20221300 Ver 1_Shoreline Stabilization_20220922

Shoreline Stabilization Application Form
NORTH CAROLINA
Environmental Quality
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*
[e-mail]
Please provide an email address for payment and requests for more information here.
Pre -Filing Meeting Date Request was 9/20/2022
submitted on: *
Owner Information:
Name: * Joseph Paul Chickene
Email: * [e-mail]
Phone Number: [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
2596 Brawley School Road
Address Line 2
City
Mooresville
Postal / Zip Code
28117-7302
Is there an agent working on the project? * Yes
No
Agent/Consultant Information
State / Province / Region
NC
Country
US
Name:* Donna P Hrko
Company Affiliation: * Lancaster Custom Dock and Lift Systems, Inc.
Email: * [e-mail]

Phone Number:*
Mailing Address:*
[phone]
(xxx)xxx-xxxx
Street Address
1156 Perth Road
Address Line 2
City State / Province / Region
Troutman North Carolina
Postal / Zip Code Country
28166 United States
A signed and dated copy of the Agent Authorization letter: *
Chickene Signed Agent Auth..pdf 150.09KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
Chickene Excavation for Boating Access & Shoreline Access Steps
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:*
35.460875
Street Address
8217 Bright Water Lane
Address Line 2
City State / Province / Region
Denver NC
Postal / Zip Code Country
28037-8533 US
Longitude: *-80.959194
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*
Chickene Detailed Site Plan and Misc..pdf 6.61MB
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.)
Chickene Photo.pdf 329.81KB
4. Location of the property (where work is to be conducted)
Nearest Town: * Denver

County:* Lincoln
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address: *
Crescent Land + Timber Section 39, Lot 61 8217 Bright Water Lane
Denver, NC 28037
Include phase/lot number
Directions to site: *
From NC-16 NB, exit to Route 73, turn right onto Route 73, turn left onto
NC-16 Bus NB, turn right onto Hagers Ferry Road, turn right onto Bright
Water Lane. 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
.731 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 to new dock that will be constructed.
Construct access steps thru existing rip rap for pedestrian lake 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.)
3,468 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.)
536 sf
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):
a $240.00 for impacts to lake (below normal water level) of less than 1 acre
a $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:
a I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the best
of my knowledge and belief
a 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");
a 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 I 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: 9/20/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20221300 Version:* 1
Select Reviewer: * Doug Perez:eads\djperez
Select Reviewing Office: Mooresville Regional Office - [phone]
Has payment been received?* No Payment Needed
Fee Received
Need Fee - send electronic notification
What amount is owed?* $240.00
$570.00

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO: 61 PLAN NO: PARCEL ID: 4612-68-6378
STREET ADDRESS:
8217 Bright Water Lane
Denver, NC 28037
Please print:
Property Owner: Joseph Paul Chickene
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):
2596 Brawley School Road
Mooresville, NC 28117
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate tothe
best of our knowledge.
Autho
8/1/2
Date Date
gnature Authorized Signature

b.
c.
d.
e.
Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
Location of any proposed structures such as buildings, retaining walls, docks, etc.
Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
Full Pond/ Normal Water Level
Shoreline
Plan View
Lake
(At Full Pond) NormaIwater Level}
Z04,1x5ix1C]''�'cJ� r e tfi red 51 tYi�--5
■
cccss
5004
po
Av r,
ps.
s0.l
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Full Pond/ Normal Water Level
-iiorm '
2 ft. , 150 It.
additional clearing
. If necessary
Plan View
Lake
{At Full Pond/ Normal Water Level}
goorr
Ft ar`�r`
atgapiarelie
strit*t Riprap
Existing Dock
30ftx7Fc
3ftx 1501t
Below full pandW N W L
It% 150ft
Above lull pordl NWL
E
North Carolina Department of Environmental Quality I Division of Water Resources
512. North Salisbury Street 11b17 Mail Service Center f Raleigh: North Carolina 27699-1617
919.707.9000

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Project Name/address:
Location Address: �
Parcel #: (.0 I Z (p
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S'OPT ®I Q AL FORM
ed - 8 I •ri vya.
C. 28037
Parcel/lot size 7 J 1 etCre-S
Disposal area required 4sq ft and/or acreage)
Acknowledgement of Noti{{''cation
and rules regarding sediment and erosion
br1
Name of Individual and Company
am aware that the site must adhere to all state regulations
control and water quality. And g1Ve permission for
e C.
to dispose of their dredge material at the above stated location
Owner:
Date- (6-1- �,rnt
Along with form, please provide:
Aerial of parcel/lot (County GIS)
Photo of proposed spoil site
identified proposed spoil site
er
Sign

—
September 13, 2022
1 inch = 82 feet

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address.
-
Owner: SOg- . ' l _linetrrIC
Print , ' h'
Contractor/agent:
Print
re
County: L! rjc 1
Signature
The ap
proval 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)]
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 (6f )
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. RSA 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. j15A 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 025.0243(5), (6)]
Acknowledgement of Notification
1' �]C35e ti 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 plans) and specification(s), and other supporting
materials.
Signature (owner):
Date:

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 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 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 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
Excavation Program
Page 1 of 13 rev 1 1l22121

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.
• From the United States Army Corps of Engineers (Carps): (** Note — The Corps may have
additional forms to submit for your proposal and an additional fee.) If the excavation can be
done under the requirements of the General Permit (GP) or a Nationwide Permit (NWP), you
will typically receive a copy of the Corps' tear sheet documenting authorization and
providing any additional instructions. If the excavation isn't covered under the GP or a
NWP, you'll be required to obtain an individual 404 Dredge and Fill permit from the Corps.
You must receive written documentation from the Corps that your application either (1)
meets the requirements of the GP or a NWP or (2) the proper 404 Dredge and Fill permit has
been received before Duke Energy can process your application.
• From the North Carolina Department of Environmental Quality (NCDEQ, Division of
Water Resources: (Note —NCDEQ may have additional forms to submit for your proposal
and an additional fee) If the proposal meets the requirements o.f 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.
• From the South Carolina Institute ofArchaeology 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 he required to address them.
Duke Energy
Excavation Program
Page 2 of 13 rev 11/22/21

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
Excavation Program
rev 11 /22/21

Duke Energy Excavation Permit Application Form
FOR DUKE ENERGY USE ONLY
Duke File No.
Application Fee $ Security Deposit $ Check # Date Reev'd Initials
Date of Duke Energy Lake Services, applicant and/or contractor on -site inspections Date ' '7-ec Initials f ,{�
Date Final Protection/Avoidance Area Markings Field - Verified Initials
Approved to Start Work 13y *
Date
(Print) (Sign)
Date Completion Required Date of Any Approved Extension Initials
Date Passed Closeout Inspection* Initials
Any Stop Work Orders or SMG Violations*? (check one) ❑Yes ©No (If Yes, explain in PART V)
Date Deposit Refunded
Initials Date Permit Database Updated Initials
* Forward copy of approved application (all pages, plus any attachments that Duke Energy changed) back to applicant
with Approval Letter and highlight any changes. File copies of Approval and Close-out Checklists and any Stop Work
Orders with a . i lication.
Part I. Applicant Information (Please Print)
Name Tb5e7 r t
Contractor Contact Person
Contractor Email Address:
LAKE LOT INFORMATION
Lake 1\611(l& YCounty L1 nCo 1n City Den V e.r
Telephone g lei- 2 7:4 - 87340
Email address: P ch i [_ken @ rick;
L e Addres Mailin Addr s (ff different)
r
�enV er, 1 C ZBO37 M.00resv'i 11e, NI C 28117
Contractor Company 1.anrct4er.5 () I tom 1)0013 �j ii44- 5 *err] 51
i�C�n c1 P I-{r lei b
Telephone 3c 4 R - f9t 9
State hiC. Tam -map -No. Ato{2/ l08• C2378
Subdivision Cyen1 Land 4. Lot I Section No. (p I Lot Size ?3lAcres
►rvnber Cpr 17.
Duke Energy Page 4 of 13
Excavation Program
rev 11 /22121

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 I unless an alternative recipient is identified.
Send the security deposit to an alternative recipient? (check one) 'Yes DNo (If Yes,
include name and mailing address below.
Name: 1.-301 +Pr & 5
Mailing Address: 1 ] Cj ,p Per -h 1 d
❑UI�YYlQY� ! l V C. z Ca 1 tD
Are there any Co -Applicants*? (check one) Yes (If Yes, include names, street
addresses or lot numbers, pier numbers, phone numbers, and email addresses in Part V —
Additional Information)
* Co -Applicants exist when the proposed work is being done under a single application, will be
performed by a single contractor as one continuous project, and is done to benefit multiple
owners 1 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 any other lake use permitting
activity.
Date of on -site inspection 7 2 7- '2
Tax ID: 510— 1 q 3 foci 4
Initials (Duke Energy) f(-t) (applicant/contractor)
Duke Energy Page 5 of 13 rev 11/22/21
Excavation Program

Duke Energy Excavation Permit Application Form
Part II. Description of Project
A. Basic Information
1. Type of excavation: (check one) 'New excavation ❑ Maintenance excavation
2. Purpose of excavation: (check one) moat Access Channel
❑ Water Intake Channel 0 Wastewater Discharge Channel
0 Other (sped):
3. Lake user category: (check one) .HPrivate ❑Residential Marina
❑Commercial Marina ❑Public
❑Other (spec):
�
4. Max. Excavation Area Dimensions (ft): Length (05k Width 5 / Depth 10%
(Note: include additional area dimensions if necessary so response to #5 below equals max. area
dimensions in #4)
5. Volume of Excavated Material (TOTAL for the project): L Q 5 Cubic yards
6. Type of material removed (applicant determines by field sample (practical):
7. Excavation Site area:. 0 7 9 Co Acre (s) Disposal Site area:
(s)
8. Total Disturbed Area (including equipment staging area):
. f 0 35 Acre
. I e3Z? Acre (s)
9. Does the project meet the requirements of the applicable General Permit? (check one)
„ia'es ONo
10. Do you claim title to the disposal area? (check one) ,OYes ❑No
11. Do you claim title to the equipment staging area? (check one) )2es ❑No
12. Are there any water -treatment facilities within 50 feet of the proposed excavation area?
(check one) ❑Yes
(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):
Dreacte. irnceter't�ke. w�-1- , lbnc ,reach exc Nctitr. Loc d oh+o du +cp
Sha re l vei e 0.Yl r -rco S po 1 Y o n� v C& of
v'olpev .51l}- �icin �' 1'VGiylOR1eS Wt11� �Je.1+'1s--4ile+0 t7regevi
Duke Energy
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:
L
'act tir eosin ex C 0..\/0-1-0r 5 nor+ recc J eX ca va +or bct,�-5 ems,
due-1-hp t-r u.c lh s a 3 D to) c cd-s
15. Will waters or wetlands be crossed in transporting equipment to or from the site?
(check one) es ONo
(If yes, explain)
At\ dredGir?C.,ecjui}��e�t i trah5por` ea „�- tx� +� plant
hcasi-er [.t S�ti n avec, c office i'le. fiQ Pairs:sec
5tifie. 01,11-41he k)bleiegavt,
16. Will return water re-enter the reservoir? (Check one) ❑Yes ONo
(If Yes, specify point(s) of re-entry and show on Excavation Area Drawing)
i/A
17. Is there an existing facility (e.g. pier) that access is being maintained to by conducting the
excavation? DYes ONo
(If provide the existing permit number. , f No, include a scaled drawing of the proposed
facility). Permit #
18. Total planned duration of the work (Include first equipment mobilization, excavation
through final mitigation measures complete):
START 1 _ ! FINISH 2 / 3
(Month) (Year) (Month) (Year)
Duke Energy Page 7 of 13
Excavation Program
rev I1/22/21

0.7
0
[ZOZIi/I I nal
g. Buried gas, water, sewer,
communications or electric lines (circle)
£. Rare or threatened species (specify)
e. Historic properties (specii'
_d. Natural Areas as identified by Duke
Energy
c. Environmental Areas as identified by
Duke Energy
— b. Buffer Zones (sped width & source
of requirement)
Protection/Avoidance Areas
(check all that apply)
a. Marshland, swamp, ponds, beneficial
aquatic vegetation or other potential wetlands
(circle all that apply)
In
eo
c
*--....... .-4Mgi
acitipz
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(ft
Work Area Dwg. ID
m
s
0
Avoid (A) or Mitigate (M)
Complete the following table including all land areas within and immediately adjoining the disturbed area:
tmptOAy J uoiloalaad
(panur jtdoa)11 1.1rd
aafE mina
v ;wand uopenmaXJ
ui.xad uoygag

suevd uope muT r :
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.IauI a1fQ
lad uopt Araxa

Duke Energy Excavation Permit Application Form
C. Applicant's Signatures
Comments:
Applicant Name (print) .....)o
Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Date C7`1 `ZU
Date
Co -Applicant Name (print)
Co -Applicant Signature*
Date
Co -Applicant Name (print)
Co -Applicant Signature* Date
Co -Applicant Name (print}
Co -Applicant Signature* Date
*Per my signature, the information provided in this application is correct to the best of my
knowledge.
Duke Energy
Excavation Program
Page 10 of 13 rev 11/22/2021

Doke Ener Excavation Permit A lication Form
Part III. Additional Information
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
e
shoreline adjoining the excavation area, equipment staging area, area crossed by any spoil
and return water lines, and the disposal area). If the applicant(s) is(are) not the owner(s) of
said property, then forward a copy of the deed and registered survey plat or other instrument
under which the owner(s) claim title plus written authorization from the owner(s) to carry
out the project on their land.
/ Excavation Area Drawing: An accurate drawing of the area to be excavated. The drawing
must show at a minimum, a North arrow; the boundaries and acreage of the proposed
excavation area and equipment staging areas; lake, county, city, cove, tributary, road and
subdivision names and lot numbers (as applicable); property corners for project front lots;
the full pond elevation contour and lines dividing the cove width into equal thirds (as
applicable); approximate volume in cubic yards of the material to be excavated; point(s) of
return water re-entry; the boundaries of any adjoining areas that are to be specifically
avoided or protected during the work and the location (address) of the disposal area for the
excavated material. [NOTE: A copy of this drawing must also be provided to the
excavation contractor to ensure restricted areas are not impacted.]
.g. Disposal Area Drawing: An accurate drawing of the proposed design for the disposal area.
The drawing must show at a minimum, a North arrow; the boundaries and acreage of the
proposed disposal area; lake, county, city, cove, tributary, road and subdivision names and
lot numbers (as applicable); the full pond elevation contour (unless disposal is well away
from the lake); the boundaries of any adjoining areas that are to be specifically avoided or
protected during the work; the location (address) of the excavation area from which the
material came and a statement of the disposal area's capacity with all dimensions labeled
that were used in the volume calculation. [NOTE: A copy of this drawing must also be
provided to the excavation contractor to ensure restricted areas are not impacted.]
Also note for projects larger than one (1) acre in North Carolina, including excavated,
equipment staging, and disposal areas, you must submit an erosion control plan. For
projects larger than two (2) acres in South Carolina, including excavated, equipment staging
and disposal areas, you must submit an erosion control plan. For projects < two (2) acres in
South Carolina, you must submit a completed standard reporting form for construction sites
disturbing two (2) acres or less to the South Carolina Dept. of Health and Environmental
Control (SCDHEC) - Stormwater Management
Vicinity Map and Driving Directions: A vicinity map and directions by road showing directions to both the excavation area and disposal area. Include the latitude and longitude of
both the excavation area and the disposal area.
Part IV. Agency Reviews and Approvals
Begin this section with a summary table of all agencies consulted and applicant response to
agency comments as shown in the example table below. Agencies should be listed in the order
Duke Energy Page 11 of I3
Excavation Program rev i irzzrzox i

Duke Energy Excavation Permit Application Form
shown in the Agency/Organization List. Consultation letters must be dated within the two years
preceding Duke Energy's receipt of the application.
Table IV -I. Sam le A2encv Comment and Response Table
Agency Comment
r
Applicant Response
Agency 1
The activity is approved as proposed.
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 your proposal.
Contacted Mr. Smith on 1/1/20xx. No
further action needed.
You must contact us immediately if
endangered species are located during the
course of construction.
Applicant will contact Agency 2 if
endangered species are located during
construction
Agency 3
Requested agency comments on 1/l/20xx and
again on 2/1/20xx. No response as of
2/16/20xx.
NA
Agency 4
Section 401 Water Quality Certification
Applicant will comply with the conditions of
the 401 Water Quality Certification
Following the table of agency comments and applicant responses, include a table of permits and
certifications issued by the reviewing agencies. As with the table of agency comments and
applicant responses, agencies should be listed in the same order as they are listed in the
Agency/Organization List.
V-2. Sample Agency Permits and Certifications Table
Agency
Permit/Certification Name
Date of
Issuance
Date of
Expiration
Agency I
Surface Water Withdrawal Permit
Agency 2
Section 401 Water Quality Certification
Following the two summary tables, include a copy of all correspondence to and from any local,
regional, state and federal agencies or other organizations with which you are required to consult,
including any required permits (e.g., Section 401 water quality certifications, Section 404
dredge/fill permits, building permits, etc.) or other approvals or comments which have been
obtained from these organizations regarding this activity. Include a copy of any local, regional,
state or federal regulations or guidelines that will be followed. All permitting issues must be
resolved and clearly documented, Correspondence should be organized in the order the agencies
are listed on the Agency/Organization list with the applicant's request for comments followed by
additional correspondence in chronological order. All permits must be valid at time of
Duke Energy
Excavation Program
Page 1.2 of 13 rev 11/22/2021

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 ] 3
Excavation Program
rev 11/22/2O21

BK 2958 PG 705 - 706 (2) DOC# 617261
This Document eRecorded: 10/02/2020 02:41:27 PM
Fee: $26.00 DocType: DEED Tax: $1,466.00
Lincoln County, North Carolina
Danny R. Hester, Register of Deeds
Excise Tax $1,466.00
Parcel Identifier No. 32050
1 Recording Time, Book and Page
M ail after record ing to: Grantee
This instrument was prepared by: D. TODD WULFHORST - Kennedy & Wulfhorst, P.A., 3758 Hwy 16 N, Denver, NC 28037
Brief description for the index
Lot 61 — Recreation Lots
DRAFTER DID NOT PARTICIPATE IN CLOSING Dar THIS TRANSACTION
NORTH CAROLINA GENERAL WARRANTY DEED
THIS DEED made this 22" d day of September, 2020 by and between
GRANTOR
KENNETH E. HART and wife,
JANET W. HART
775 Crosspoint Drive
Denver, NC 28037
GRANTEE
SIIEILA CHICKENE and spouse,
JOSEPH PAUL CHICIKENE
2596 Brawley School Road
Mooresville, NC 28117
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.
WITNESSETI-I, 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 [and situated in
the Town of Denver, Catawba Springs Township, Lincoln County, North Carolina and more particularly described as follows:
Being all of Lot 61 in Section 39, as shown on map recorded in Map Book E, Page 64 in the Office of the Register
of Deeds for Lincoln County,
The property does not include the primary residence of the Grantor.
Submitted electronically by "Samantha M. rerres, Pt,LC"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Lincoln County Register of Deeds.

LI L:�.�u
r V I VV LJuVT'r
The property hereinabove described was acquired by Grantor by instrument recorded in Book 837, Page 496
A map showing the above -described property is recorded in Book E, Page 64
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 Grtuitor 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 Granter 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:
All valid and enforceable reservations, restrictions, easements, conditions and right-of-ways in the record chain of title.
IN WETNESS WHEREOF, the Grantor has hereunto set his hand and seal, or if corporate, has caused this instalment to be signed in its
corporate name by its duly authorized officers the day and year First above written.
KENNETH E. HART
LJL) o.L
ETW.HART
SEAL -STAMP
D. TODD WULFHORST
1.40';ARY PUBLIC
Lincoln County
North Carolina
My Commission Expires May 9, 2023 Date:
_(SEAL)
(SEAL)
STATE OF NORTH CAROLINA COUNTY OF LINCOLN
I certify that the following person(s) personally appeared before me this day, each
acknowledging to me that lie or she signed the foregoing document:
KENNETH E. HART and JANET W. HART
a/ 412,D 2,0
My Commission Expires:
L
Official Signature of otary
C:]•i , Notary Public
Notary's printed or typed nacre

5/16/22, 2:19 PM
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CORPOtt6T ON LAKE
Pro r not:
Todd Primavera
Kathleen Primavera
39 OF THE CRESCENT
NORMAN RI,;CREATION
As RUWrdein:
1]A. 837, PG. 4.96
PR. E, PG. 6 4
LAND
LOTS
Site A&klress:
83I71111141-1r \t ATER i.ANE
t)I:NVliti DfC.28a35
CAT I UW> 4 t111tiN[iS
I.INCOLN COUNTY
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18335 Old SlatLwillc Road Ste. A
Cornelius, `#.C, 28031
744-765-5134 PhntteA'ax
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odd Primavera
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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
CIO LAKE SERVICES — EC 12 Q
526 SOUTH CHURCH STREET
CHARLOTTE, NC 28202
Applicant's Name: Joseph Paul Chickene
Street Address (at lake): 8217 Bright Water Lane
Lake Name: Norman
Subdivision Name: Crescent Land + Timber Corp.
Property Section: 39 Lot #: 61
City: Denver County:
Lincoln
State: NC Zip:
Telephone: [phone]
28037
Directions (from major road or highway):
From NC-16 NB, Exit to Route 73 East Bound toward HuntersvlletDenver,
Right onto Route 73, Left onto NC-16 Bus NB, Right onto Hagers Ferry Road,
Right onto Bright Water Lane, Property is on the left near end of road.
Descriptive Structures) on Property (i.e. brick garage, white fence, mobile
home, etc.)
*Note: Please use the back of this form if desired to draw us a map to the site.

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Address or Place
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8217 Bright Water Lane Denver, NC 28037
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Decimal Degrees Latitude:
Decimal ❑egrees Longitude:
35.460866
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-80.959123
121