20240108 Ver 1_Site Plan_20240118

Proposed
(Plan View)
Poll Pond/ Normal Water Level
Shoreline 0
Lake
(At Full Pond/ Normal Water Level)
I
; -i , t
7"- 4L
DYI-C
y e- 38C��IregUIre
S1ope.5
COrrl
Lake
(At Full Pond/ Normal Water Level) Existing Dock
36ftx7ft
3 ft z 156 ft
Full Pond/ Normal Water Level Below full pond/ NWL
fu
Riprap IS
Oft Full ponn ft
d/ NWL
2 h. x 150 h. 'r
additional clearing
if necessary
E'AMPLE
Plan View

7
�i
La ke
CD
(At Full Pond/ Normal Water Level)
M
�:1W-
C
E .O
N7
-_-z_=
T3
Side View
U-
3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing
'if necessary
Existing bank
10 ft. bank a
height
Q
Side View
FORM: 5SGP 02-2017 Page 4 of 4

Catawba county Geospatial Real Estate Search
0dK,NG. LIVING. err,ta Information Services
" 1 in=80ft
w + E
s
Parcel: 461704508673, 4232 SIGMON COVE LN TERRELL, 28682
Owners: DAVIS SILAS T JR,
Owner Address: 4232 SIGMON COVE LN
Values - Building(s): $28,100, Land: $360,200, Total: $388,300
This map/report product was prepared from the Catawba County, NC Geospatial Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling information contained on this map or data on this report. Catawba County promotes and recommends
the independent verification of any data contained on this map/report product by the user. The County of Catawba, its employees, agents, and
personnel, disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect or consequential which arises or may
arise from this map/report product or the use thereof by any person or entity.
Copyright 2023 Catawba County NC
0111412fl24

1 /3/24, 9:53 AM
Parcel Report
Parcel Report - Catawba County NC
Parcel Information:
Parcel ID: 461704508673
Parcel Address: 4232 SIGMON COVE LN
City: TERRELL, 28682
LRK(REID): 802988
Deed Book/Page: 3762/0766
Subdivision: THE VINEYARDS AT KISER
Lots/Block: 4/
Last Valid Sale: $560,000 on 2022-08-12
Plat Book/Page: 64/178
Legal: LOT 4 PLAT 64-178
Calculated Acreage:.850
Tax Map:
Township: MOUNTAIN CREEK
State Road #:
Tax/Value Information: Tax Rates
City Tax District: All in County
County Fire District: SHERRILLS FORD
Building(s) Value: $28,100
Land Value: $360,200
Assessed Total Value: $388,300
Year Built/Remodeled: /
Tax Revaluation 2024: Info, COMPER
Online Appeals
Valid Sales (COMPER) for this parcel
Contact Tax Dept. at 828-465-8436
Current Tax Bill
Miscellaneous:
Current: If available, Building Permits for this
parcel.
Before 12/4/23: Building Permit Address Search for
this parcel.
If available, Building Permits for
this parcel. Septic links are not permits.
Septic Final Permits prior to 08/2018, contact
Environmental Health.
Building Details
WaterShed: WS-IV Critical Area
Voter Precinct: P41/ Voting Map
Parcel Report Data Descriptions
Owner Information:
Owner: DAVIS SILAS T JR
Owner2:
Address: 4232 SIGMON COVE LN
Address2:
City: TERRELL
State/Zip: NC 28682-9802
School Information:
School District: COUNTY
Elementary School: SHERRILLS FORD
Middle School: MILL CREEK
High School: BANDYS
School Map
Zoning Information:
Zoning District: COUNTY
Zoningl: R-30
Zoning2:
Zoning3:
Zoning Overlay: CRC-O,WP-O,FPM-O
Small Area: SHERRILLS FORD
Split Zoning Districts: /
Zoning Agency Phone Numbers
Firm Panel Date: 2008-03-18
Firm Panel #: 3710461700K
2010 Census Block: 5016
2010 Census Tract: 011504
Agricultural District:
List all Owners Deed History Report
Assessment Report
httpsJ/gis.catawbacountync.gov/nomap/pareel report.php?key=461704508673&typ=P 1/2

-*-� Dwrg
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 H-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 i of 13 rev t 1nMI
Excavation Program

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 (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 submitfor your proposal
and an additional fee.) If the proposal meets the requirements of the Clean Water Act Sect.
401 Water Quality Certification, you will typically receive a letter from the NCDEQ Division
of Water Resources documenting Sect. 401 Certification and providing any additional
instructions. You may also receive a letter requiring additional information or -
recommending modifications. You must receive written documentation from NCDEQ
noting any required Sect. 401 Certification has been received before Duke Energy can
process your application.
• From the North Carolina Wildlife Resources Commission (NCWRC): If you do not receive
any documentation from the NCWRC within 30 days of their receipt of your application, you
may proceed with the application process without submitting a follow-up request,
recognizing however if comments come in later in the application process, you will be
required to address them.
• From the South Carolina Department of Health and Environmental Control (SCDHEC):
(Note — SCDHEC may have additional forms to submit for your proposal and an additional
fee) The SCDHEC conducts a joint application process with the USACOE in S.C. If the
proposal meets any applicable requirements of the Clean Water Act Sect. 401 Water Quality
Certification, you will typically receive a letter from SCDHEC documenting Sect. 401
Certification and providing any additional. instructions. You may also receive a letter from
USACOE requiring additional information for the'agencies participating in the joint
application process. You must receive written documentation from SCDHEC noting Sect.
401 Certification has been received if required before Duke Energy can process your
application.
• 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 rev 1 to mi
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 it/=I
Excavation Program.

Duke Energ_Excavation Permit Application Form
FOR DUKE ENERGY USE ONLY
Duke File No.
Application Fee $ Security Deposit $ Check #} Date Recv'd Initials
Date of Duke Energy Lake Services, applicant and/or contractor on -site inspections Date Z 5 Initials.
Date Final Protection/Avoidance Area Markings Field - Verified
Approved to Start Work By * :
Date Completion Required
Date Passed Closeout Inspection*
(Print)
Date of Any Approved Extension
Initials
Initials
Date
(Sign)
Initials
Any Stop Work Orders or SMO 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 application.
Part I. Applicant Information (Pleea-se- Print)
Name_ S 1 CIS t cV t `J �) r' . Telephone 1704 " 191 -
Email address: 51 Xl7QC� Q QY�Q 1 CO YYl
L-4ke Ad ress, M�ilm Ad ess (if different)
! WGrloci
y--re. N C le N `._ .Z45031
Contractor Company L-w(I.5TUYY! :Jpc- ) L F6 ,3r cfn `J, l e7G .
Contractor Contact Person a OQ T. I Q Telephone _-5o4 - " & 9 -- W g&
Contractor Email Address: ao0na. _� O'ncrt4e rcj ndi S C�t q mct I. CQYY1
LAKE LOT INFORMATION
`fir PIN
Lake �— .n Comfy city �er�- c.1 j State Iv l.� Tax Map No. 1 T045v81o73
Subdivision .Ihe �,�'1rA SCt�" Lot / Section No. Lot Size•E6Acres
�i15er'
Duke Energy Page 4 of 13 rev 11122/21
Excavation Program

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Duke Enemy 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) 4Yes ❑No (If Yes,
include name and mailing address below.
Name: 1mnr _DOC.V)S Tax ID: 6(:0 - I Q3 (�p9-44
Mailing Address:
ou+-may�, NC ZMO& -
Are there any Co -Applicants*? (check one) ❑Yes *o (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 / 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 �-7-1 Z
Initials (Duke Energy) (A (applicant/contractor)
Duke Energy Page 5 of 13 rev 11/22121
Excavation Program

Duke Ener_gy Excavation Permit Application Form
Part U. Description of Project
A. Basic Information
1. Type of excavation: (check one) J"New excavation ❑ Maintenance excavation
2. Purpose of excavation: (check one) ABoat Access Channel
❑ Water Intake Channel ❑ Wastewater Discharge Channel
❑ Other (specify):
3. Lake user category: (check one) JKPrivate ❑Residential Marina
❑Commercial Marina ❑Public
❑Other (specify): �� L4,5h0)
Y1 K co 3 ZZ 3 G x.4. Max. Excavation Area Dimensions (ft): Length Width 4n Depth)
(Note: include additional area dimensions if necessary so response to 45 below equals max. area
dimensions in 44) -'d-. ( zt F,S $ODs f .
5. Volume of Excavated Material (TOTAL for the project): ��0 Cubic yards
6. Type of material removed (applicant determines by field sample if practical):
�xuncl , Sl1+ 4 day - -
7. Excavation Site area: Acre (s) Disposal Site area: Acre
(s)
8. Total Disturbed Area (including equipment staging area): /T¢ Acre (s)
9. Does the project meet the requirements of the applicable General Permit? (check one)
Yes ❑No
10. Do you claim title to the disposal area? (check one) ❑Yes 1!*0
11. Do you claim title to the equipment staging area? (check one) ❑Yes 1PNo
12. Are there any water -treatment facilities within 50 feet of the proposed excavation area?
(check one) ❑Yes *0
(If Yes, specify):
13. How will the excavated material be entrapped and the erosion controlled? (e.g. see attached
erosion control plan and disposal area desi n):
r e % % -h Ion rM01 exca roa-� r. 14 M ria S In o-}7 e..
HaLLt-hWrA
id
-Wan r ed An 81 S I
Duke Energy Page 6 of 13 rev F V2221
Excavation Program

Duke Energy Excavation Permit Application Form
14. Type(s) of excavation equipment to be used:
long reccc.h eXCcL\jaj-or, 5 hort-r c ex c�vQ �;
i
1)u�M- P�uc.yl S
15. Will waters or wetlands be crossed in transporting equipment to or from the site?
(check one) %Yes ❑No
(If yes, explain)
�r irk ui Ment `^J i II be an �br v+a oa n m
1-Un cd Old : �aM hoc O ce i n area 0. osS
UL L- Nor n tlro ed j
16. Will return water re-enter the reservoir? (Check one) ❑Yes ❑No P&A
(If Yes, specify point(s) of re-entry and show on Excavation Area Drawing)
17. Is there an existing facility e.g. pier that access is being maintained to by y conducting the
excavation? ❑Yes OqO 1 � eve Docy) -}"D be CD�S-�r'i tL CC w 4� 511 p OL acCeV1'-
(If Yes, provide the ex' 'n permit number. IfNo, include a scaled drawing of the �rroposed
facility). Permit # 1 t l �JCO � D e X I S� ✓l dt)1— 1 �CC�`C + O ► A .
EXI�Ain LSO V) C?ti � � C� NO Will be-- re►�Oved .
18. Total planned duration o the work (Include first equipment mobilization, excavation
through final mitigation measures complete):
START _Z I FINISH_ I
(Month) (Year) (Month) (Year)
Duke Energy Page 7 of 13 rev 11/22/21
Excavation Program

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Duke Energy Excavation_ Permit Application Form
C. Applicant's Signatures
Comments:
Applicant Name (print)
Applicant Signature* Date /-
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Date
Date
Date
Co -Applicant Signature* Date
*Per my signature, the information provided in this application is correct to the best of my
knowledge.
Duke Energy Page 14 of 13 rev t 1/22J2o21
Excavation Program

Duke Eneray Excavation Permit Application Form
Part M. Additional Information
A. Deed and Survey Plat: A copy of the deed and registered survey plat or other instrument
under which each applicant and co -applicant claims title to the affected property (the
shoreline adjoining the excavation area, equipment staging area, area crossed by any spoil
and return water lines, and the disposal area). If the applicant(s) is(are) not the owner(s) of
said property, then forward a copy of the deed and registered survey plat or other instrument
under which the owner(s) claim title plus written authorization from the owner(s) to carry
out the project on their land.
B. Excavation Area Drawing: An accurate drawing of the area to be excavated. The drawing
must show at a minimum, a North arrow; the boundaries and acreage of the proposed
excavation area and equipment staging areas; lake, county, city, cove, tributary, road and
subdivision names and lot numbers (as applicable); property corners for project front lots;
the full pond elevation contour and lines dividing the cove width into equal thirds (as
applicable); approximate volume in cubic yards of the material to be excavated; point(s) of
return water re-entry; the boundaries of any adjoining areas that are to be specifically
avoided or protected during the work and the location (address) of the disposal area for the
excavated material. [NOTE: A copy of this drawing must also be provided to the
excavation contractor to ensure restricted areas are not impacted.]
C. Disposal Area Drawing: An accurate drawing of the proposed design for the disposal area.
The drawing must 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 rev i 112212021
Excavation Program

Duke Energy Excavation Permit Auaflcation 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. Sample Agency Comment and Response Table
en Comment ; A licaat.Res once
A en 1
The activityis approved as proposed.
NA
Agency 2
The on -site well provides drinking water to the
Contacted 1VIr. Smith on 1/l/20xx. No
public. Please contact Mr. Smith to discuss the
further action needed.
proposed changes and potential issues
associated with your proposal.
You must contact us immediately if
Applicant will contact Agency 2 if
endangered species are located during the
endangered species are located during
course of construction.
I construction
Agency 3
Requested agency comments on 1/l/20xx and
NA
again on 2/l/20xx. No response as of
2/1620xx.
AgencyAgmcy 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.
Table IV-2. Sample Agency Permits and Certifications Table
Agency
Permit/Certification Name
Date of
Date of
Issuance
Expiration
Agency 1
Surface Water Withdrawal Permit
Agency 2
Section 401 Water Quality Certification
Following the two summary tables, include a copy of all correspondence to and from any local,
regional, state and federal agencies or other organizations with which you are required to consult,
including any required permits (e.g., Section 401 water quality certifications, Section 404
dredge/fill permits, building permits, etc.) or other approvals or comments which have been
obtained from these organizations regarding this activity. Include a copy of any local, regional,
state or federal regulations or guidelines that will be followed. All permitting issues must be
resolved and clearly documented. Correspondence should be organized in the order the agencies
are listed on the Agency/Organization list with the applicant's request for comments followed by
additional correspondence in chronological order. All permits must be valid at time of
Duke Energy Page 12 of 13 rev I1=021
Excavation Program

Duke Energy Excavation Permit Application Form
application and have a term longer than the projected schedule for completing the permitted
project.
Part V. Additional Information
Provide relevant additional information. Reference previous parts as applicable. Include the
FERC-required Environmental Assessment if you were directed to do so during the initial site
visit. If there are co -applicants, this is where their information would be provided (see Part 1).
Duke Enemy Page 13 of 13 rev 111=021
Excavation Program

FILED ELECTRONICALLY
CATAWBA COUNTY NC
DONNA HICKS SPENCER
NORTH CAROLINA GENERAL WARRANTY DEED
Excise Tax: 1,12 0.00
FILED Aug 12, 2022
AT 10:53:00 AM
BOOK 03762
START PAGE 0766
END PAGE 0768
INSTRUMENT # 17787
EXCISE TAX $1,120.00
Parcel Identifier No Verified by County on the day of ,
By.
Mail/Box to' 1318C Davie Ave, Statesville. NC 28677
This instrument was prepared by:.
Brief description for the
THIS DEED made this 10t—h day Angnst by and between
GRANTOR
Kevin A. Grossbeck
and wife,
Penny Grossbeck
134 Trotter Ridge Dr
Mooresville, NC 28117
GRANTEE
T. Davis, Jr.
Property address:
4232 Slgmon Cove Lane
Terrell, NC 28682
Enter in appropriate block for each Grantor and Grantee: name, mailing address, and, if appropriate, character of entity, e.g.
corporation or partnership.
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 avaluable 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, parcel of
land or condominium unit situated in the City of , Mountain Creek
Township, Catawba County, North Carolina and more particularly described as follows:
See Exhibit A, attached.
The property hereinabove described was acquired by Grantor by instrument recorded in Book 3620
page 1081
All or a portion of the property herein conveyed jLincludes or _ does not include the primary residence of, a Grantor.
A map showing the above described property is recorded in Plat Book B4 page IL 71B
NC Bar Association Form No. 30Revised 7/2013 Page 1 af2 This standard fora has been ataxoved jointly bv:
Printed by A! submitted electronically by "ALAN G CARPENTER PA"
In compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Catawba county Register of Deeds.

TO HAVE AND TO HOLD the aforesaid lot or parrcee oflann 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, other than the following exceptions:
Easements, rights of way and restrictions of record, if any.
IN WITNESS WHEREOF, the Grantor has duly executed the
(Entity Name)
By;
Title:
BY*
Title:
By -
Title:
State of North Carolina - County or City of
1, the undersigned Notary Public of the County or City of
personally appeared before me this day and acl
therein expressed. Witness my hand and Notarial
My Commission Expires: —`i
(Affix Seal)
%r-Ni�
State of
1, the undersigned
A.
written.
(SEAL)
(SEAL)
(SEAL)
(SEAL)
and State aforesaid, certify that
Lion of the foregoing instrument for the purposes
day of A -up, at , 9 0,22. .
Notary Public
Notary's Printed or Typed Name KXNNETH S. 80 mmE5
of and State aforesaid, certify that
personally appeared before me this day and acknowledged the due execution of the foregoing instrument for the purposes
therein expressed. Witness my hand and Notarial stamp or seal this day of ,
My Commission Expires:
(Affix Seal) Notary Public
Notary's Printed or Typed Name
State of - County or City of
1, the undersigned Notary Public of the County or City of and State aforesaid, certify that
personally came before methisday and acknowledged that —he is the
of , a North Carolina or
corporation/limited liability company/general partnership/limited partnership (strike through the inapplicable), and that by
authority duly given and as the act of such entity, —he signed the foregoing instrument in its name on its behalf as its act and deed.
Witness my hand and Notarial stamp or seal, this day of ,
My Commission Expires:
(Affix Seal)
NC Bar Association Farm No. 3 C+ Revised 712013
Primed by Agreement with the NC Bar Association
Notary Public
Notary's Printed or Typed Name
Page 2 of This standard form has been approved jointly by:
North Carolina Bar Association —NC Bar Form No.'3
North Carolina Association of Realtors, Inc. - Standard Form 3

EXHIBIT A
BEING ALL of Lot No. 4 of THE VINEYARDS AT KISER, as the same is platted, planned and
recorded in Plat Book 64, pages 178-179, Catawba County Registry.
Parcel: 0802988
PIN:461704508673
Property address: 4232 Sigmon Cove Lane, Terrell, NC 28682

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THE INFORMATION CONTAINED W THIS DRAWING IS THE SOLE PROPERTY OF LANCAS TER S DOCK& LIFTS SYSTEM INC.
ANY REPRODUCTION W PART OR AS A WHCLE WITHOUT THE WRITTEN PERMISSION OF LANCASTER'S DOCK & LIFTS SYSTEM INC. IS PROHIBITED
A LL DIMENSIONS USED IN THIS DRA WING ARE NOMINAL
ISSUE CLIENT
■ 01-09-24 Terry Davis
DRAWN BY 4232 Sigmon Cove
I�A M.H. Terrell N.C. 28682
Lancaster Custom Dock and Lifts
1156 Perth Road Troutman
North Carolina

THE INFORMATION CONTAINED IN THIS DRAWING IS THE SOLE PROPERTY OF LANCASTER S DOCK& LIFTS SYSTEM INC.
ANY REPRODUCTION IN PART OR AS A WHOLE WITHOUT THE WRITTEN PERMISSION OF LANCASTERIS DOCK & LIFTS SYSTEM INC. IS PROHIBITED.
ALL DIMENSIONS USED IN THIS DRAWING ARE NOMINAL
ISSUE
CLIENT
■ 9-25-23 Terry Davis
0 nRAWN BY 4232 Sigmon Cove
1-116 M.H. Terrell N.C. 28682
Lancaster Custom Dock and Lifts
1156 Perth Road Troutman
North Carolina

DRE )GE spm® nrwncAn FtOR l
Project name/address:
i7 t S a I�r County: v- + �5 c
Location ddressl lU Pic
v e� i vJa >r C I l
Parcel #:-4CDJ f
Parcel/lot size
Disposal area required (sq ft and/or acreage)
Acknowledgement of FVoti}icotlon
am aware that the site must adhere to all state regulations
and rules regarding sedim nt and erosionVy
co roI a d wa r unVi2�
fi
Name of Individual and Company
to dispose of their dredge material at the above stated location
Owner:
Print Date; 1 5igna ure
�— !
Along with form, please provide:
Aerial of parcel/lot (County GfS)
Photo of proposed spoil site
Identified proposed spoil site

No Raeaae Stamps per NCGS 5eckloa 10f3.22EL2 M
No ciosmg facia
No 00 opinion randered
Tax W140.
WO prepared by Cvion W.
Scu& Maio 9tr0 , Moaresvllte, NC 28113 v
Brief Description for the bxlu
Type: CONSOUDATED REAI
Reccuded:112512018 3:08:B1
Fee Amt: VS.00 page 1 of 8
Revenue Tom $0.00
IrodoO County, NC
Ronald N. Wyatt Reglster of E
BK 25M PG 172,
Pawd ldwM= No. 408.20.14M
•1732
estby, Attorney at Law, Homestay & Whtgo Law Group Pla 330
maamw.eem
Loci 2 of Rmmbbaatioa rtat, mat Book dl at Loop 111
NORTH CAROLINA QUITCLAIM DEED
Brywat F.Iatnter, Jr. and wik Cynthia A.
Jai W Thomas Lm mlermd w*, Tent' Leigh
* ---- -
lk, Id+C, at Nori6 Carolltta
1162 l 162 Ittva H{�hisvnv
Rh7te.1+IC28t 17
um=r ana wwmo as used heroin shall hrcIuda said pwtws, their heirs, saeocaaota,
Plu4m=ulhkkfttb ortmtia as required by diem.
pap
PO 8t A.O.!
Boole 2M Pages 1727 Page 1 de

'that said mmmoG � and hi oo� „� de �„ � ran Dollma {Shoo} m hhn pad, � �
has r�tdaad and t>shataed and by those p � . ��. �yoy end fo of � thethe
CnatrEna� his hehs sod/or steers sad assigas, eit right, tide, ah�&n ead inoaa+cst oftho tt�arsrstnr h1 and tb a amtaht erpenoel of Ana � � aye Tom at tREDEtd. COUMY, At�Bt t�re>ina and tame d �
SEE E7MIT "A" ATrAC® R MTO AND INCORPORATED
Bode 206 Pages 1727 page 2 of 6

SIT W
North Carolina QnftdWM Deets
BMW() a l of Lot 2 as shown on that certain pint entitled "Recombination Plat of 10.SS3 Acees t
High V ISO prepared for Big Daddy's of Lake Norman" as am is shown on map recorded in
the Iredell County Public Registry, reference to which is hereby made for a r
Also eoaveyed herewida is a perpchW non-cxclusive easement for ingress egress and regress and such
as are V Mad hr that essamant recorded in peat Book 2293 at Page 1332 of the TredeA County Publ
This ecnvoyaaoo is also subject to such easements as are granted in that saran *mocnt agreement,
This pruporly (the "fmpNWI has been held in the trust (the ` frust j established in item Six of the Li
Testament of Bryant F. Lancaster as found in lMdell County File Number 97 E 496. Parsuaut
BOW=t agreement found in said filc,, Bryant F. Laacestar, Jr. is the trustee of the Trust and b
PWPWtY 'a UMJo P. Lance, the � Bryant F. to the tWm$ Of Item sLancaster which a Jo Anne P. Lancaster dterm inchxW the payment
ed in 2017. Bof ey du
Of the Truk the Trust principal shall be distributed to Bryant F. Lancaster, Jr., John Marcus Lan=
Thom Leacaar and Shari Lancaster Bail (amllcctively the "13e0ficiad0n. free of trust. Lot 2, t
Is the principal of the Trust. The Beneficiaries and the Trustee have determined that it is in their i
intend to distribute the froporty to Lancaster Family, LLC ap this is a limited liability oouapauy that 1
Of the BetefloWas equally as its members. By their execution of this dead, the Beneficiaries s
consent and agreanhont to this transft and authorize the Tehstee to make this conveyance to die Lan=
LLC.
d on N.C.
Book 61,
particular
Will and
a family
held the
Wfnam to
rovislons
r, Jeffimy
may,
teal best
craposed
My their
Family.
Bode 25M Pepe: 1727 Page 3 of a

(Nater Do eat place seal
outside tbia bux huo the
malmin) STATE OF NORTH CAROLINA,
COUNTY OF mwELL
I am* that the Hallowing pemau(s) peMonagy appeared bef)m me i
Je ftWT�wj I and at elm signed fire €crmste doaua
Witness my I=d and official SUAIP Or seal, ft.&.& day Off
Notary M
MY Con Miwon Rvhles:
M.
SOOk 2W6 Page: 1727 Page 4 of 0

PUSUW to 19.C" § 1053172(4 tbts certaia tot or pared ofland does not i:ulnde the Gtantot°a
P* 41 sad ep0minabove Book U4 � byC by inshwircant enaonded to Book 12f9i Pie 2474 Book 2@g6,
A mg "wingtbc abovo•dascribed propa:ty is moasded in Plat Book at Patpea
TO HAVE AND TO HOLD do affimsald W or pvW of lad sad all priv90M and appurtanmtaes dtaw to the
G=to% hip heba mWw saccas M and sssiges, fiBe and db dwpd Am all dgh dtia, claim and interest of OmWw or
mWm dblollblift ughorunderhim.
11IFI8R80F i
�= dho ti Q'ft has h=UU3 sat has hand end seak er if ompm2N has ceased tads 1104MUM to be
DheCt m the y�ar �aboveIls �writt�t. Whozind ° and ib seal to be baarmio atihced by setimrhy Boa=d of
Lnncaater,Jr.
Brut F. i aaeaater, Jr., Trustee
(Note: Dot& place seal
, w3tsidetltis box into the �
STATE OF NORTH CAROLINA,
COUN Y OF iREDELL
1 c wdfy that the following Parsot(s) Pmwully appemW before me 1 hisday,
each aoknowlcdging to ma that he or she signed the Bing d0ow cut
Bryant F. Lancaster and wipe, Cymbist A. Iawuater and %yannt F
4 �'`•tip%,,, Lancaster, Jr.. Trustee,
a.TARy,•:
pyft81.1o:I Witness my hand and official stamp or soal, this day of
L�••N. ••�• 20&•
COu Notary Publi `
My Commission Ettpicas: ©�
Book 2555 PaW 1727 Pago 5 as s

not
oatsiOhft dd p� saa] STATE OF NORTH CA OLINA,
outaido this boot into the
non) COiJIV'IY OF _..r_ ray& l
I ca* that dw following persons) FersonADY appeared before me
cwh lodging to tne tbat he or sire monad the faigoWS doom
1� Ban and tdiand, Dcnuia Lynn Ball
SOT r ' Wita my band and afHcial or
In
�'•......••� .
co� N Pab
�< y _
My Commission Expokes:4: p
IL
14:4)
{Note Do not plsoe seal
outside Phis baoc into the
STATE OF NORTH '` O ,1NA,
margin)
COUNTY OF
J r
...... Lefth
I caft that the iblbwb* PusMs) Per appmed before me thl
w to me that he or she signed the fategoing
I der,
John
Q
�y ,• p[1BL�+!?�v
W my head and official stamp or seal, ibis s�day of
fit)
Fjl
N+otery
CpU�
Pubs
My Commission Expires: j
0
I
DOWC 2ba$ Pages 1727 Page 9 oia

Y
TYPW. CONSOLIDATED REALM OPERTY
Recorded: 4flrA14 5.02�9 P
Fee Amt $2&00 Pape 1 of 5
Reveriuo Tara'0J>fl
tredeli Coulny, NC
ARatthew J. McCaU RsQister of s
BK 2293 PG 131 1323
No Revenue Stamps
'�0. itooksad $age
Tul.& o. PanWId arNo. PardwOMM-1
3MNby on tltodW*-f20 by
ma mor Mile butfulaw Wes p VVW by Laura & Temple A#Qmq at Law. H*mt ft & Wtugo Law Group FLU WO Sou*
Maim ShIG4 MocraviDog NC 29115 wwe lalmamvuu lawaa m
BridDeecripdtal fortho bndmr I L,ot i ofReoomblanden Plat
NORTH CAROLm QUITCLA= DMD
BryawF. T and vft Cyadds A. T.0 Fandly,Mq a North Caroiima
Lmenter U&bMty compmW
1162 River Hie M
MOONSWII&KC22117
Laacadwmd vylk TeM Leh
Lallenter
P.O_ Harr 147Z WOOMMi tw NQ 291 IS
Sled LM and huWud, Da Na LM m Bap
4913auhMain Stm L Lim mom NG 2am
Lilo MWMW UMW ad Uu'BMtee a used herein shall Each de sold paitim !bait helm, eta, and assl&A& and Shad
iaehlde , F�s >aasanllaa, f�alnine OT npuar ffi l+ogllired by omtfitou..
'that said tlleato; far' and in com9godin of fho mm of Ton Dollars ($10.00) to hhn paid, the wooipt of b hereby
admowlads , has rembed sad released and by these peesem doss nmrise4 mice , convey and forever unto the
lira tm hishdm andkr mccemom and awlso4 all dght, di* chdm and Imest ofthe G reala r in and to a certain or parool of
Lead bring and being in the Davidaoa Townddp of MEDELL COUNTY, North Carollm and more padcaWb"* bed as
fellows
SEE EXIT "A" ATTACBBD BERETO MID INCORPORATED BY RE
�
�u� ROTC
Book 22W Pogo late Page 1 of 5

� tbaN C,C:,S, 1051,317.=i2� this wra is lot or ptrcei ofMd dmndbdm dethe GtaeW#
�
4 a" demOW was wquu+nd by des bN mromrm in Book aA Pap 1474 Boak 20K
e 800kM4fags70L
A map ftwingthe aNw&d=wfW Fope4Y is =Mded in pW Book at pages
TO HAVE AND TO HOLD to atbresaid lot at pascal of land aad all privneges and apt *M to
be
csYea t^ bia bdo AmVcr Rd assign9, BW and dbobarged from all AA title, alaim and bmw of c �u or
2t+ane olaimingibmughor underhim.
IN VfitTXM WIIMUM. the Gnalar has hateva09 an his had end sot or if c9rpnoon , has caused this I=
sigtW io its cote me name by its d* mdl Mftd offkm and its sal to be hm
ent as be
anb affixed by authority oil0.1oard
D aa,the4W ndyou t�abo�ewrlmett
of
F Lancaster
A.L w
SEAT-)
I
t
{Mote: Do not place seal
outmode this box into the
I
margin)
STATS OF NORTH CAROLINA,
COUNTY OV IRBDELL
I certify that the following pm l*a) personally appeared before the
ft day,
Evmop
each acknowledging to me that he or she signed the foregoing doctu
=t;
*90&0*
1ltyaw Jr. Iaa sad Vdk t A. Tantssoer
Wig my hand an l-o c' or seal, tltisMat day of Mmrk
2014.
Notary o
My 28 2017
eoolc 2293 Pago;1310 Pap 2 at 5

(Note: Do not glace seal
outside this box into dw
margin)
,Ti
SEATS OF NORTH CAROLINA.
COUNTY OF DELL
I mdfy that the f011Owfug Persons) PaaoU211Y apPearW before me t Lb da x
each Jemmy TTtonras $ erwd wilt TSWLeigb Len
'wimps nW hand and or seal, ft hat day of March, 14.
Notary e
MY Bxuaxs► 28L201 i
Boole 2293 Pages 1319 Page 3 of 6

(Note: Do not place seal
outside this bbx into tha
STATEOPNORTHCARMik
COUNTY OF MW13LL
i cattily the &CfWWWing P+Wn(s) lrersonally appeared before ran
L. HaII sad L mh $ to me that he or she a*cd the faragoing . Igo
usbW4 Dennis Lytm Ball
Wittress myhood ole p orsa4 tbbSiltday ofM=4
Nolmy Pub
w Com Janus 28 17
Book2293 Paom 1319 Page4d5

• . .
r a �
North CarGMM QmMbim heed
BEINt3 all of Lot 1 0 shown on that cmdn plat enMW -Recombination, Plat of I O.S53 Acros 150ilr red for
t of
Iredell Couaty's oPufblioLike Nomlan" as same is shown on map recorded
descrWft34 eefanm�oe to which is hensby+ made for a 1
bed on N.C.
Asap Book
e pmfwukz
Boole 2203 Page:1319 Page S a# S

gg4pw
Z"%'rt 04oFITH
i` nGCN
.+gOLIN
u & a Q _.
FILED
CREPIEL t. COUNTY
to mr
$91 J141 7 PH 4 25
qcex0823mdM
1 BELL
REG[B i t:. OF DEEDS
taeow0w trtmm. awl: awd ~
TU Lot s. ,. — . .. _._ _ _. _ _ .. Pland idomWer No.... w
'tretfded b3► —_ _.»._ __ _.... — ».... tbaafy as am dw at .. .. _..... __
Ar
Also sailor ra tdlag to .......... _may r .ik __ _.._».....�..... _ ..
8C , 20115 ... ._ d .
Tlf1' ant waa ptepmd lw ...%r_Sai .BUY,. lTr.. , Attatnnf at inv ..
Dow daaa tobn for the Indes � t
WORM CAROUNA GIEN£RAL WARRANTY
VERB 1M teede thEr ..2th..... der of .. __ _ JUM ..
GVANTM
$AD28 A. BAi1BY and vue,
IBM S. SAniBY
of Iredeil Cotmty, S.C.
. 0 91 . by and between
aRAi' TER
BTs DUMIS OF Lum =woo
a FArm Darollas aolDOlatia
Whose nallitt6 ad4ress sat
Volute 8s Buz S81
maerasa311as. ve 2"15
"""— tn,wwpdda MA for ascb tm7r =a% a"mom sak z mumm ts. domwr at mom. sq, mpunum or pastas
T10 dssiswmm Grams* End *mat" as =ad beasda slide vaailaa, tialr hydra, saweaator% say
" brinda stssgu%% idarot =umlta4, fe *dm or neater as regairal by coabmL
WPl'=BBM that the *=At^ fw a Valwhic tottai oMfos paid by tho Grastm the reaatnt of vM
%dacmdeftek has and by these prumb does graal, Wptn. sail and eot M Mato the Qsabe Est he st
eettain lot or Intel of ]sud Aftua w is am M of _ . DalvirJsoa
Iredali C mnV.X*rlh Cmrd iaa and aware pattEeot$tty drxeEred as faRaws:
B URM art a point in the cotter of & . 1396, Braid Point or begirgAms being
the soi^theast mteer of V. A. EiMrA =A snnOing times with the coat erline of
S.B. 1396 wa rth 06 an as ado. 40 sea. Nast: IS0.03 goat to a point, tits aanl3oea
co=az of Sidney Hapn and t wU& the tdth do Hassle line Sarah 87 deg. 56
udn. 37 sea. Vest 1.147.b5 feet to as isen Pas to the Albert jr. Tbrraaaa lines
thomm with tiro tosrence line South 50 deg. 16 nin. 47 sec. Most 270.12 feat
to an irm pin, the northwest comas of iln=W Lommster= thence tclth the Lane"
lies Moarth, 88 dog. 53 sin. 14 sac. Bast 652.12 teat to an Sran Pin, comom cam
of Yaagy Laneestm and IF. A. Bovteerd; thomea vith the Bound lira Song 83 des.
36 ada. 10 me. test 273.0 tact to the point of nommme the aaere be ft Sot era
with a survey =de by Dom Alley Swmayttra, IOC.a dated Kay 31, 1991.
And being the sauces psopcM coavaysd to Eddie R. Heiler attd ti0es Paggy S.
by deed Xecordad in Deed Book 759, at Pages Mo litedell County Begietry.
and
to bH'ebi
R alE that
KCar4*nmr mW39nrx.tkrr,aatsn
.wwa.v�a�.nw,. a aaai. -tap
t♦

aiJPmr
The tn'oyerty haremabosa deaeribed w" acquired by Grantor by lastrtiment ret:orded in
Geed Book 754t.. p 808a Iredeil Co Ile t
A MOP shoving the above dammed prP,,4t is recnrdod in Plat Rook ........
" HAVE AND TO $OLD the aforaoid lot or Parcel et land and all privil - Pa>ia---........-
am Grantee in tee simple, eg a and appmtonaacem tharotn in
And the Grantor eo+:eeaatd itll the Grantee, that GraatOr is seated of the pt mhas in Yee simple, has the right
awcy
���the same Itr Yee s3mPls, that IfUe is Ma4wifible and tree and clssr o4 all [u[eumbranees, and that Grantor vi ill warrant and
��roaY� tbn lawful doth M is pateoas r, the never except for the excepU as bereioafter stated. P herelaaho►� deaet¢bed is saLject to the foliotriag emeptioaa:
This conveyance is n[ade SitBJW2 TO all restrictions. easem=rs and rights of way
es£ x"OTdy including those for utilities sad public roadwags.
Af 1rgZ7a $ BEMISpB, ®e O[asme 3a3 balsam& we bb Asmd aW =a,, re tt a7hW anteNWANd VW las¢aYmsat td ha eta
a rtll>eana[ae hT usdsly sm0lad.Aan
ed Pltlesm d n. WI m 64 aereanaa attlsaa by eperiWe s.[eea[lq eat US �'h SW ep a iRar ilk:
x Eddie R. Salley
Sri ley ---
xrrarr: x
V
___..-_________-.-.-.------.____— —...
s a keu,s tka[ es no Ce=dy X" ew. 4a&n.4¢s..+ecur we _
G` O +i i 's .x ...-- ?..�&. 3Ynd Sid - —_... —• - ., ..�
s.: r = 3=a_.�RggY._S�_iR11.eA--•------
3 Lt G'a = arpsared 9sfars =w /[ dsY sad ad[oarledHd ue.asoaan at [ha ta[aaatr4 •- a Wl1a aaa v
�4 _' "••.... ..•f•! r alma sad SIUCW OZAD oa scat. ttUa __7tfc _ dv at dune _ --- --- -- •• ys,-,91
N,h•n[.nn,d A¢y caaimtutaa .see:.._ 11. 42;:42 —'---- ���
7Gu4[y a5¢aS¢s
cifaO,arAa�: Kane$ ra&ne..� -------- ----------- ---cam• '
1G a timlz[y ftbUa at C[m Caaa77 mad &text ale.css4 ai4!¢ mu
a� Dd W[ amr Ammm me " daq sad mehmomt." d .t _--. ar b ...•....R.....Y
it —_ a lnatus c�a swmaaatl� sad tRat 1d[ au ,1¢�
i4 ahea sad >: the act at tee eoiyy[ aml the twMalaa I arts steed In us tam! W ft --
eas.ldeat, stated adra Im &&motet& arst and auaud 6Y -- as aszi
_-•---........�_
anmetu tar his" and OMSA damp ear seal. I t—_,-_a.r a4------__—�..--._-_�.
tdr oGat[t E.M C41ta:---•-----_'---_•_'----............
— ------ gawk
7aee SeaSLami Ceazioa kW al
10 t4 e0IINC SHIa 2ZS&bma21! sad M& e ttMuto ssa datY "aAo .a aC It.r dale ewd t¢a[e sad le aW �ia/Zfc and Sane >apam tlr Ar
-.—... �._._ � �- L¢' _�satBSsse oa• a6a:ma dam--- ����y.c..._. [E!
�1 ...sports=
II
i
AL 4n � aaaa fFu•mPCSS E F97a awucd fa ¢4?'d- axc-.sum. or_ c.. [n.».m-..K c zi.75n

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DUKE ENERGY DIRECTIONS BY ROAD FORM
Lake Use Permit Applications and Contractors: Ease of locating a proposed project
site can 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 12Q
526 SOUTH CHURCH STREET
CHARLOTTE, NC 28202
Applicant's Name: Silas T Davis Jr.
Street Address (at lake): 4232 Sigmon Cove Lane
Lake Name: Norman
Subdivision Name: The Vineyards at Kiser
Property Section: Lot #: Lot #4
City: Terrell County: Catawba
State: NC Zip Code: 28682
Directions (from major road or highway):
From I-77 NB, Exit 36, Left onto NC-150 WB into Catawba County, Left onto Kiser
Island Road, Left onto Sigmon Cove Lane. Property is on the right.
Descriptive Structure(s) on Property (i.e. brick garage, white fence, mobile home,
etc.) Building Lot.
Note: Please use the back of this form if desired to draw us a map to the site.

4232 Sigmon Cove Lane, Terrell, NC
0 125 250 375 ft
0
CD
0
Uj
9
35.576820,-80.964579
aMaps Legal _ +
CRM ♦ Deg ♦ DMS Help
Decimal Degrees Latitude: 35.576820
Decimal Degrees
-80,964579
Longitude:

DUDE ENERGY DIRECTIONS BY ROAD FORM
IANCASTER CUSTOM DOCKS
Lakc i•.Tse Permit Applicants and Contractors. Fuse of locating the proposed project
site canhatea big impact on perniittin F p of ect
return it aloe R processing
to- time. Please cofnpiete this form and
R R'I�1 YOU completed application to:
1]i1KE ENERGY
CIO LAKE SERVICES — EC 12 Q
526 SOUTH CHURCH STREET
CHARLOTTE, NC 28202
Applicant's Name.
Street Address (at lake) 1 l b2 Riv r H' bvva lido villa N 28117
Lake Name: jv
an
Subdivision Name.. 131D 9s of L e Norm
Property Section: Lot #:
City: Mo sville County: 1 e
dAll
State: N
------�-- Zip: 28117
Telephogle: — 704z361,49og
Directions (fi'0W major road or highw y): ;from 1--77 ND, Exit 36, Left onto NC -
'So WB, Disposal Area is on the right behind Big Daddy,s Restaurant
Complex.
Descriptive Structure(s) on Property {i.e. brick garage, white geriee. mobile
home, etc.)
*Note: Please use the back of thiig form if dtaired to draw us a map to the site.

1162 River Highway Mooresville,NC 28117
0 250 500 750 fc I
RUSTIC WAY LN
a
Z
0
Z
m
0
i
• Performance
Hitch and Trucl
Accessories
•
35.604043,-80.910286
Drag Me?
R
BP
a
U
U
Foothills Marine
Maps^g—of fake Norman — -�
Le al
CRM v Deg v DIMS Help
Decimal Degrees Latitude: 35.604043
Decimal Degrees Longitude: �-80-910286
Clear Show Point

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CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
( Z32, 5 r morl 64/eLn
Project Name/address: vI eCi�� `Fev-n 11 C County:*
Owner:
Contract
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)]
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, 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, Sl �� � � �Cl� l S �1Y` , 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.
Date: 12
Signature (owner): 11 e� /� `� �

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO:
STREET ADDRESS:
4232 Sigmon Cove Lane
Terrell, NC 28682
Please print:
[aV.-I ■►[i�
Property Owner: Silas T. Davis, Jr.
Property Owner:
PARCEL ID: 461704508673
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):
P.O. Box 1709
Huntersville, NC 28070
Telephone:
We hereby certify the above information submitted in this application is true and accurate tothe
best of our knowledge.
C(.a-
Authorized Signature
5-26-2023
Date
Authorized Signature
Date