20221035 Ver 2_Shoreline Stabilization_20221103

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 11/2/2022
submitted on:*
Owner Information:
Name: *
Email: *
Phone Number:
Mailing Address: *
USA Alternatives, LLC c/o Brent Zande
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
19701 Bethel Church Road
Address Line 2
Suite 201
City
Troutman
Postal / Zip Code
28166
Is there an agent working on the project?*
Agent/Consultant Information
Name: *
Company Affiliation: *
Email:*
Yes
No
State / Province / Region
North Carolina
Country
United States
Donna P Hrko
Lancaster Custom Dock and Lift Systems, Inc.
[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:*
Appleby Signed Agent Agreement Form.pdf 142.44KB
Ayyad Signed Agent Authorization Form.pdf 152.24KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: *
Ayyad 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: *
35.499694
Street Address
130 Points End Drive
Address Line 2
City State / Province / Region
Mooresville NC
Postal / Zip Code Country
28117-7303 US
Longitude: *-80.940688
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*
Ayyad Dredge Detailed Site Plan and Misc.
Documents.pdf
Please use the diagram at the link below:
5.7MB
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.)
Ayyad Photos.pdf 1.11MB
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. Section 6, Lot 433 103 Points End Road, Mooresville, NC
28117
Include phase/lot number
Directions to site: *
From 1-77 NB, Exit 35, Left onto Brawley School Road. Continue beyond
The Point and Brawley School Road ends into Points End Road. The
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
.88 Acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Dredge area around new dock for boat slip 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.)
3672 sf
square feet
10. Total amount of disturbance above the normal pool lake level/ normal water level and 50 feet land-
ward:*
*
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
500 sf construction
corridor
square feet
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet landward to
be impacted:*
(number of trees, for instance)
NONE
Sketch:
Application Fee:
Once the application has been accepted. You will need to send a corresponding fee in with the appropriate DWR#. The
application fee is as follows (pursuant to G.S. 143-215.3D):
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
a I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:* Donna P. Hrko
Signature:
Submittal Date: 11/2/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20221035 Version:* 2
Select Reviewer: * Alan Johnson:eads\adjohnsonl
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: 113 PLAN NO:
STREET ADDRESS:
4090 Cindy Lane
Denver, NC 28037
Please print:
PARCEL ID: 4605-62-6766
Property Owner: Wayne Appleby _
Property Owner:
The undersigned, registered property owners of the above noted property, d❑ herebyauthorize
Donna P. Hrko
(Contractor/Agent)
of Lancaster's 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):
1207 Princeton Ave
Charlotte, NC 28209
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate tothe
best of our Knowledge.
Authorized Signatur
Date1/16/2021
Authorized Signature
Date

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO: 433
STREET ADDRESS:
130 Points End Road
Mooresville, NC 28117
Please print:
PLAN NO:
Property Owner: USA Alternatives LLC William A ad
Property Owner:
PARCEL ID: 4624223478
The undersigned, registered property owners of the above noted property, d❑ herebyauthorize
DONNA P HRKO , of LANCASTER'S CUSTOM DOCK & LIFT SYSTEMS,
INC.
(Contractor/Agent)
(Name of consulUng 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):
C/O Brent Zande 19701 Bethel Church Road Suite 201
Cornelius, NC 28031
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate tothe
best of our knoa*ge.
Authorized S' ure
6-022
Date
Authorized Signature
Date

b. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
c, Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
d. Location of any proposed structures such as buildings, retaining walls, docks, etc.
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
Full Pond/ Normal Water Level
Shoreline
Plan View
Full Pond/ I
Plan
Lake
(At Full Pond/ Normal Water Leve
�0�%)6-
fi�
Lake
(k NO P-WHannd Wmr Lnd}
Existing Dock
NMI' Carolina ❑gm anent a£ Lnviranniental Quality 13ivisiou (if Water lLesources
I �-- F. 0 0--4j 512 rilorth SakishnrySlrw : l617 1AaU Sarviw CeNcr ! Raicipq, :dnrdi Cavalina 27699-1617
l4a

W
Oi
Lake �-
Full Pond/ Normal Water Ui/
t
4,
zo
Side View
U-
1�1 y Noah Carolina fkpmment of F.nvimnmcntal Quality ; nivision of Water Rcsm ces
`•— .
�J 512 North Safis6Esry SEsort 1617 Mail Service Center : Raleigh, North Carolina 27699-1617

Iredell County, North Carolina
Tax Map Information
• PIN
462422-U78.000
• Address
130 POINTS END DR
• GIs Owner
USA ALTERNATIVES LLC
• Deed Ref.
2881/2237 - WD
•Deed Date
20211221
• Tax Acres
O.BB Ac.
Lot 0
433
• Plat Ref.
34.13
• Subdivision
CRESCENT LAN D+TIMBER CORP
•SO Phase
S6
• Description
CRESCENT LAN D+TIMBER S5 M17.W9
MECK-NECK PB34-13
• 01d Parcel it
001361 16
• Total *7Z8,230
Assessed
Wue
.]Lrly 3ql 2022
Ayyad Shoreline
Aft
.Ail ,� • ►fir
31,
r +
t
I�.ar• x t .
�1 1" = 135.76846203385136 ft
MAP FOR REFERENCE ONLY
NOT A LEGAL DOCUMENT
lredeN County, North Carolina makes no alairns and no
warranties, expressed or implied, concerning the validity or
accuracy Of the G IS data presented on this map,
Print map scale is approximate.
Critical layout or measurement
activities should not be done using
this resource,

TaWBA RIPARIAN BUFFER NQTIF1CATi�N FAR
Project Name/address: r )1
Owner:
Print
Contractor/agent.
Print
Sign
l�
'.. i. 14l0,1
V ' 5ignatu re
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)]
Frees 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 0213 .0243(4) and (6)]
Work to be conducted from land mast 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), (g)]
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 flaw at non -erosive velocities to the lake. [15A NCAC 02B .0243(5), (6)]
Acknowledgement of Notification
I, hereby state that I have been informed of the Catawba
Riparian Buffer Rule. Any w r 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 specifications), and other supporting
materials. A
Signature (owner);
Date: 4L_

�D6E SP09d �I PpSAL Fo���
Froj" Name/address:
Location Address.. 1-30
Parcel/lot site
Disp0.$2i area required (sq ft and/or acreage)
4
Aekaayykdd eat
, w
TC
and rules regarding sediment and erosion c trol and water uali
am aware that the site must adhere to all state regulations
dame of Individual and Corn an •And give ermissivn for
y
to dispose of their dredge material at the above stated loca an
Owner: CxV-
Pl
Date: 5igna tyre
Along with form, please provide;
Aerial of parcel lot (County G1Sj
Photo of proposed spoil site
Identified proposed spoil site

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 ll-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. Defer 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 Mai] receipt) in the complete application to snow
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 Darin A enc 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 3 Q 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 my 1 112212i
Excavation Program

at the top of the follow-up letter and include it in the application along with proof of the
agency's 1 Organization's receipt of the letter (e.g., Certified Mail receipt). You may proceed
with the application process recognizing, however, that if its comments come later in the
application process, you will be required to address them.
From the United States Army Corps of Engineers (Corps): (** Note — The Corps may have
additional forms to submit for your proposal and an additional fee.) If the excavation can be
done under the requirements of the General Permit (GP) or a Nationwide Permit (NWT), you
will typically receive a copy of the Corps' tear sheet documenting authorization and
providing any additional instructions. If the excavation isn't covered under the GP or a
NWP, you'll be required to obtain an individual 404 Dredge and Fill permit from the Corps.
You must receive written documentation from the Corps that your application either (1)
meets the requirements of the GP or a NWP or (2) the proper 404 Dredge and Fill permit has
been received before Duke Energy can process your application.
From the North Carolina Department of Environmental Quality (NCDEQ), Division of
Water .resources: {Note NCDEQ may have additional forms to submit for your proposal
and an additional fee.) If the proposal meets the requirements of the Clean Water Act Sect.
401 Water Quality Certification, you will typically receive a letter from the NCDEQ Division
of Water Resources documenting Sect. 401 Certification and providing any additional
instructions. You may also receive a letter requiring additional information or
recommending modifications. You must receive written documentation from NCDEQ
noting any required Sect. 401 Certification has been received before Duke Energy can
process your application.
From the North Carolina Wildlife Resources Commission (NCWRC): If you do not receive
any documentation from the NCWRC within 30 days of their receipt of your application, you
may proceed with the application process without submitting a follow-up request,
recognizing however if comments come in later in the application process, you will be
required to address them.
From the South Carolina Department of Health and Environmental Control (SCDHEC):
(Note — SCDHEC may have additional forms to submit for your proposal and an additional
fee) The SCDHEC conducts a joint application process with the USACQE 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 be required to address them.
Duke Energy Page 2 of 13 rev 11/22r21
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 la2r21
Excavation Program

Duke Energy Excavation Permit Application Form
FOR DUKE ENFRGV tfsE ONLY
Duke File No.
Application Fee $ Security Deposit $ Check # Date Recv'd Initials
Date of Duke F.nergy lake Services, applicant and/or contractor on -site inspections bate ' C' =ram .1y'ni€ials Y�
Date Final I'MccliOn/Avoidance Area Markings Field - Verified
Approved to Start Work By * :
Initials
Date
{Print} (Srxn}
Date Completion Required Date of Any Approved Extension
Date Passed Closeout Inspection*
Initials
Initials
Any Stop Work Orders or SMG Violations'? (check one) ClYes ❑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) hack to applicaat
with Approval Letter and highlight any changes. File copies of Approval and Closeout Checklists and any Stop Work
Orders with annlientinn
Part I. Applicant Information (Please Print)
Name er V up, Telephone 'I(A
D r ZR►r1 G Email address: r �cr- e_iL
a. Go m
Lake AdAress Mailing Add ess ifd� re t
rt,r e. 0 ZoI
�11e�11
Contractor Company
Contractor Contact Person 1)bV1nQ , p HY t'l�'� Telephone
Contractor Email Address: Ao Ylnra .1 r i%n r ri z-, t- w-A r r V e rn-) n ,rnn', I _ r,,.r► _,
LAKE LOT INFORMATION
Lake "i't ,vvou-ntty lr £tl City 0 11 State&j ,Tax Map No. g6442LM76
Subdivision 1►7 1 v Lot / Section No. 3 AQ Lot Size •bt Acres
Duke Energy Page 4 of 13 rev 11/22/21
Excavation Program

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) ,KYes ©No (If Yes,
include name and mailing address below.
Name: C { Y e> Tax ID: 5(p - 115 (AA4
Mailing Address:
Are there any Co -Applicants*? (check one) LlYes 5 No. (If Yes, include names, street
addresses or dot 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 / 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
Nuke 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 10 75 7 7-
Initials (Duke Energy)
(applicant/contractor) 1C /?—
Duke Energy Page 5 of 13 rev 1 fl22M
Excavation Program

Duke 1EHerff Excavation Permit A lication Form
Part H. Description of Pro'ect
A. Basic Information
t. Type of excavation; (check one) AdNew excavation ❑ Maintenance excavation
2. Purpose of excavation: (check one) WBoat Access Channel
❑ Water Intake Channel ❑ Wastewater Discharge Channel
❑ Other (spec):
3. Lake user category: (check one) OPrivate ❑Residential Marina
C1Commercial Marina OPublic
❑Other (spec):
4. Max. Excavation Area Dimensions (ft): Length 'Width 5qt Depth
(Note: include additional area dimensions if necessary so response to 4 below equals max. area
dimensions in #4)
5. Volume of Excavated Material (TOTAL,for the project): _ Aaa`Cubic yards
6. T e of material removed irapplicant determines by aeld scan le i ractica�:
'na
7. Excavation Site area: Acre (s) Disposal Site area: (s) Acre
8. TotaI Disturbed Area (including equipment.staging area):. JJ- Acre (s)
9. Does the project meet the requirements of the applicable General Permit? (check one)
des []No
10. Do you claim title to the disposal area? (check one) EJYes 'ENO
11. Do you claim title to the equipment staging area? (check one) OYes AETNo
12. Are there any water-treatt!e
V facilities within 50 feet of the proposed excavation area?
(check one) ❑Yes ONO
(If Yes, sped):
13. How will the excavated material be entrapped and the erosion controlled? (e.g. see attached
erosion control Ian and dis osal area desi
�r r l+h Ion Yaor reach exCa�c r
4 Vi 1�v� r ar eb dc.trre�-'kCK46. {{{nu1 away b jpcx
�o e+ -� d s 1 area . `�
Duke Energy Page 6 of 13 rep i trz2r2
Excavation Program

Duke EnerU Excavation Permit Application Form
14. Type(s) of excavation a ui meet to be used:
LoAej reach excava`1nr) 51Idr+ fe �xrava Y,]a es
dLLv p - ruclti s .
15. WiIl waters or wetlands be crossed in transporting equipment to or from the site?
(check one) CA'es ONO
(If es, explain)
��gq--v �1 hO,r�a wV1ccvlc S+e S�" �1mo}S ►ch
16. Will return water re-enter the reservoir? (Check one) ❑Yes ❑No */A
I Yes, s eci oint(s) o re -en v and show on Excavation Area Drawinv?
17. Is there an existin facility (e.g. pier) that access is being maintained to by conducting the
excavation? ❑Yes ,No
(If Yes, provide the existing permit number. If No include a scaled drawing of the proposed
facility). Permit # New (4o�-h-p be— CDY►��ru,L�i'd t n n ectr
u�t7re . �Y ►Vrx�r' tc 1,+i es cun-!:rWuchon Av lica`hori
I S. TotaI planned duration of the work (Include first equipment mobilization, excavation
through final mitigation measures complete):
START — f 1 FINISH 0 1
(Month) (Year) (Month) (Year)
Duke Energy Page 7 of 13 rev 1V2 I
Excavation Program

I ZOZ'ZZ/ ! I ^al
ro
ro
f. Rare or threatened species (spec )
OPtiv
77.
R
n
aurptond / uop
uoi;aIaasaG ! Jb
(panutluoj) •II 3.113c1
V IZuraad 1109111AnaWW

i
W
a
�
�'�a
mow•
a
�
n
�
n
l0
Pe
G.
a
7
n
�
�vp
a�
�
R
�
x•
v
v
m
A
0
a

Duke Ene Excavation Permit A iication Form
C. Applicant's Si Matures
Comments:
Applicant Name (Pri
Applicant Signature*
mot} am N yC,A
Date
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature's
Co -Applicant Name (print)
Co -Applicant Signature*
Date
Date
Date
Date
`Per my signature, the information provided in this application is correct to the best of my
knowledge.
Duke Energy Page 10 of 13 rev t i 12aa2o2
Excavation Program

Duke -Energy Excavation Permit ApRlication Form
Part M. 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 (the
shoreline adjoining the excavation area, equipment staging area, area crossed by any spoil
and return water lines, and the disposal area). If the applicant(s) is(are) not the owner(s) of
said property, then forward a copy of the deed and registered survey plat or other instrument
under which the owner(s) claim title plus written authorization from the owner(s) to carry
out the project on their land.
Excavation Area Drawing: An accurate drawing of the area to be excavated. The drawing
must show at a minimum, a North arrow; the boundaries and acreage of the proposed
excavation area and equipment staging areas; Iake, county, city, cove, tributary, road and
subdivision names and lot numbers (as applicable); property corners for project front lots;
the full pond elevation contour and lines dividing the cove width into equal thirds (as
applicable); approximate volume in cubic yards of the material to be excavated; point(s) of
return water re-entry; the boundaries of any adjoining areas that are to be specifically
avoided or protected during the work and the location (address) of the disposal area for the
excavated material. [NOTE: A copy of this drawing must also be provided to the
excavation contractor to ensure restricted areas are not impacted.]
�C! Disposal Area Drawing: An accurate drawing of the proposed design for the disposal area.
The drawing must 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 ern cantr )IDlan. For
projects larger than two (2) acres in South Carolina, including excavated, equipment staging
and disposal areas, you must submit an erosion control nlan. 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 W. Agency Reviews and Approvals
Begin this section with a summary table of all agencies consulted and applicant response to
agency comments as shown in the example table below. Agencies should be listed in the order
Duke Energy Page 11 of 13 rev 1 lf2M021
Excavation Program

Duke Energy -Excavation Permit ADplication 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-1. Sam
The activity is
Akencv 2
,,-encY Comment and Response Table
Comment
as proposed
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.
You must contact us immediately if
endangered species are located during the
course of construction.
icant
Contacted Mr. Smith on I/I/20xx. No
further action needed.
Applicant will contact Agency 2 if
endangered species are located during
construction
Requested agency comments on 1/1 /20xx and NA
again on 211120xx. No response as of
2116120xx.
� enc 4
Section 4Q1 Water Quality Certification Applicant will comply with the conditions of
the 4Q1 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. Sara le A enc Permits and Certifications Table
Agency Permit/Certification Name Date of Date of
Agency 1 Surface Water Withdrawal Permit Issuance Ex iratio
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 fo]lowed by
additional correspondence in chronological order. All permits must be valid at time of
Duke Energy Page 12 of 13 rev l i 12Z'2021
Excavation Program

Duke EnerLv Excavation Permit AnDlication 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 13 rev 111=021
Excavation Program

Type: CONSOLIDATED REAL PROPERTY
Recorded: 12/21/2021 11:21:28 AM
Fee Amt: $26.00 Page 1 of 2
Revenue Tax: $0.00
lredell County, NC
Maureen P. Purcell Register of Deeds
BK 2881 PG 2237 - 2238
NORTH CAROLINA NUN -WARRANTY DEED
Excise Tax: JQ..00
Parcel Identification No. 4624223478.000
Title Insurance Company: NA
Mail/Box to: Grantee
This instrument was prepared by: Hankin & Pack PLLC 5955 Carnegie Boulevard Suite 350 Charlotte NC 28209
Brief description for the Index: LOT 433, MB 17, PG609
THIS DEED made this i 7 day of December, 2021 by and between
GRANTOR I GRANTEE
The William G. Ayyad Trust dated April 2, 1996
Mailing Address:
PO Sox 5243
Mooresville, NC 28117
USA Alternatives, LLC, a Wyoming Limited Liability Company
Mailing Address:
PO Box 1150
Jackson, WY 83001
PropertyAddress:
130 points End Drive
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.
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 or condominium
unit situated in the City of Mooresville, IredeII County, North Carolina and more particularly described as follows:
BEING all of Lot 433 in Section 6, as same is shown on map thereof recorded in Map Boots 17, Page 609, Iredell County Public
Registry.
The property hereinabove described was acquired by Grantor by instrument recorded in Book 2817 Page 1615.
All or a portion of the property herein conveyed includes or X does not include the primary residence of a Grantor.
A map showing the above -described property is recorded in Plat Book 17, Page Aff
File No., 2 i-5225 Page I of 2
submitted electronically by "Rankin & Pack, PLLC"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the lredell County Register of Deeds.

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.
Easements, Restrictions and Right of Way of Record.
Ad Valorem Taxes for Current Year
IN WITNESS WHEREOF, the Grantor has duly executed as of the day and year fast above written.
The William G. A rust dated April 2, 1996
By: K04
Name/Title: W' sa Tru
STATE OF
COUNTY OF i
;ion
Public, do hereby certify that William G. Ayyad personally appeared before me this day
and acknowledged th due execution of the foregoing instrument in the capacity indicated.
Witness my han and fficial seal this
Official Signa r of Notary
My Commission Expires:
i 7 day of December, 2021,
v Notary putrlic G'
z union
_ county
MY COMM. 60 2 4t
y
�1/11r1IIns► 0
File No.: 21-5225 Page 2 of

•
ktlt"
q p G7
Yr
F
`Rs.
—
ig
$Ili; 1I
qj 1Fl 1 1I
I
Pqraiffi g
z m7
ygdJ
algid
•
l
Ver
•
,
V
n
1:14011
wa
44.
gA
•`,
Pa
�.lHti1�4�rN.......
y€
1 �!

n
01
r-
Icy y w m LTO�'���'
th, � _ � fit"
3 y n Gboil
CD Np111l1nffrrN► '� �.4 � �'
CD
I UN
�� r

L�

J
_�
'� -- - -
E C.

G)
1p
iwri
oil*
jw

DUKE ENERGY DIRECTIONS BY ROAD FORM
Lake Use Permit Applicants and Contractors: Ease of locating the proposed project
site Carl have a big impact on permitting processing time. Please complete this form and
return it along with your completed application to:
DUKE ENERGY
CIO LAKE SERVICES — EC 12 Q
526 SOUTH CHURCH STREET
CHARLOTTE, NC 28202
Applicant's Name: USA Alternatives LLC William AXXad
Street Address (at lake): 130 Points End Road
Lake Name: No
Subdivision Name: Crescent Land + Timber
Property Section: . 6
Lot #: 433
City: Mooresville County: Iredel
State:
Telephone: [phone]
Zip: 281
Directions (from major road or highway):
From I-77 NB, Exit 35, Left onto Brawley School Road. Continue beyond The
Point until Brawley School Road becomes Points End Road. The Property is on
the right. A new home is currently being constructed on the lot_
Descriptive Structure(s) on Property (i.e. brick garage, white fence, mobile
home, etc.)
*Nate: Please use the back of this form if desired to draw us a map to the site.

3:04
< jchmap.ccm e Q n
Address or Place GO
130 Points End Road Mooresville MC 28117
0 0.5 L 1 1.5 mi.A -Ij
- � q #It
0�
CRM ■ Deg ■ DM5 Help
Decimal Degrees Latitude: 35.49ssso
Decimal Degrees Longitude:-so.940686
Clear Show Point
O 27

D URE E NERG Y D IRECTI ONS BY R OA D FORM
LANCASTER CUSTOM DOCKS DISPOSAL, SITE
Lake Use Permit Applicants and Contractors: Ease of locating the proposed project
site earl have a big impact on permitting processing time. Please complete this form and
return it along with your completed application to:
DUKE ENERGY
CIO LAKE SERVICES — EC 12 Q
526 SOUTH CHURCH STREET
CHARLOTTE, NC 28202
Applicant's Name: Lancaster Custom Dock Dis josal Site
Street Address (at lake): 1162 River Hi 41- 1.11 Mooresville NC 28117
Lake Name: Norman
Subdivision Name: Big Dadd 's of Lake Norman
Property Section: Lot #:
City: Mooresville
County: Iredell
State: NC Zip: 281.17
Telephone: [phone]Q8
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_

3:661
< achmap.ccm Q
Address or Place L GO
1162 River Highway Mooresville NC 28117
❑ 0.5 9 1.5 mi �
rL 9 111
J
i W PLAZA t
Lake • ^�
Norman .
sMaps w—"% ) Legal — +
CRM ■ Deg ■ ❑M5 Help
Decimal Degrees Latitude: 35.604043
Decimal Degrees Longitude: 1 -80.910286
Clear Show Point
<- 4 Q
0

7-7-
ati
4• -;t• f y �
7
WNW.
dL-aamimma=R_
c,
-.�,�-

r Y
^icrf
• - r i

it °AL _-

.dkW
Ap
{� r
ti �-