20240490 Ver 1_Site Plan_20240401

[�D� �Ye��e 1p0�X�0xfD
Proposed
Slopes.
3CpQ��' (Plan View) (P
be- low
La ke
i
(At II P 6d/..Normal Water Level)
4
FuII Pond/ Normal Water Level
Shoreline'.'I
-- 5o'A/D` 560s f
e0/15+. Con-l'dol-
La ke
{At Full Pond/ Normal Water Level)
Existing Dock
30ftx7ft
3ftx150ft
Full Pond/ Normal water Level eeiow full pond/ NWL
Shoreline 4 ft x 160 ft
Riprap s y r Abave full pond/NWL
2 ft. x 150 ft.
additional clearing E
• if necessary {
i
AMPLE,'
Plan View i

7
W
_..-Lake
(At Full fond/ Normal Water Level) is
CID
c
i6 —
} E
3 0 s
Z. v,
c
Side View
U-
3 ft. below full pond water level 4 ft. above frill pond water level 2 ft. additional clearing
if necessary
Existing bank
10 ft. bank
height �csQ+a
Q�0
FORM: SSGP 02-2017 Page 4 of 4

IfeUell I.UUHLy, IVUILII C.dIVlllld iViari,ii lo, cvc +
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1 i _
— 194E
a9 t
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893
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1" = 135.67047907019898 h
Tax Map Information
Print map scale Is approximate.
PIN
4626038676.000
Critical layout or measurement
- Address
897 KEMP RD
activities should not be done using
-Account#
Acct77435469
• Tax Owner
$LOOM ADAM
this resource.
•Mailing
19220 DAVIDSON CONCORD RD
Address
MAP FOR REFERENCE ONLY
•
DAVIDSON, NC 28036
NOT A LEGAL DOCUMENT
• GIS Owner
BLOOM ADAM+NICKIE
• Deed Into
1597 11555 - WD - 20041102
iredell County, North Carolina makes no claims and no
• Tax Acres
0.933 AC
warranties, expressed or implied, concerning the validity or
• Lot #
197
accuracy of the GIS data presented on this map.
• Description
CRESCENT LAND+TIMBER S8 PB15-
Geometry updated 0212012024
56
Data updated 03/18/2024
Zoning
RR
Old Parcel#
1702FO300OA197
• Bldg Value
$615,960
OBXF Value
$11,450
• Land Value
$810.000
• Total Value
$1,437,410
Defer Value
$0
• Tax Districts
-ALLCNTY FIRE- -

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-HI.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 I 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 Ietter, type "NO RESPONSE"
Duke Energy Page 1 of 13 rev 11/=1
Excavation Program

at the top of the follow-up letter and include it in the application along with proof of the
agency's I 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 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 NC WRC 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 (SCMA): 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/=1
Excavation Program

Step 4: Final Application & Submittal to Duke Energy
Following the consultation process, finalize the application. The final application submitted to
Duke Energy should incorporate all comments and recommendations provided by agencies and
organizations during the agency consultation process as well as copies of all permits received. In
addition to the final application include the following:
• One check payable to Duke Energy for the application fee and security deposit
• If applicable, a separate check payable to the appropriate Habitat Enhancement Program fund
• Signed Excavation Program Applicant's Agreement
Note: Co -applicants must also submit the application fees and applicable HEP fees with the
application.
Duke Energy Page 3 of 13 rev 11=1
Excavation Program

Duke Enerey Excavation Permit Application Form
FOR DUKE ENERGY USE ONLY
Duke File No.
Application Fee S Security Deposit $ Check # Date Recv'd �II Initials
�
Date orDuke Energy Lake Services, applicant and/or contractor on -site inspections DatLZ ZL.p 4ials
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 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. He copies of Approval and Close-out Checklists and any Stop Work
Orders with application.
Part I. Applicant Information (Please Print)
Name Mann ' l rnn-) Telephone 104' 784- 3 47L
Email address: {
Lake Address Mailing Address (if different)
gq-1
I onre_-vi IIP_ 2LB 117 _ ty�d �, _ N ('_ 2803(o
Contractor Company Lxincatkc Lb:6na _ x.6 9 L .F± 5)e54x*_ ' Inc.
Contractor Contact Person 'P LAr to 1 Telephone
Contractor Email Address:
LAKE LOT INFORMATION 1�
Laket >o � County 1 >r e d &_j t City r State � TaxMap No. V(p
Subdivisio 4- Lot./ Section No. Lot Size •133Aeres
► mber czrp.
Duke Energy Page 4 of 13 rev 11i22121
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) IXYes ❑No (If Yes,
include name and mailing address below.
Name: �a in af)l& r oC- Tax ID. (�~_ 4 1� q�14
Mailing Address: 115L Pe'r+�) ' -
7-e-nulamn, N G 2811oCa _
Are there any Co -Applicants*? (check one) ❑Yes gio (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 inspectionQZ -Z.0 Z.I-
Initials (Duke Energy)
(applicant/contractor) V
Duke Energy Page 5 of 13 rev 11/22/21
Excavation Program

Duke Energy Excavation Permit Application Form
Part U. Description of Project
A. Basic Information
1. Type of excavation: (check one) ONew excavation ❑ Maintenance excavation
2. Purpose of excavation: (check one) 0 Boat Access Channel
❑ Water Intake Channel ❑ Wastewater Discharge Channel
❑ Other (specify):
3
Lake user category: (check one)
❑Commercial Marina
❑Other (specify):
, Private ❑Residential Marina
❑Public
4. Max. Excavation Area Dimensions (ft): Length �� Width 4!C Depth / 0
(Note: include additional area dimensions if necessary so response to #S below equals max. area
dimensions in 44)
S. Volume of Excavated Material (TOTAL for the project): Al 5 C- Cubic yards
6. Type of material removed (applicant determines by field sample ifpractical):
SQy)d 5a QLAd C low
7. Excavation Site area:.0 Acre (s) Disposal Site area: , d�.3 Acre
(s)
8. Total Disturbed Area (including equipment staging area):_ _ ._%�O Acre (s)
9. Does the project meet the requirements of the applicable General Permit? (check one)
) 3Yes ❑No
10. Do you claim title to the disposal area? (check one) ❑Yes ❑NO
11. Do you claim title to the equipment staging area? (check one) ❑Yes -EINo
12. Are there any water -treatment facilities within 50 feet of the proposed excavation area?
(check one) ❑Yes ,0N0
(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 design):
�Y w 1 �-h 1 o r ecLC.h f XCa"Ja r; P l 4C�e nn CAJer i'a IS i n hopper
� ' e, �-iau 1 av � b ba,r e, It o�-c 114 d 'I n to dum p JYLLL 6 �
Duke Energy Page 6 of 13 rev i ]/=]
Excavation Program

Duke Enerev Excavation Permit Application Form
14. Type(s) of excavation equipment to be used;
Lu"A *- eac_.h a xCoLv a r-j :5V10 r} reach e x ca.V r bar es
an cdurn p +ruc.l,s ' 5
15. Will waters or wetlands be crossed in transporting equipment to or from the site?
(check one) P Yes ❑No
(I yes, explain)
-D+redCAinqq egos prrnen Will e, r4hs or %ita 1 n plav+
-�M Lax )CQSA-e'r Cus- VYN 'DOCYN 0 C^1 and S-�a�i i area
a tro5s "V�e t-lo ry-ncan +D P r'o3ec.+ 1 n c" on .
16. Will return water re-enter the reservoir? (Check one) ❑Yes ❑No XN/A
(If Yes, specify oint s o re -en and show on Excavation Area Drawing)
17. Is there an existing facility (e.g. pier) that access is being maintained to by conducting the
excavation? ❑Yes ,P..lNo
(If Yes, provide the existing permit number. If No, include a scaled drawing of the pro osed
facility). Permit # a a N eve doc l-i -M b e Con 5 ?"U [M .
Old dock -1D be removed.
18. Total planned duration of the work (Include first equipment mobilization, excavation
through final mitigation measure complete):
START / r) FINISH
(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)-AA(IV-A
-)-
Applicant Signature* Datet0 �CJ
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)
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 TOV 11/2212021
Excavation Program

Duke Energy 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 U22/2021
Excavation Program

Duke Energy Excavation Permit Auplication 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 Res once Table
Agency Comment Applicant Response
AgencyAgwy 1
The activity is approved as proposed.
NA
Agency 2
The on -site well provides drinking water to the
Contacted Mr. 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.
construction
Azency 3
Requested agency comments on 1 /l /20xx and
NA
again on 2/l/20xx. No response as of
2/16/20xx.
_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.
Table IV-2. Sam le 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 1112 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 I).
Duke Energy Page 13 of 13 rw 11l22l2021
Excavation Program

Feoordad;: 11%©212004atTiQ,�49. AM Fae Amt:i694T o0 page t of 2
OExclse Tax: $yyigo,0
r... a101. Bell .Reglstar of Deeds
BK 1597 PO 1555-155 V
NORTH CAROU NA GE UL WARRANTY DEED
Excise Tact:
Parcel Identifier No. Verified by County onto day of . 20
to: Grantee
This instrument was prod by: Soloman & Mitchell, PLLC, w/o benefit of tax advice
Brief description for the Index
THIS DEED made this day of ` . 20 _, by and between
Joyce A Larson, widow
Adam Bloom and GRANTEE -
Nickie Bloom
99,7 *-rnr ou
/V ao 1 r a 66 lIt /VC—
A8// 7
The designation Grantor and Grarke as used herein sha11 include said parties, their heirs, sttecessors, and assigns, and shall inchtde
dqWff, Pam, 10ascul1ine, feminine or neuter as required by context,
Wl1W=EnL that the Cam, fora vahusble consideration paid by the Game, the receipt off is b"acbmAedged, has
and bydneptesentsdoes gmg,bargain, sell and conveyunto the Gravbc in fee 6itnp16, allthat celftin lotorp�viceloflsnd situated
in the City of Township, IredeIl. Cotmty North Carolina and
more fly described as follows:
BEING all of Lot 197, in Section 8 as shown on map recorded in Map Book 15 at Page 56, I edell County Registry.
The property bereinabove dascn`"was acquired by Grantor by inWW=nt recorded in Book 706 page 666
A map showing the above described property is recorded in Plat Book 15 page 56
NC BarAmociation Form No. 1-3 C)1976, Revised 0 1977,2002
Printed by Agreement with the NC D ar Association —1991 SoRPro Corporation, 333 E. Site Forks Rd., Raleigh, NC 27609

TO HAVE AND TO HOLD the aforesaid lot orparcei of lani and A ptivileges andappurDananc es unto betargingto the Grantee,
is iba simpim
And the Grantor eovenantswith the Grantee, thatGnatar is seined ofthe Fremises in fee simple, has the right toconveythe same is
fee simple, flat We is roar%etable and free and clear ofall encumbtnaces, and dust Grantor will warrant and defend the title against
the lawlhl claims of all persons whoroftever, other than the following exceptions: Ad valorem takes for subsequent years
which are alien but not yet due and payable, Easements and Restrictions of record.
IN WMMM WH RMP, the Grantor has duly "ecnted the fomgomg as of the day and year 5rst;above written.
" 4:2 r'1 _ (SSA-)
Name) Joyee'A Larson
By: (SEAL)
Title:
Tide. {)
Bar.
Tile: {SEA )
State ofNorth Gasoline - County of*edell- ;�t� uiAad
I, tine tmdearsigned Notary Public of des Cotmfy and State that Jo ce A Larson } .N....,�
Ply a
acknowletW ft due execution of tine sng but umOnt (bI the PUPOses dwrain WPvwvA Witness
My Conunwcn Expires:— ;— J 't rCk . j p '.
otary Public r 's.,,v�� �� P1 <3
Stage of Nottit Carolina - County of
I. the ur d NotaryPublic of the Countyand State aforesaid, =* that
personally caste before me thin day and ackmowkdgcd that he is the of
a Nor@t Carolina or
corporatim4fiAtedliabik aOy�gla F (anike thagh 1lie iaaFplicable� and
that by authority dulygiven and as the act ofsach entity, __,lro signed the fore80ing inatngrrcnt in its name on itB behalf as its act and
deed. Witness my hand and Notarial stamp or seal, this day of . 20
My Canmission Expires:
Notary Public
State of North Carolina - County of
1, the rmdarsived Notary Public of the County and State aforesaid, certify that
Witness my land and Notarial stamp or scat, this day of , 20 .
My Commission Bvins:
MWforagoiagCedficate(s)of� .,a ___&JA
islareecestifiedtobecorrect, Ibiteitt�n a addriacartific;aUM
✓i 1r/ice♦ .� �` // ��: � 1__. ��
1 W.FM
i
Notary Public
the date and time and is the Book =d Page shown
Prinbdb]fAgwc43MwMftNCBwAmdatkm-1981 SofPvo Corporation, 333 E. Six Forks Rd., Raleigh, NC 17609

DON DALLEN & ASS 0 CIATE:S,P, A.
"Since 1971"
Commercial * Residential * Mortgage Surveys * Multi—Famlly
Construction Staking * SubdiviZa, Design * Topographical
[phone] [phone] Fox
1, certify that this map was drawn under my supervision from an actual
survey made under my supervision recorded in deed book 1597 page_1555 and/or
plat book— 15 page_-56._ that the ratio of precision is 1':10,000, that this map
was prepared in accordance with the General Statutes of North Carolina Chapter 89C.
my hand and seal on the 07 day of NOVEMBER A-r)-?Q 05
VICINITY MAP *** NO SCALE
760 CONTOUR PER ACTUAL
FIELD SURVEY /
CO
! �/ �STOOP-,
zM
W WAM
LAKE
NORMAN
-*"*NWPM ca+raut PER Ac1uAL
RELD'SURYEY
LO'k 197,
0.95 ACRES
fir( }
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T PO
LOT 196 Pp
PLAT BY- 15 PG. 56
a N 82'17-04" E
30.05'
0. 20' 40' 100'
SCALE IN FEET
NOTES
1) THIS PROPERTY MAY BE SUBECT TO
ANY EASEMENT AND/OR 11304iS-OF
WAYS OF RECORD.
2) AREA COMPUTED BY THE COORDINATE
3) DUSTING 760 & 761 CONTOUR ELEVATION
BASED ON LAKE NORMAN LAKE LEVEL
AT COWAWS FORD DAM (READING ON
NOV. A 2003) ELEVATION•736.20'
2
10
LOT 198
PLAT BK 15 PG. 56
:\fi3
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Pie E _,
W
(.A�
P H YSI CAL SURVEY s:"'Oj aA
897 KEMP ROAD
LOT 197 CRULM LAND & i[MBLE CORP. L ES CT. )
SCALE 1" = 40' DAVIDSON TWSP., iREDELL CO.. NC. Fl� 1038e 704 Pa as
ACQUIRED BY: ADAM & NICK'.E BLOOM TAX MAP NO. 4626038075

DD O N ALLEN & ASS 0 CIATE..S, P, A.
S"Since 1971" ' .
Commercial * Residential * Mortgage Surveys * Multi —Family
Construction Staking * Subdivision Design * Topographical
[phone] [phone] Fax
1, certify that this mcp was drawn under my supervision from on actual
survey made under my supervision recorded in deed book 159? page�T555 J and/or
plat book .__�5------ page__5fi _ , that the ratio of precision is 1':10,000, that this map
was prepared in accordance with the General Statutes of North Carolina Chapter 89C.
my hand and seal on the a7 day of 40VEMBER 05
` r
regvi►neU W1LLiAM a o
\ � a slopes
LAEE � 4
az Nc NDRE, RO NORMAN
�I
µ,N•[ ego 3�p0 N� 3 I a CONTOUR PER ACTUAL
FIELD SURVEY
4, ik
36 1
TY MAP *•• Na SCALE Op
tp LOT 197 11
78O CONT ` A*AER ACTUAL' --;. ��,. 0.95 ACRES °+
nE..O SUR
/ 1z,r h 127'
Ln `
Ta.a & la5 Za s `•, V a.*�
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� STOOP ti .. 26:2'
a
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CMom' s9• \�36'sETTiA-
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LOT 196 PEE
PLAT BK. 15 PG_ 56 LOT 198
PLAT BK. 15 PG_ 56
/ REAR 1�"c
N— 82'- 17'04" E k
Q� 30.05,
1
0' 20' 40' 100' 1� r
SCALE IN FEET'
TIE is
1) THIS PROPERTY MAY BE 5uBJECT TO ��k •u(7E ` gyp �t
AMY EASEMENT AND/OR RIGNTS—OF — — 225.86' — — —'
WAYS OF RECORD. `
2) AAEA COMPUTED BY THE COORDINATE /� (� ryt
3) E�5nNG 76C & 761 CONTOUR ELEVATION PHYSICAL SURVEY
BASED
COWAN'S
O AS FO
RD (READINGRMAN LAKE
OF
O.�.gjj
M1OV- 3, 2005) ELEVATION=736.20' 097 NEW ROAD 1'2,G7O'`i/S
LOT 197 CRESCENT LAND & TIMBER CORD SECT. 8) �Y
SCALE 1 — 4O FILEE: DAVIDSON TWSR., IREDELL CO., NC. FIL, sgox: 704PG44
10369
oc FILE:
ACQUIRED BY: ADAM & NICK E BLOOM
TAX MAP N0: M6036676

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169
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THE INFORMA77ON CONTAINED 1N THIS DRAWING IS THE SOLE PROPERTY OF L4NCASTER'S DOCK& LIFTS SYSTEM 1NC.
ANY REPRODUCTION !N PART OR AS A WHALE WITHOUT THE WRITTEN PERMISSION OF LANCASTER'S DOCK & LIFTS SYSTEM INC. IS PROHIBITED.
ALL DIMENSIONS USED IN THIS DRAWING ARE NOMINAL
a ISSUE CLIENT
0 2-28-24 Spencer Bloom
DRAWN BY 897 Kemp Road
MA Mooresville, N.C. 28117
Lancaster Custom Dock and Lifts
1156 Perth Road Troutman
North Carolina

11090 1 PG 1356
MMMA. COMM
59
FLED
IREDELL cA)URTy
93110Y 15 PH 3: 13
SHERDA M BELL
P-"1-qTr* ArnrFfts
Recanum 71ft Boa mm
Tax 14t No........ ....»..». —.— ...... ............. . ........ ... ..... .. ........ Parcel Identifier . ....... . . ... .... ......... . .... .. . .................
Veraw by . . . . . ................ . . . . . .......................... ...... County on the . ....... day of ..... ..... . ....... . . ... ....... ..... ..... _., 19
by. ..................... . .................
ND TITFZ OPMON
MMafter recording to ........... .......... ................. .... ... . ...... . . . . .... ........ ....... . ........... . ..... ..... . ............. ............. . ......
.............. . ... . .... ................................... ............... . . ... . ......... .. . ..... ..' .. .... . .... . . ..... ... ........... -
This '401ru-g-t W" Prepared, by .. 4049-PcLdlu Masmy, Attormy.q. P.....O .ftx. 1.22, Statesvina. NC 28687
...... . .... ... .. . . ... ... ..
Briet d"Uption for the Index
NORTH CAROLINA GENERAL WARRANTY DEED
TMSDMMmade this jq0. day f.. November
19.93 brsad between
Eff'117k-m-
PAIUL C. WAG= and wife,
MR= R. MGM, of
bredaU Cmmty, North Carolina
GR"rEN
DC UMAS At.ZEN HANWRE, of
Irede3a County, North Carolina
Mailing Address:
Route 5, Box 571
Statesville, NC U677
Platk ebaracur of taw. r4 CO2ponjim of paltnump.
The dalimatton Grantor and Grantee as used barein oban Include Said Parttek their heirs, sueenum, and aft%cm, and
8MU ftclude S'Mbr, VIUMOL MRSOVIUM leminine or neuter as required by context.
WITNESMIL that the Grfttor. for A valuable consideration Paid by the Grantee. the receipt of which Is hereby
ackwwkd&*4 has and by then Prwezft does grant 11STSMIn. aell and convey unto the Grantee in lee dzw&. all that
COASIn lot or parcel of land situated in the Citr of N/A. Barringer Township.
. . 1"&.11 County, North C4mJkm And more Parficularb- described as follows:
RMN6 OU OELots NO. Four (4) and Five (5) of Tram= 13..Siam park as the am is *UK planned
M4
==Mkd in Pilo Book 19. pp 63, If COMY RejOy.
7UdMV04=01W reparly is bft amvWW aftea to ft mgdCtiV*mVmM reconW in 9"k M pp
1216, hedeU Couity pegjay.

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BKD90 1 P6 1 357
The NOMW heretnabova described was aegnlr" by Gramme by instrumut recorded in ».........
»
_.. -.............. »....».....»»...................... .»_.. _............
» . _ »...»»... »...»w.»..» .........» ._»...»....»..».... ». »... _.... _.
A the above described Property is reeerded in Plat Book .......... .................... »... pass. ......»»». ».»
map ahowlag
TO HAVE AND TO HOLD the ataresaid lot or parcel of land and all privileges and app Unanaes thereto belonsi ng to
Me Grantee in fee shapie.
And the Grantor coveaaats with the Grantee, brat Grantor is seised of the premises in be simple, has the right to mo%W
the smote in iec attnpie, that title is rma katable sad free and clear of sit enembrancm and that Gmstor will wamni and
defend the title against the lawful claims od sit persons wttottsaever Vmpt for the exceptions bereinaf0ee stated.
Title to the greyer Y hendu8bove described is subject to the followlug e:coptiona:
Auy and easeaeente for publfa roads and utilities that may affect the premises and the
rastrictiops bereft out out and referrers to.
far wfltexaa WUMBOt4 au ctaatot tw aetsoato sec ets trend sad tw. m it cm"mte. ass eawM am sk�d mite
aaen WO M as fats adhabM ankeea at to see to ae htteaato ^MMd by awamMy of tee eP nasammmt sear sad ieaa ft:s
-»«-...._.._.._ tcapreaa Haase) «.._...•.._ ,...._.......«.__c$am.t
y Paul C.Wagner
--------------------------- ----•---..._.... td _ `_?�,�1Ki?. 61 .«.�._ �..._.te t�
........ _._-------- ltedfeat .. Martha R. 1ag i'
tea9ee u Self
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p"� : bell» me tbts fyr eas acaeaatsandtne ........................................
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� ;. • �, � -r,.• b. Oi sae ta'=eioasf tnKeaneesl. wttaep m7
�4a - ;,..•�yi: ,. a sass atta oftlds) stamp or sea4 mhr fOtil_ deer es __a. Ovember ga8-1
ssr camMsstea taartec .......... •---------- _ ..o. xots sts tntatta
L a Natm paalte of no ConMW sad stab afseestmF "U" tact ..�.._.««_. ._......
ma-ft Cass berm at tab far aed ad=oa edged tt , -_.. he is
-_.._ _._.«.�».._-...._..........�._w.M._ a xofth Cash- esfpeatkn mid maf sy satasstt. aw
Stem and as the set of me satpat UC% tine C t dmfmr=mdon atarM* in US can tat .............�
Sam lath us eQWn to sees sad xUatm to as nt ......... seteetaw.
wttaen sal tread attd Mew Wmp sir sal, a& .__....fat
my w empbes,..............................._...«........«.......-_«._..._..» tktaq iU)ia
She t atalaa eesaaeuettip a
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S syatatCnM tea ae • eC ML late bub meot ago mil aatla"ta ap edy seostnsd as sae dale WO lose am in me Oeta me Pie ta6>ta es yea
or asses fie-«.. 8130LL
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Iredell County, North Carolina
Haneline Disposal Area
v_ l
- �115i
i h
r,, G
_ r -
• 1" = 67,73184478249442 ft
Tax Map Information -- _ ---- — — -
•PIN 4740775566.000
Print map scale is approximate.
• Address 844 SOUTH MAIN ST Critical layout or measurement
•Account# HANELINE 63
DO activities should not be done using
• Tau Owner HANELINE bOUGLAS ALEN
• Mailing 3379 AMITY HILL RD this resource.
Address MAP FOR REFERENCE ONLY
Gi5 Owner HANELINE STATESSVILLE, NC A NOT A LEGAL DOCUMENT
• DOUGLAs A
• Deed Info 90111356 - wD - 19931115 Iredell County, North Carolina makes no claims and no
• Tau Acres 0.8 AC warranties, expressed or implied, concerning the validity or
• Lot 9 4 accuracy of the Gi5 data presented on this map.
• Description TROUTMAN 13USINE55 PARK P619-
63 Geometry updated 1Li6721123
• Zoning GB Data updated 13J1412023
4 • Old Parcel ft 1604F04000A604
`t • Bldg Value $46,130
p OBXF Value $4.290
• Land Value 3120,006
Total Value $170.510
Defer Value $0
• Tax Districts ALLCNTY FIRE- -

Iredell County, North Carolina
February 5, 2024
Haneline Disposal Area - Lot #5
Tau Map Information
•PIN 4740776627.000
• Address SOUTH MAIN $T
• Account # Acct 77371963
• Tax owner HANELINE DOUGLAS ALLEN
• Mailing 3379 AMITY HILL RD
Address MAP FOR REFERENCE ONLY
Gi5 Owner HANELINEDOUGLASA
STATE5NOT A LEGAL DOCUMENT
• A
• Deed Info 90111356 - WD - 10931115 Iredell County, North Carolina makes no claims and no
• Tau Acrea 0.8 AC warranties, expressed or implied, concerning the validity or
• Lot # 5 accuracy of the GIS data presented on this map.
• Description TROUTMAN BUSINESS PARK P819•
63 Geometry updated 1711512023
• Zoning Gg Data Updated 1111412023
• Old Parcel 1604Fo4000AOD5
• Bldg Value $0
• OBXF Value g0
Land valuo 5120,009
• Total Value $120.000
• Defer Value $0
• Tax Districts-ALLCNTY FIRE- -
i
ay
40
1" = 57-73184478249442 ft
Print map scale is approximate.
Critical layout or measurement
activities should not be done using
this resource.

ID it
LOCUleli
Pamm #:
niter d1119 a f: ..dlmeng 'Vi'"" am aware that must adhere to ail ate regulatorsa��ntrol
In and water quality. And give permission for
�v t of IrPdMdual and
to diWGGe of their dredge ramterl41 @t tho t.hnve catet! lozs}418n
f � � •��ra .t,� 1f � /ter
Dais. �ML3 Sign'
A voith kmpleo C pj•avide:
; cri ar Parow of (County GiQ
PIMO Of PM d spofl site
#deftnetl proposed spoil s #e

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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: Adam Bloom
Street Address (at lake): 897 Kemp Road
Lake Name: Norman
Subdivision Name: Crescent Land + Timber Corporation
Property Section: 8 Lot #: Lot # 197
City: Mooresville County:Iredell
State: NC Zip Code: 28117
Directions (from major road or highway):
From I-77 NB, Exit 35, Left onto Brawley School Road, Right onto McKendree Road,
Stay on McKendree Road to close to the end of the road. Turn Left onto Kemp Road
just before the end of McKendree (second access entrance to Kemp Road.) 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 H desired to draw us a map to the site.

897 Kemp Road Mooresville, NC 28117
0 0.125 0.25 mi
Q
Race City
Injector
fl
0 Hagers Creels
Access Area
•
35.557927,-80.947267
Drag Me!
%Maps Leg a!
CRM ♦ Deg ♦ DMS Help
Decimal Degrees Latitude: t35.557927
Decimal Degrees _.
80.947267
Longitude: -----�__.-.

DUKE EXEROY DIRECTIONS SY 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 compljete this form
and return it along with your completed application to:
A
CIO LAKE SERVICES — EC 12Q
526 SOUTH CHURCH STREET
CHARLOTTE, NC 28202
Applicant's Name: Haneline Disposal Area
Street Address (at lake):
Lake Name:
844 South Main Street
Subdivision Name: Troutman, Business Park
Proper Section: Lot #: Lot #4 & 5
Cam: TroutmanCounty:Iredell
State: NC Zip Code: 28186
Directions (from major road or highway):
From I-77 NB, Exit 42, Left onto US-21/South Main Street Troutman. The property is
on the left just beyond Flower House Loop.
Descriptive Structure(s) on Property (i.e. brick garage, white fence, mobile home,
etc.) Building Lot.
Note: Please use the back of this form H desired to draw us a nap to the site.

844 South Main StreetTroutman, NC 26166
0 250 500 750t
n
35.680180,-80.859925
I
tMaps lag' -I
-
Diamond
Detailing
State ► iectcic
supply Co.
7
f
CRM v DMS Help
Decimal Degrees Latitude. 35.680180 _.
Decimal Degrees
Longitude, 80.859926

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CAT kWBA RIPARIAN BUFFER NOTIFICATION FORM
Project
Owner:
Contrac
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 028 .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 [imitation on size for decks. [15A NCAC 02B .0243(4) !and (6)]
Work to be conducted from [and 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
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. A 1___)
Signature (owner): t/ Date: I - ZO -Z,5

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 197 PLAN NO.
STREET ADDRESS: 897 Kemp Road
Mooresville NC 28117
Please print:
Property Owner: Adam Bloom
Property Owner:
PARCEL ID: 4626038676
The undersigned, registered property owners of the above noted property, do hereby authorize
Donna P. Hrko
of
(Contractor / Agent)
Lancaster's Custom Dock and Lift Systems, Inc.
(Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
19220 Davidson Concord Road
Davidson, NC 28036
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature Authorized Signature
Date: 12-20-23 Date: