arty other lake use permitting
activity.
Date of on -site inspection i 2GZ
Initials (Duke Energy) !.)ILK.( 11
Duke Energy
lixcavation Program
(applicant/contractor) C ``
Page 5 of 13 rev '22121

211rivate
❑Public
dllllen.S1011S in # 1)
2,3
5. Volume of Excavated Material (TOTAL fbr the project):
Duke Ener2v Excavation Permit Application Form
Part II. Description of Project
A. Basic Information
1. Type of excavation: (check one)
2. Purpose of excavation: (check one)
❑ Water Intake Channel
❑ Other (.specffj)):
0 New excavation ja'Maintenance excavation
%Boat Access Channel
❑ Wastewater Discharge Channel
3. Lake user category: (check one)
❑Commercial Marina
❑Other (.specify):
4. Max. Excavation Area Dimensions (IV : Length ` ^^
(g � Width "�2., Depth 8`
❑Residential Marina
(Note: include additional area dimensions if necessa/y so response to #5 below equals ma` area
fi
2Cubic yards
6. Type of material removed (applicant determines by, field sal )le if practical):
LC*Curla CtCLy
7. Excavation Sitc area: . 07 Acre (s) Disposal Site area: 0 / Acre
(s)
8. Total Disturbed Area (including equipment staging area):
i Q 8 Acre (s)
9. Does the project meet the requirements of the applicable General Permit? (check one)
Oyes ❑No
10. Do you claim title to the disposal area? (check one) ❑Yes .0No
1 1. Do you claim title to the equipment staging area? (check one) ja'Yes ❑No
12. Are there any water -treatment facilities within 50 feet of the proposed excavation area?
(check one) ❑Yes ,moo
(If Yes, specify):
13. How will the excavated material be entrapped and the erosion controlled? (e.g. see attached
erasion control plan and disposal area design):
r wvkhon rettc h exc4var. "Place maker led i n ho Rex bar a,5,
4 *xi b j IQ� r e� . O{ 1 owd onit 6.043
t o �i w ePoSg1 si-I, . d fi''4+
Dukc 13ncrgy
Excavation Program
Page 6 of 13 rev 11/22/21

Duke Energy Excavation Permit Application Form
14. Type(s) of excavation equipment to be used:
U retch exCO��
4�t0(', Sti10ri- ec.c.h excct.i-orbar8es
et d� , P s
15. Will waters or wetlands be crossed in transporting equipment to or from the site?
(check one) 121.es ONo
(Yves, explain)
1 �"e�.t e u t pvnen t If) ircfn sp r+ed v IC4. 4f Ioc i 1 w»�h
?5'' - rn Loy' cAs ie.r Cksto r 1.)0C.111 t�
�rc � S1+ o ► n Qv 4�c,e,
j n 1.a�he l�ler>'nan g
16. Will return water re-enter the reservoir? (Check one) ❑Yes ONo K/A
(If Yes, speck point(s) o, f re-entry and show on Excavation Area Drawing)
1 7. Is there an existing facility (e.g. pier) that access is being maintained to by conducting the
excavation? J 'es ONo
(If Yes, provide the existing )ernr;l number. If No, include a .scaled drawing of the proposed
.facility). Permit # 1 2,
18. Total planned duration of the work (Include first equipment mobilisation, excavation
through final mitigation ineasureb' complete):
START 7 / 7 ,, FINISH Z / 2.5
(Month) (Year) (Month) (Yecn)
Duke Energy Page 7 of 13
Excavation Program
rev I1;22.'21

g. Buried gas. water. sower,
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Duke Energy Excavation Permit Application Form
C. Applicant's Signatures
Comments:
Applicant Name (print)
Applicant Signature*
riCcY Z i ✓ r vriPr►�11 Cc ✓1
Co -Applicant Name (pri,ii)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Date 3-1'22.)
Date
Date
Date
Date
*Per my signature, the information provided in this application is correct to the best of my
knowledge.
Duke Iincrgy
Excavation Program
Page 10 of 13 rev 1 I22/2021

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 ofthe 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 Tots;
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 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
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 11 of 13
Excavation Program
rev I Ii22/2021

Contacted Mr. Smith on 1/1/20xx. No
further action needed.
Applicant will contact
endangered species are located during the endangered species are located during
course of construction. construction
Agency 3
Duke Energy Excavation Permit Application )Norm
shown in the Agency/Organization List. Consultation letters must be dated within the two years
preceding Duke Energy's receipt of the application.
Table IV-1. Sample Agency Comment and Res onse Table
Agency Comment Applicant Response
Agency 1
The activity is approved as proposed. 1 NA
Agency 2
The on -site well provides drinking water to the
public. Please contact Mr. Smith to discuss the
proposed changes and potential issues
associated with yourproposal.
You must contact us immediately if
Requested agency comments on 1/1/20xx and NA
again on 2/1/20xx. No response as of
2/16/20xx.
Agency 4
Section 401 Water Quality Certification
Excavation Program
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
Agency 1
Agency 2
Agency Permits and Certifications Table
Permit/Certification Name
Surface Water Withdrawal Permit
Section 401 Water Quality Certification
Date of
Issuance
Date of
Ex iration
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 11/21/2021

Duke Ener Excavation Permit A lication 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 Energy Page. 13 of I.,
Excavation Program
rev 11122'2021

ype: UUNSULIUAI tU KtAL N11UI4t11I Y
Recorded: 1/18/2022 4:35:56 PM
Fee Amt: $6,826.00 Page 1 of 2
Revenue Tax: $6,800.00
Iredell County, NC
Maureen P. Purcell Register of Deeds
BK 2888 PG 2187 - 2188
NORTH CAROLINA
GENERAL WARRANTY DEED
Excise Stamps: $6,800.00
Parcel IDiTax Lot Number: 4624453374
Mail after recording to: Grantee's Mailing Address
Prepared By: The Coley Law Firm, PLLC, 10150 Mallard Creek Road, Ste 209, Charlotte, NC 28262
Title Insurance with: Master Title
Brief Description for the Index:
Lot 498 of the Exception Plat of Crescent Land & Timber Corporation
THIS DEED made this l 5- day of January, 2022 by and between:
GRANTOR
Clifford W. Fiscus II and wife,
Jennifer D. Fiscus
Forwarding Address:
4401 Barclay Downs Drive #334
Charlotte, NC 28209
GRANTEE
Brian T. Zimmerman, married with 75%
ownership and Rogerio Brasil, married with
25% ownership
Property Address:
235 Gainswood Drive
Mooresville, NC 28117
Mail to:
4 Little Meadow Way
North Reading, MA 01864
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and
assigns, and shall include singular, plural, masculine, feminine or neuter as required by context.
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, all that certain lot or parcel of land situated in the City of Mooresville, Iredell County, North Carolina
and more particularly described as follows:
BEING all of Lot 498 of Exception Plat of Crescent Land & Timber Corporation, Section
6, as same is shown on map thereof recorded in Map Book 17, Page 614 in the
Mecklenburg County Public Registry, and further recorded in Map Book 61, Page 34, a
revision of Map Book 34, Page 18, in the Iredell County Public Registry pursuant to
General Assembly of North Carolina Session Law 1998-15, Senate Bill 1222. Said property
commonly known as 235 Gainswood Drive Mooresville, NC 28117; PIN # 4624453374
Submitted electronically by "The Coley Law Firm, PLLC"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Mecklenburg County Register of Deeds.

If initialed, the property includes the primary residence of at least one of the Grantors.
(NC GS § 105-317.2)
The property hereinabove described was acquired by Grantor by instrument recorded in Book 2189, Page
1408.
A map showing the above described property is recorded in Map Book 61, Page 34.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto
belonging to the Grantee in fee simple.
And the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee simple, has the right
to convey the same in fee simple, that title is marketable and free and clear of all encumbrances, and that
Grantor will warrant and defend the title against the lawful claims of all persons whomsoever, except for the
exceptions hereinafter stated.
Title to the property hereinabove described is subject to the following exceptions:
Enforceable easements, restrictions and rights of way of record.
Current Year Ad Valorem Taxes
IN WITNESS WHEREOF, the Grantor has hereunto set his hand and seal, the day and year first above written.
(SEAL)
W. Fiscus II
.`�-
�Je fifer D. scus
SEAL -STAMP
STATE OF NORTH CAROLINA, COUNTY OF k k (
I certify that the following person(s) personally appeared before me this day, each
acknowledging to me that he or she voluntarily signed the foregoing document for
the purpose stated herein and in the capacity indicated:
Clifford W. Fiscus II and Jennifer D. Fiscus, Individually as Grantor
Date: 1 — I.5 --c c9� , '>'ze_.49
/
O cial Signature of Notary
My Comm Exp: . Expires n ';�+ `a h C
04; 21 /2024
s Printed or Typed Name

DON ALLEN & ASSOCIATES,P. A
1J+0
"Since 1971"
Commercial * Residentlai * Mortgage Surveys 4 Multi —Family
Construction Staking a Subdivision Design • Topographical
111—D Raceway Drive * Mooresville * NC " 28117
[phone] [phone] Fax
I, certify that this map was drawn under my supervision from an actual
survey made under my supervision recorded In deed book-- 6306 _, page 565 _, and/or
plat book 34 , page18 , that the ratio of precision is 1':10,000, that this map
was prepared in accordance withs the dGen ay oal StartuEes of North D Caroli�n 1Crhap'er NC.
2
my hand and seal on the
iVICINITY MAP'"NO SCALE STE
ty/r
`r. LOT 499
DAVLD E. STEPHENS
3954\288
LAKE NORMAN
76O• CONTOUR UNE PER Itrr11
ACTUAL FIELD SURVEY -7��
195 FDUND
•"' �1 �
cog' --
O
W
F
i
IsereAac .•:•1 ,+7., 1 i_._:rDRIVE FNCRDACASPHALTFIESA ,i•"'•`� ,!
E o0V0 N C2 :M1t ,'�ci ,, �`
S�'g3;i��,��r°`: A.
"."'•_. "-y4;;:.,v,,ibFos�°
� • OVERFLEAD POWER - \ \
GAINSPTOOD RD. �'r`6�
(60' PUBLIC R\W) N664 4<Y9�
LOT 498 41 •1• . DECKAa<0.s� •
77 AC. 1 ,'• _tt pRDPiR une it
I
r'-.SCRFEN 19Ael 021.3�p1
to ta.d CfM
S7.d �• - ..� gam./PORcri m I Y
NYL 501K� L;
0. m
;tifkiefILLTE} `{t• K III' T PORCH
�`781' CONTOUR UNE PER / \
ACTUAL FIELD SURVEY
/ \
/ r/
LOT 497'
l$ OLAN R. GOODNIGHT
•
`'•?':':i rt 2094\574
CURVE TABLE ---
CUIi�E UTNGTH 8EARINa _ ' CHOItD...l
i C1 T304..15-1 S7.e4' N 68'ID)2_t
L2 L • 176.10__L 33L93' _ , N 5YIT52' E 33,88'
1)
2)
3)
4)
NOTES
TES PROPERTY MAY BE SUBJECT TO
ANY EASEMENT
R AHD/DR RIGHTS -OF WAY
AREA COMPUTED BY THE COORDWATE
METHOD.
EIOSMO 76D' & 78t' CONTOUR ELEV-
ATION BASED ON LAKE NDRMAN LAKE
LEVEL AT COWAN'S FORD DAM ((READEJO
ON 6/25/12) ELEVARON: 766.21'
NO GRID MONUMENT FOUND WITHIN
2000 MET.
SCALE
ACQUIRED BY;
--' LINE TABLE --
UNE BEARING tp 1 N
i - -N 62'46'16' E J 3241' 1
0' 25' 50' 100'
SCALE IN FEET
PHYSICAL SURVEY
OF
235 GAINSNNOD ROAD
LOT 498CRESCENT LAND & 11MBER CORP., SECT. 6
DAVIDSON TWSP., IREDELL CO., N.C.
CUFFORD & JENNIFER FISCUS
LEGEND
cap = P.P. = POWER FOIE
DUKE POWER TRANS
EJ.P. = DESTINE; IRON FOUND
LJ?S. a fro REBAR SET
R/W = RIGHT-OF-WAY
WELL
X,T. m LP = LIGHT PDLP
JR.
FIELD BOOK:
FILE: CUT LOT 428
DC FTLE
TAX MAP NO: 4624453374

--retka9 i3:3a : i'r E i7 i
ySCetat:
NC General License Contractor # 49723
The "Customer"
Brian Zimmerman
235 Gainswood DR
Mooresville, NC 28117
978-815-0829
Brianzim2011 @gmail.com
The "Contractor"
Lancaster's Custom Dock & Lift Systems, Inc.
1156 Perth Road
Troutman, NC, 28166
[phone]
DESIGN SKETCH
42
23'
- 4' DEEP
- S' DEEP
6' DEEP
7' DEEP
8' DEEP

PROJECT
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DUKE ENERGY DIRECTIONS BY ROAD FORM
Lake Use Permit Applicants and Contractors: Ease of locating the proposed project
site canhavea 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
Applicant's Name: Brian Zimmerman
Street Address (at lake): 235 Gainswood Drive Mooresville, NC 28117
Lake Name: Norman
Subdivision Name: Crescent Land + Timber Corp.
Property Section: Lot #: 498
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. Proceed straight.
Take 2nd right at the traffic circle and continue straight on Brawley School Road.
Turn Left onto Gainswood Drive. Property is on the left.
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.

arrell
12:57 7
itouchmap.com
Address or Place
c Q U
235 Gainswood Drive Mooresville NC 28117
35.507798,-80.93435
Lake
Ilk Maps 1 Norman
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Decimal Degrees Latitude: 35.507798
Decimal Degrees Longitude:
Clear
-80.934358
Show Point

DUKE ENERGY DIRECTIONS BY ROAD FORM
LANCASTER CUSTOM DOCKS DISPOSAL SITE
Lake Use Permit Applicants and Contractors: Ease of locating the proposed project
site canhavea 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
Applicant's Name: Lancaster Custom Dock Disposal Site
Street Address (at lake): 1162 River Highway Mooresville, NC 28117
Lake Name: Norman
Subdivision Name: Big Daddy's of Lake Norman
Property Section: Lot #: 2
City: Mooresville County: Iredell
State: NC Zip: 28117
Telephone: [phone]
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_

12:59 7
itouchmap.com
Address or Place
GO
1162 River Highway Mooresville NC 28117
•
35.604043,-80.910286
Drag Me!
CRM
♦ Deg
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Decimal Degrees Latitude:
Decimal Degrees Longitude:
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35.604043
-80.910286
Show Point

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