20161059 Ver 1_Shoreline Stabilization_20161031

State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
15A NCAC 02H .0500—Water Quality Certification,Shoreline Stabilization
Division of Water Resources FORM: SSGP 10-2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resources
401 & Buffer Permitting Unit 2 0 1 6 1 0 5 8
1617 Mail Service Center -
Raleigh, NC 27699-1617 p
I. Applicant Information [15A NCAC 02H .0502(a)] �)(' '� 1 2016 I�
1. Owner InffQxmation
,�
Name: e e ,
Mailing Address: I ZLD June,nyag-- Aef- _R
M(nresy i I le. NL ZE 11-7
Telephone Number: "704- LEV- $II k Fax Number:
E-mail Address: lje' e_- � S5 I Qb !:Nma',1 . C vy-,
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http://www.saw.usace.army.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM. df) must be attached if the Agent has signed this application form.
Name: Y1 1,�0
Company Affiliation: Loy\ ke✓Y- C .
Mailing Address: cj(-D Pey- VN
Telephone Number: `704- rJL Fax Number: `704.- 5ZS-340
E-mail Address: O eY` al CD M
Person to receive the Certification Approval: 1 r
II. Project Information [15A NCAC 02H .0502(a) & (b)]
1. Attach 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.
2. Provide a detailed site plan showing property boundaries and proposed locations of
vegetation clearing, structures (buildings, retaining walls, docks, impervious surfaces,
FORM: SSGP 10-2013 Page 1 of 3

etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
and construction access corridors. You may use the diagram provided at the end of this
application form.
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale
of some sort- a yard stick, shovel handle, etc.)
4. Location of the property (where work is to be conducted) II
County: I Y P P Nearest Town: C)(>Y'e�j�I
Subdivision name or site address (include phase/lot number): pre_5een azirl
4 Timber Lo+ l(ocil 5ec-lkl? �o.
Directions to site - please include road names and numbers, landmarks, etc.: -ro 1.77
/V8 7a& eklf35 . Tur.) left na2�n 5/aWlev SChml fid. Ooh- aye,
or) RrawJ r l r
rp
Latitude (in decimal degrees) 35, 51P)Z31 Longitude (decima degrees) —�O—q 77CJ()_ZJ
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): �ieSlae -bat
6. Property size (acres): l. toJ ^'
7. Lake/ river/ocean adjacent to property: /yfl r-ma 7
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): _Dre&p. (a erA -�p I Oqkk� Pond -fnr
YJ ��✓1G Ct �'e�..x�.
9. Will work be conducted from land? ❑ From water?
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool lake level/ Normal Water Level in square feet or acres:
1 . 38
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake level/ Normal Water Level and 50 feet land-ward in
square feet or acres: -__ SCJ
12. 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):
F�Q19LS�°tC
Owner/Agent's Signature Printed Name Date
[15A NCAC 02H .0502(f)]
#Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

7 ;. Lake
(At full Pond/.Normal I)
i � r
T�?q t-A IIfid
Full Pond/ ZZ
Normae�:Level
.. .. .�
Shoreline
See ��hed
S E-" i VA
PkCAJ.
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ft x 100 ft)*:
1. All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
3. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
4. Location of any proposed structures such as buildings, retaining walls, docks, etc.
5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
FORM: SSGP 10-2013 Page 3 of 3

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DUKE ENERGY 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[O t3 1Z 1�J Initials
Date Final Protection/Avoidance Area Markings Field-Verified Initials
Approved to Start Work By*: Date
(Print) (Sign)
Date Completion Required Date of Any Approved Extension Initials
Date Passed Closeout Inspection* Initials
Any Stop Work Orders or SMG Violations*?(check one) ❑Yes []No (If Yes,explain in PART V)
Date Deposit Refunded Initials Date Pen-nit 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(Please Print) p
Name 4e-- ear— , Telephone (J-7A )_607-- gill RICA
Lake Address I l t) �n e�e-1� �d . Mailing Address �btymni (.►rl e t IC 1.
(If different)
Kcoce�,vi111e ►�CZali� i�loore�v; l le, NG ZN 17
Contractor Company J" 16ivm ' L—h " L:R ca y S 1 _S I n C
Contractor Contact Person , C)V Nn( l�r V Telephone ( ) D?"-1((� lf1O'i��L
LAKE LOT INFORMATION tnG
Lake f1+n�Yl County ,Y' City M(�Y'e jV,(l l 11 P State
/� Tax Map No. cZq�3 q5
Subdivision)rQsCen+ anA 4( �srA Lot/Section No. �V�`1� ` 0 Lot Size I Acres
Are there any Co-Applicants*?(check one) ❑Yes ❑No (If Yes, include names,addresses,phone nos., lot nos.,lot
sizes in PART V-ADDITIONAL INFORMATION) *Co-Applicants exist when the proposed work is being done under a
single application,will be perfonned 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. The check for the application filing fee and security deposit
should be from the party shown as Applicant and not several checks from the Applicant and Co-Applicants.
Do not continue the application until an on-site inspection has been conducted between a Duke Energy Lake Services
Representative(DELSR)and the applicant and/or the excavation contractor. NOTE:Initializing this portion of the
application by a DELSR in no way constitutes approval or eminent approval of the excavation or any other lake use
permitting activity.
Date of on-site inspection (.` 17- 1 J Initials(Duke Energy) � (applicant/contractor)
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
PART II.-DESCRIPTION OF PROJECT
A. BASIC INFO
1. Type of excavation: (check one) New excavation ❑Maintenance excavation
2. Purpose of excavation:(check one) PrBoat Access Channel ❑ Water Intake Channel
❑ Wastewater Discharge Channel ❑Other(specify):
3. Lake user category: (check one) JAPrivate ❑Residential Marina ❑Commercial Marina
❑Public ❑Other(specify): f� I
4. Max. Excavation Area Dimensions(8): Length 00` Width LPO \ Depth ! O
(Note:include additional area dimensions if necessary so response to#S below equals max. area dimensions in#4)
5. Volume of Excavated Material(TOTAL for the project): 12 1�3 Cubic yards
6. Type of material removed(applicant determines by field sample if practical): Y'N 6 I S I I�- I .d QV
. OZ3 C d,V`,s►+c-
7.
e
7. Excavation Site area: 1.aJ� Acre(s) Disposal Site area: -00 7 stk�cre(s)
8. Total Disturbed Area(including equipment staging area): , ?J Fj Acre(s)
9. Does the project meet the requirements of the applicable General Permit?(check one) 2f,s ON,
10. Do you claim title to the disposal area?(check one) 2`6s ONO
11. Do you claim title to the equipment staging area?(check one) ;3Yes ONO
12. Are there any water-treatment facilities within 50 feet of the proposed excavation area?(check one) ❑Yes ONO
(If Yes,specify):
13. How will the exca ed mat rial be entra ped d the er sion controlled?(e.g.see attached erosion control plan and
disposal area design): Vl Y' f 13E 6 ILS
r
L 0. On+0 uvylp �Yl ice on 1 Ou. si IL Y'
T e(s)of excavation qui ment to be used: e �bQ� `J• aS 5���i�l 0 vl a C �I LLIrI
-�"ulc we"ac �'-)tcA; data �nz
15. Will waters o w tla s be c ossed in transporting equipment to yr froT the site?(check one) es o
(16 s, explain) Y' l
r
16.Will return water re-enter the reservoir?(Check one) ❑Yes ONO J2N/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 conducting the excavation? ❑Yes 'Mo
(If Yes,specify the existing permit number. If No, include a scaled drawing of the proposed facility). Permit# I k 3(�
18. Total planned duration ofh work(Include first equipment mobil*z on, exc tion through final mitigation measures
complete): START /�fZ FINISH /
(Month) (Year) (Month) (Year)
Note: Notify Duke Energy Lake Services at 1-800-443-5193 prior to commencing any excavation work within
the project boundary.
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
PART II.(Continued)
B. PROTECTION/AVOIDANCE AREA DESCRIPTION
Complete the following table including all land areas within and immediately adjoining the disturbed area:
Identification Method(*)
Protection/Avoidance Areas Approx.
(check all that apply) Acreage Field ID Work Area Dwe.ID Avoid(A)or Mitigate(M)
**
a. Marshland,swamp,ponds,beneficial
aquatic vegetation or other potential wetlands(circle all
that apply) v
b. Buffer Zones(specify width&source of -75" Dir ri wilt be c�conpll ed
requirement) W Lo
V0. r. ale rPxl be.
►owed:►.� �
e o 0 )OU c1..
Z 1"dsc crrnsC `x t,}
to wt11l edd
C
c. Environmental Areas as identified by Duke t G a
Energy /� ML1l rt C S j�N_'r
i V to s r-lnt6 J0- erid WI ele%(w
d. Natural Areas as identified by Duke Energy
e. Historic properties(spec)
A/A
f. Rare or threatened species(specify)
g. Buried gas,water,sewer,communications
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
Identification Method(*)
Protection/Avoidance Areas Approx.
(check all that apply) Acreage Field ID Work Area Dwg.ID Avoid(A)or Mitigate(M)
**
or electric lines(circle)
h. Impact Minimization Zones as identified by �
Duke Energy
L Other areas requiring specific avoidance,
protection or mitigation(specify) /
V
* For"Field ID"column,specify entity or person that performed the identification and how it was physically marked(e.g.Duke Energy(John Doe)/Pink and purple-dotted tape,
Corps of Eng.(John Smith)/yellow flagging). For"Work Area Dwg ID"column,show the symbol that is used on the drawings to identify the protection/avoidance area.
** List and attach mitigation plans
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
C. APPLICANT'S SIGNATURES
Comments: r)11"n V rce.k I Z+ �� C p YYl rI P S
Sjyneny)a,r lei er RA av-)A 140 tinneenar er
SVID\N n C) ►n +V- t Sur\Iey an Pa e. repnr
toe 117 Ser 11
-
Applicant Name (print) Lot# p
Applicant Signature* Date U
Co-Applicant Name (print) Lot#
Co-Applicant Signature* Date
Co-Applicant Name(print) Lot#
Co-Applicant Signature* Date
Co-Applicant Name(print) Lot#
Co-Applicant Signature* Date
Co-Applicant Name(print) Lot#
Co-Applicant Signature* Date
Co-Applicant Name(print) Lot#
Co-Applicant Signature* Date
*Per my signature, the information provided in this application is correct to the best of my knowledge.
BEFORE YOU MAIL THE APPLICATION TO DUKE ENERGY LAKE SERVICES ENSURE YOU HAVE:
• CHECKED THE INFO THOROUGHLY
• MET ALL REQUIREMENTS FOR A COMPLETE APPLICATION(see cover letter of application package)
• INCLUDED A SINGLE CHECK TO DUKE ENERGY FOR THE APPLICATION FILING FEE AND SECURITY
DEPOSIT
• INCLUDED ALL AGENCY PERMITS OR COMMENT LETTERS AND RESOLVED ALL ISSUES RAISED
• INCLUDED ALL REQUIRED DRAWINGS(INCLUDING PROPOSED FACILITIES),PERMIT#FOR EXISTING
FACILITIES,SURVEYS AND PLANS
• INCLUDED COPIES OF DEEDS AND AUTHORIZATION LETTERS
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
PART III-INFORMATIONAL REQUIREMENTS FOR ALL APPLICANTS(NC&SC)
In addition to the completed application form PARTS I &11,the following items must be provided to Duke Energy Lake Services
for all applicants in North and South Carolina:
A. A copy of the deed and registered survey plat or other instrument under which the applicant claims title to the affected
property(the shoreline adjoining the excavation area,equipment staging area and the disposal area),OR if the applicant is
not claiming to be 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 cant'out the project on
their land.
B. An accurate scaled drawing(1"=25' for projects<1000 cubic yards of material removed or I"= 100'for larger projects)of
the area to be excavated,including all the infonnation required under Application Process-ITEM 5 of the Application
Package cover letter(Attachment 1).
C. An accurate scaled drawing(1"=25'for projects<1000 cubic yards of material removed or I"= 100'for larger projects)of
the proposed design for the disposal area,including all the information required under Application Process-ITEM 6 of the
Application Package cover letter(Attachment 1). Also include any erosion control plan or standard reporting form
requirements as noted under ITEM 6 of the Application Package cover letter.
D. A map or Duke Energy Directions by Road fonn showing directions to the excavation area and disposal area.
E. A USGS topographic map with a directional arrow indicating the exact location of the excavation project and Latitudinal
and Longitudinal coordinates for the project site.*
F. A list of names and addresses of adjoining property owners for both the excavation area and disposal area.
G. A copy of all permits and/or letters of correspondence to/from local,state and federal agencies that require notification or
issue individual pen-nits.
H. Provide the existing permit number if excavation is being conducted to maintain access to an existing facility(e.g.pier)or
provide an accurate scaled drawing of any proposed facility if a facility does not currently exist. Note:A separate
application and approval is required for proposed Private Facilities(e.g.pier).
I. A check for the application filing fee and security deposit and the signed Excavation Project User's Agreement letter.
*USGS maps may be accessed via the Internet at http://jzis.enr.state.nc.us/utilizing the following pathway: Data
catalogue/Digital Raster Graphics/specific county. Longitudinal and latitudinal information is available via the Internet at
www.ma_pblast.com,www.mapsonus.com or www.maptech.com.
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
PART IV—AGENCY REVIEWS/APPROVALS REQUIRED
A. NORTH CAROLINA APPLICANTS ONLY
1. The following agencies and the Catawba Indian Nation Tribal Historic Preservation Office require at least 30 days prior
notification for all excavations in North Carolina reservoirs. Notify them by forwarding a completed copy of this
application,including the information required under PART III A-F to:
U.S.Army Corps of Engineers N.C.State Historic Preservation Office
Regulatory Field Office N.C.Dept.of Cultural Resources
151 Patton Avenue Division of Archives&History
Room 208 c/o Ms. Renee Gledhill-Earley
Asheville,North Carolina 28801 4617 Mail Service Center
[phone] Raleigh,NC 27699-4617
[phone]
Catawba Indian Nation Tribal Historic Preservation Office
Dr.Wenonah Haire
1536 Tom Steven Road
Rock Hill,SC 29731
[phone]
What to Expect:
a)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 NWT,you'll be required to obtain an individual
404 Dredge and Fill permit from the Corps.
b)You will typically receive a letter from the NC SHPO documenting their concurrence with your application,
requiring additional information or recommending modifications. You must address each comment in your final
application.
c)You must receive written documentation from the Corps that your application either meets the requirements of the
GP or a NWP or that the proper 404 Dredge and Fill permit has been received before Duke Energy can process
your application.
d)If you do not receive any documentation from the NCW RC within 30 days of their receipt of your application,you
may proceed with the application process,recognizing however that if their comments come in later in the
application process,you will also be required to address them. (See exception for Commercial/Conveyance/FERC
review applications below).
e)If you do not receive any documentation from the NC SHPO within 30 days of their receipt of your application,you
must provide that agency with a follow-up letter requesting the agency comment on your proposal within 15 days
from the date of the letter. If you do not receive any response as a result of this second letter,you may proceed
with the application process,recognizing however that if their comments come in later in the application process,
you will also be required to address them. Note:This second 15-day letter requirement also applies to the
agency reviews in PART IV.A. 14 when the application is for a Commercial Facility, Conveyance or other
application requiring FERC review.
2. In addition to the three entities in PART W.A.1 above;if the proposed excavation is located in the counties listed below,the
applicant must also provide at least 30 days prior notification to the following agency by forwarding a copy of the completed
Excavation Permit Application Form(including the infonnation required under PART III A-F)to:
(For Alexander, Catawba, Cleveland, Gaston, (For Burke, Caldwell,McDowell or
lredell,Lincoln or Mecklenburg Counties) Transylvania Counties)
N.C.Dept.of Environment&Natural Resources N.C.Dept.of Environment&Natural Resources
Division of Water Resources Interchange Building
610 East Center Avenue;Suite 301 59 Woodson Place
Mooresville,North Carolina 28115 Asheville,North Carolina 28801
[phone] [phone]
[phone](fax)
What to Expect:
a)You will typically receive a letter providing Division of Water Resources concurrence,which may require additional
information or recommend inodifications. You must address each comment in your final application to Duke.
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
b)You must receive written documentation from the NCDENR that 401 Water Quality requirements are met before
Duke Energy can process your application.
3. In addition to the above requirements,if the proposed excavation is located in Mecklenburg County,the following agency
must be provided with a copy of the completed Excavation Pen-nit Application Fonn(including the information required
under PART III A-F):
Mecklenburg County Land Use and Environmental Services Agency
700 North Tryon Street
Charlotte,North Carolina 28202
[phone]
What to Expect:
a)You will typically receive a letter from the county documenting their concurrence with your application,requiring
additional information or recommending modifications.You must address each comment in your final application.
b)If you do not receive any documentation from the county within 30 days of their receipt of your application,you may
proceed with the application process,recognizing however that if their comments come in later in the application
process,you will also be required to address them. (See exception for Commercial/Conveyance/FERC review
applications below).
4. In addition to the above requirements,if the proposed excavation is part of a Commercial Facilities Application,
Conveyance Application,or will require FERC review,the applicant must provide at least 30 days prior written
notification to the following additional agencies by forwarding the completed Excavation Permit Application Form,
including the infonnation required under PART III A-F:
N.C.Wildlife Resources Commission U.S.Fish&Wildlife Service
c/o Mr.Chris Goudreau c/o Mr.Mark Cantrell
645 Fish Hatchery Rd. 160 Zillicoa Street
Marion,NC 28752 Asheville,NC 28801
828-652-4360 Ext.223 [phone] Ext.227
(For lakes Wylie,Mtn.Island,Norman,Lookout, Hickory) (For lakes Rhodhiss and James)
N.C.Dept.of Environment&Natural Resources N.C.Dept.of Environment&Natural Resources
Division of Environmental Health Division of Environmental Health
Public Water Supply Section Public Water Supply Section
c/o Mr.Britt Setzer c/o Mr.Harold Saylor
610 East Center Street;Suite 301 59 Woodfin Place
Mooresville,NC 28115 Asheville,NC 28801
N.C.Dept.of Environment&Natural Resources
Division of Parks and Recreation
12700 Rayleaf Church Road
Raleigh,NC 27614
[phone]
What to Expect:
a)You will typically receive a letter from each agency documenting their concurrence with your application,requiring
additional infonnation or recommending modifications. You must address each agency comment in your final
application.
b)If you do not receive any documentation from an agency within 30 days of their receipt of your application,you
must provide that agency with a follow-up letter requesting the agency comment on your proposal within 15 days
from the date of the letter. If you do not receive any response as a result of this second letter,you may proceed
with the application process,recognizing however that if their comments come in later in the application process,
you will also be required to address them. Note: This second 15-day letter requirement also applies to the
agency reviews in PART IY.A. 1-4 when the application is for a Commercial Facility, Conveyance or other
application requiring FERC review.
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
PART IV—AGENCY REVIEWS/APPROVALS REQUIRED
B. SOUTH CAROLINA APPLICANTS ONLY
1. Consultation or review is required by the S.C.State Historic Preservation Office(SC SHPO)and the S.C.Institute of
Archaeology and Anthropology(SCIAA)for all excavations in South Carolina. The applicant must submit a copy of the
completed South Carolina Department of Archives and History State Historic Preservation Office Project Review Form
(attached)to:
S.C.State Historic Preservation Office S.C. Institute of Archaeology&Anthropology
Department of Archives and History c/o Mr.Jim Spirek
c/o Ms.Caroline Wilson 1321 Pendleton Street
8301 Park Lane Road Columbia,SC 29208
Columbia,SC 29223-4905
What to Expect:
a)You will typically receive a letter from the resource agencies documenting the agency's concurrence with your
application,requiring additional information or recommending modifications. You must address each agency's
comment in your final application.
b)If you do not receive any documentation from the resource agencies within 30 days of their receipt of your
application,you must provide that agency with a follow-up letter requesting the agency comment on your proposal
within 15 days from the date of the letter. If you do not receive any response as a result of this second letter,you
may proceed with the application process,recognizing however that if their comments come in later in the
application review process,you will also be required to address them.
c)For the SCIAA agency 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,
recognizing however that if their comments come in later in the application review process,you will also be
required to address them.
2. (For Lake Keowee only) Consultation or review is required by the Eastern Band of Cherokee Indians(EBCI)for all
excavations on Lake Keowee. The applicant must submit a copy of the completed Tribal Historic Preservation Officer
(THPO)Consultation Information Form(attached)to:
Eastern Band of Cherokee Indians
c/o Tyler Howe
PO Box 455
Cherokee,NC 28719
What to Expect:
a)You will typically receive a letter from the EBCI documenting the tribe's concurrence with your application,
requiring additional information or recommending modifications. You must address each comment from the tribe
in your final application.
b)If you do not receive any documentation from the EBCI within 30 days upon their receipt of your application,you
must provide the tribe with a follow-up letter requesting the tribe's comment on your proposal within 15 days
from the date of the letter. If you do not receive any response as a result of this second letter,you may proceed
with the application process,recognizing however that if their comments come in later in the application review
process,you will also be required to address thein.
3. (For Catawba- Wateree lakes only) Consultation or review is required by the Catawba Indian Nation Tribal Historic
Preservation Office for all excavations on the Catawba—Wateree Lakes in South Carolina. The applicant must submit a
request for comments to the Catawba Indian Nation Tribal Historic Preservation Office at:
Catawba Indian Nation Tribal Historic Preservation Office
Dr.Wenonah Haire
1536 Tom Stevens Road
Rock Hill,SC 29731
[phone]
What to Expect:
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
a)You will typically receive a letter from the Catawba Indian Nation Tribal Historic Preservation Office documenting
the tribe's concurrence with your application,requiring additional information or recommending modifications.
You must address each comment from the tribe in your final application.
b)If you do not receive any documentation from the Catawba Indian Nation tribal Preservation Office within 30 days
upon their receipt of your application,you must provide a follow-up letter requesting comments on your proposal
within 15 days from the date of the letter. If you do not receive any response as a result of this second letter,you
may proceed with the application process,recognizing however that if their comments come in later in the
application review process,you will also be required to address them.
4. If the excavation meets the requirements of the applicable General Pen-nit(GP 87-14-001)and will remove from 50 to 150
cubic yards,in addition to the entities listed above in PART IV.B.1 and 2,the S.C.Department of Natural Resources
(SCDNR)must be provided with a copy of the completed Excavation Pen-nit Application Form,including the information
required under PART III A-H for at least 30 days consultation:
S.C. Dept.of Natural Resources
c/o Mr.Mark Hall
206 Laurel Valley Road
Sunset, SC 29685
[phone]
What to Expect:
a)You will typically receive a letter from the SCDNR documenting the agency's concurrence with your application,
requiring additional information or recommending modifications. You must address each agency comment in
your final application.
b)If you do not receive any documentation from the SCDNR within 30 days of their receipt of your application,you
may proceed with the application process,recognizing however that if their comments come in later in the
application process,you will also be required to address them.
5. In addition to the entities listed above in PART IV.B.I and 2,the following agencies must be provided with a copy of the
completed Duke Energy Excavation Pen-nit Application Form,including the information required under PART III A-H,for
all excavations not covered under the applicable General Permits on South Carolina reservoirs:
(For Lake Keowee) (For Catawba-Wateree lakes)
S.C. Dept.of Natural Resources S.C.Dept.of Natural Resources
c/o Mr.Mark Hall c/o Greg Mixon
206 Laurel Valley Road Rembert C.Dennis Building
Sunset, SC 29685 2600 Bull Street
[phone] PO Box 167
Columbia,SC 29602
[phone]
S.C.Dept of Health&Environmental Control
Water Quality Standards&Wetland Section
c/o Mr.Chuck Hightower
2600 Bull Street
Columbia,SC 29201
[phone]
What to Expect:
a)You will typically receive a letter from each entity documenting concurrence with your application,requiring
additional infonnation or recommending modifications. You must address each comment in your final
application.
b)If you do not receive any documentation from an entity within 30 days of their receipt of your application,you must
provide that entity with a follow-up letter requesting comment on your proposal within 15 days from the date of
the letter. If you do not receive any response as a result of this second letter,you may proceed with the application
process,recognizing however that if their comments come in later in the application process,you will also be
required to address thein.
Duke Energy Page 10 of 11 rev 9/19/14
Excavation Program
e:\#daren\@duke permit\c-w excavation application 11.3.10.docx

DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
6. In addition to the consultation requirements specified for the agencies listed in Part IV. B.1 and 2,the following agencies
must be provided with a copy of the completed Duke Energy Excavation Pen-nit Application Fonn,including the
information required under PART III A-H,for any excavation that is part of a Commercial Facilities Application,
Conveyance Application or will require FERC review on South Carolina reservoirs:
U.S.Army Corps of Engineers S.C. Dept.of Health&Environmental Control
Regulatory Functions Branch Water Quality Standards&Wetlands Section
c/o Mr.Colton Bowles c/o Mr.Chuck Hightower
1835 Assembly Street 2600 Bull Street
Room 86513-1 Columbia,SC 29201
Columbia,SC 29201 [phone]
[phone]
US Fish and Wildlife Service S.C. Dept.of Natural Resources
c/o Ms.Amanda Hill c/o Greg Mixon
176 Croghan Spur Road,Suite 200 Rembert C.Dennis Building
Charleston,SC 29407 PO Box 167
[phone] ext. 12 Columbia,SC 29202
[phone]
S.C. Dept.of Parks,Recreation&Tourism
c/o Mr.Tony Bebber
Edgar A.Brown Bldg.
1205 Pendleton Street
Suite 110
Columbia,SC 29201
[phone]
What to Expect:
a)You will typically receive a letter from each entity documenting concurrence with your application,requiring
additional information or recommending modifications. You must address each comment in your final
application.
b)If you do not receive any documentation from an entity within 30 days of their receipt of your application,you must
provide a follow-up letter requesting comments on your proposal within 15 days from the date of the letter.If you
do not receive any response as a result of this second letter,you may proceed with the application process,
recognizing however that if their comments come in later in the application process,you will also be required to
address them.
PART V-ADDITIONAL INFORMATION
(Reference previous parts as applicable.If more pages are needed,add a suffix to last page(e.g. 12a, 12b, 12c, etc.)
0 r)f\fjAnl oY, �14-e. EroS1hrI by;yra 1 -9 la in
Duke Energy Page 11 of 11 rev 9/19/14
Excavation Program
e:\#daren\@duke permit\c-w excavation application 11.3.10.docx

Type:CONSOLIDATED REAL PROPERTY
Recorded:7/29/2015 4:07:46 PM
Fee Amt:$1,526.00 Page 1 of 2
Revenue Tax:$1,500.00
Iredell County,NC
Matthew J.McCall Register of Deeds
BK 2370 PG 1300 - 1301
tnweTasl4a w Rec«alotibn6 B0*wd
TU Lot No. PmmdIdmdia'No.jU43931"" 20
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by
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TlotiotammtwupnpmvdbyTodd J.Falow xt L",Im LaIm L"Offim Fit.C.P0Baac4328.Maaesvilk NC 28117
BddDwm%d=ferdtendsu LOT101CT.ATSECT6;P81w
NORTH CAROLINA GENERAL WARRANTY DEED
TMS DEED mule l 3016 mdbma
GRANTOR GRANITE
UNDA M.BAKBR WIDOW VERONICA CAIROMILSO BLAQRAM A RUMAND
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AT PACE S,M THE OFPK.T:OF THE REOMM OF DUM POR MnUL COONTV,NOR771 CAROLVIA.
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And dm arm=oovemsmm MA the Gamx,dm&moor L seised of 8m pmmim 4 See skvk bts the f**m aonvey the sum'm am
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empook nme by its duly m dmtmd adiom and in sed iobe bmcmao dkW by sadtaityof b Board ofDirsamm dm dgaadym
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BAKER
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avidmw of dm paiockea wcow.by a emcat smo or fodaai mumcasm MA do P&Voors
�\\1(1111 f pLowpnph L ie lAem of a.�_d fiver lioarr aadt atlmoo4odpbp to m¢dat lm or ehti vciletatlb
�RAXERwpoeeal.eodihaein.m>otha
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is*v omMW lobe Wormer.TLL istmtawt aaddtr eetti5ane are dtdytepiraed ae the dak end tbs tad io meBook and P+pe tbowuen
the Eatpnpe heteoi:
REGISTER OF MM FOR lREML COUNTY
By
Dq"lAselamt-Reyna of Dealt

TABLE FOR PROPERTY LINE
LINE TABLE NOTES RECO SUNVEY N OF NIOTNIX CATEGORY,C UN As IEEE
Q 1)ThM waPaNr mar k•Nlb)aet to anY aasamanb ad/a RECOMBINATION OF EJOSIING PARCELS.A COIMT-ORDERED See[0: 016177x00001 Trw:CRP
q UNE BEARING LENGTH Rgllral-waY of n�TMM1 SURVEY',OR OTHER ExcEPTOM To THE DEFINITION OF MoordM:W/xt/xOfe•T a0:N:60 T
e1Lr Lt 321' •E 58.76' 2)iM•aM WNeae e/Mb Plat M to Maps tM recorded 50'eetbadi and F..Awt:9x7.00 Pelta t of f
•aeD W WMr to match me Rad i-ot"760'oM,ba Ilna. S1IBONSION. InE.3ll Caunty.IC
L2 S 88'0500" 24.7' 3)M Wt,a•wJML to a 10'Utility aM Drainoge EaaMmnt. Tletthw J.It0a11 R•glater er Mad.
L3 N W43'00"E 105.46' to Nat an IoM•IM of the peaatr R,A, _ °164 Pe94
L{ N 17'17'00" 25-00' 4)P,,aty m d:R-20 and aB WFramdN ProPWU- PROFESSIONAL LAND SURVEYOR
5)MMxaen Baxding Saleock Per County ZonMy 35'Fant
L5 TOT. S 111'2"E 20.71' SO LAKE(50'Lake G*Ra Line)
35'REM SEIBACN
NdNltt NM NO SCALE TABLE FOR 760 CONTOUR 25'CORNER SIDE
OWNER CERTIFICATE FOR EXCEPTION PLATS
UNE TABLE •NOTE• •A'LtlW Bohr Line Eaaad M add MM Wcotatl 760 Mot—line
ME BEARING LENGTH R101E• InM1 aamlr Ouse not enMm a Mapel ewe raatrklbne. STATE OF NORTH CAROLYIA KNOW ALL MEN BY THESE PRESENTS,THAT I(FF)t11ErREBY
G 9.1� e)The E- h,y N to tY N DAVIDSONKAMTwp.,MMPW@M Co..N.C. COUNTY OF REDELL CERTIFY THAT IAM(wE ARE)ENE HIRER(5)OF TIE
79'06'1'E .4S' 7)Tm PacW/(pN numea). N624395195 PROPERTY SH011N AND L DESCRIBED TW HEREON AND MAT
ttI(WE)HEREBY A(XNOMlEOOE TRO PLAT ANO ALLOTMETIT
6)D..a M.- 2J]0/13DD 1,911a•e•A•A►A.(�xwnE ,RENER'OFFICER of IREDELLTOS ACTN 214'14' 1q)Ne geaMtk mawm4nl frod.INF 2000'of•aM prpaly. COUNTY,CERTIFYTHATEHEMIiP OR PIAT TON 71' 1 10 Ra ewna a kuxtlar mot dewk daW raetricllaea.Noma Ownan Aewebtlane MRIdI 1M5 CERTF1CAlld1 l5 AFFIIWD MEETS O 111' ' 8{ )a the Ae ftNe l It M Cem Rtae e W to any nw eaneWctbn. ALL STATUTORYTHE FOR RECORDING. PATE _ --
b�Y�� �ji t11/• 711/Y/__.
p� RENEW OFF10Efl DATE OWNER
LOT 56
NORTH
BROWN IREDiL` NT
949\1524 I.
Prl�:y 8 iY/.✓
A NOTARY PUBLIC FOR SAID COUNTY AND STATE,
PFR ^^ \ I HERESY IONTTo THAT THIS PLAT FOR RECORDATION IS
Q DO HEREBY CERTIFY HEAT
502'32'33"W 257.18 AN EXCEPTION i0 THE SUBDIVISION ORDINANCE OF IREOELL VERONICA C.BLACXHAM
.\ COUNTY.NORTH cARDLmA. JAMES P.BLACKMAN A
_ 15 SDE SETBADN
OWNER(S)pCRSOFIALLY APPEARED BEFOPE ME THIS DAY.
ro\j- L4& y\y0 �' I �f Yj(/' �0�• •/ AND Ad(NOM.EDLED THE EWEr OF THE FOREGOING
\ o4T og\ `& I I SUBON5101 AOAIMS1RAlOR MTIESS Y AND OFFICIAL SEAL,
\ }* Z TMS AY OF 2018. —
LAKE \ ) \'Ilu E D ' N TINY P1191C .,,.n.. ,..
NORMAN ` I o Nt MY COMMISSION EXPIRES: 8-17-1,T QVVt"'
IREDELL COUNTY,NORTH CAROLINA ✓,.M .
CW LOUR
APER �(lob 1h/ •o
80
,NAL T.R SURVEv CP�J L ``
THE LOT SHOWN ON THIS PT TO THE BEST OF MT KNOWLEDGE ^.
' I LIES WITHIN TIE-WS-W CRITICAL AREA OF THE 1 �
LAKE NdtMM/CATAWBA WATERSHED AS DESIGNATED BY THE
to,
// g FERIA FLOODUNE
g ) I NORTH CAROLINA DIVISION OF EFNNROfAIENTAL
/ �E / MAN AGEMENT AND AS APPEARS ON THE •.
Lt .4S ^ LOT 1691 p r 3 WATERSHED PROTECTION MM OF RIDDELL COUNTr. '•'..,tt(r f:��\•:.
1.63 AC.
AV
DAA3gN510N ADYIMSIRATIXt
SURVEYORS CERTIFICATION
1,NWA/M.ALLEN CERTIFY THAT THIS MAP WAS DRAM
\ I UNDER MY sUPERNSON FROM M ACTUAL SURVEY MADE
LRN
UNDER T z INNT suPaN ITEED TMASCRIPTIONRATIO RECORDED
\
PRECISION AS CALCULATED BY LATITUDES AND
\ I =Aft RES IS 1:10000. (THAT THE BWROARIES NOT
CP I SlNR4E%ME SHOWN AS BRO(EN LYPA PLOTTED FROM
\ VfORMATION FOUND IN BOOK_=PAGE
THAT 1165 MM WAS PREPARED IN ACCORDANCE WITH
G.S.47-30.AS AMENDED. ',/
J ....WRpyF1. .4V WI MY AND AND SEAL r.T.�M(�5�y�•DAY OF
A.D.2016.
`R\ =Q
PROFESSIONAL UND SURVEYOR
LOT 1692 '4\ ` ' 4t OmaQ�Flx
39.e a �X191
RENE J. DESCOTEAUX ys 'o IS� {H CATION dSTRIATION NUMBER
1197\604 'V>,�ty��p ' _ ' ` �•?O'Dskidy}i'Lt
••7jj.5
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LEGEND Y n± ' EXCEPTION PLAT
P.P.>:POWER POLE \, ` J p I OF
o -POWER TRANS. _ CRESCENT LAND CIC TIMBER CORP., SECTION 8
E.I.P.-EXISTING IRON FOUND TJGr�Y
I.P.S.=/4 REBAR SET 690 p�� Ge TP LOT 1891
R/W-RIGHT-OF-WAY 6Biio �,.� I (PLAT BK 18 PGa 55)
CP-COMPUTED POINT
DAV690N TWVMML CO-Kr-
SCALE:
.0.SCALE: 1'-50' DATE SURVEYED: FEB.11,2016
DATE PLATTED: PARCH 14,2016
Pk NAL
OWNER: JAMES P. & VERONICA C. BLACKHAM
140 STONEMRERD.
D ^q MOORESVILLE A NKCR 28117
DON ALLEN k ASSOCIATES P. A.
'$Ice 1971' A PORTION OF THE SUS ECT PROPERTY IS LOCATED WITHIN A
Ca _"`•Resdmtlal•Mart r!=,:•MWtI-Fan•y SPECIAL FLOOD HAZARD AREA ACCORDING TO fLlX1D 0' 25' SO' 100'
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131 daaMWa Pak Orhw-SWts l02• Yaeran9la,NG]Df1) INSURANCE RATE MAP-COMMUNITY PANEL#371G"2400K
[phone] (704)9N-e0{1 Fm EFFECTIVE DATE 03/02/2009 SCALE IN FEET
daaRRrwFWeMdalrawn.rM FILE NAME:CLT 1691-TOPO -- 13407.dwg

10127/2016 ConnectGIS Feature Report
SPCOINECTIredell
GIS Printed October 27,2016
wEe HOSTING I
See Below for Disclaimer
4624-39-0489 addresses
•
Nowtside4malum
Itesidem4l Use
-1, 24_ y-0334 11692 Streez
4624-39-2386
Ramp
US Mwi
Hwy
XS41 0 132 4624-39-90 MemPoad
0 20- LOC31 Road
N
1, 4624-39.63 118
4-.2 -29-8194 4
138 128
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140 4624-' 1 195 Pm.a!e
•
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Parcels Hooks
N2
4624-39-8056 Parcels
Rd L13 126 ❑
303 Parcel mailing Address
Parcel Labels
anl'
City Limits
4624-38-1858 41324-3 M 96 I
4624-38-38rIz-. -162.1.38-587-1 Lake Norman
Iredell Countylive
NC
4,-.- 1 118 Feet Counties
e maps prepared for this website are generated from recorded deeds,plats,and other public records.Users of these maps are hereby notified that the information provided herein should be verified.Iredell Countyassumes no
legal responsibilities for any of the information contained on this site.Users are advised that the use of any of this information is at their own risk.All maps on this site were prepared using a 100054E-Grid based upon the North
Carolina State Plane Coordinate System from the 1983 North American Datum.The delinquent real property tax overlay is updated monthly.The information presented is not intended to be used or relied upon as official notice of
tax liens.For additional information regarding delinquent taxes,contact the Iredell County Tax Collector's Office.
http:/firedell.conriectgis.com/DownloadFile.ashx?i=_ags_map759242999e5c42cd9ffac7863d4823adx.htm&t--print 1/1

Err,,
Peter Slackharn
138 Stonernarker Rd
Mooresville NC 28117
NOT TO SCALE!
4
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100-ft long
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10/27/2016 ConnectGIS Feature Report
iGS Iredell
CONNECI
Printed October 27,2016
WEB H•�;iiG1 MT, • See Below for Disclaimer
Aodresses
11�� • If'!'aftry(tlTe
•
113
NioWessderMal Use
• Pesrderr,al use
4624-39-?334 1592
streets
4624-39-2385 ' ,1 -- interstate
�91 Ramp
50 _
S US MW,
y+' 243 t 6 J r State Mwi
--tita'naoed
1;2 4624-39.82.0,
4-i74-2�1-8144 138N " c� A M 128 LocalR*ad
• 4-24-3- 5 11.
w,r 4624-: 1 195 Resrder&al
140 n+ `Prate
62 :rectF.e
Parcels Hooks
132
4624-39$056 Parcels
Stu^ennarkrr Rd ; 126 ❑
Parcel mailirg Address
15C' r Parcel Labels
chi Crty Urnts
4624-38-9961
424-38-18`8 4524-38-5,879 t, Lake Norman
41:24-3$_389` .. �
W r 106 Iredell Courtpline
S •
46. 1?8 Feet NC CoLmnes
'' 1 : --)
The maps prepared for this website are generated from recorded deeds,plats,and other public records.Users of these maps are hereby notified that the information provided herein should be verified.Iredell County assumes no
legal responsibilities for any of the information contained on this site.Users are advised that the use of any of this information is at their own risk.All maps on this site were prepared using a 10004ۥm Grid based upon the North
Carolina State Plane Coordinate System from the 1983 North American Datum.The delinquent real property tax overlay is updated monthly.The information presented is not intended to be used or relied upon as official notice of
ax liens.For additional information regarding delinquent taxes,contact the Iredell County Tax Collector's Office,
A}P'-G)( rWCL4e.ty [cooYvu+e
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Pro lOf-rty .
http:/firedell.connectgis.com/DowrdoadFile.ashx?i=_ags_rnap75924299ge5c42cd9ffac7863d4823adx.htm&t=print 1/1

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DUKE ENERGY DIRECTIONS BY ROAD FORM
Lake Use Permit Applicants and Contractors: Ease of locating the proposed project
site canhave a big impact on permitting processing time. Please complete this form and
return it along with your completed application to:
DUKE ENERGY
C/O LAKE SERVICES —EC 12 Q
526 SOUTH CHURCH STREET
CHARLOTTE, NC 28202
Applicant's Name: 'P,},r 2)�aLy,�laYYl
Street Address(at lake): ��oyl e Marµl2.►" Ra
Lake Name: 1�uc Alan
Subdivision Name: C Y`e`f�+ � `,1 ynber
Property Section: Lot #: (�0q,
City: el County: I r e e
State: I V 01�VA CCA ro �,1 Y-\ GL Zip: F)I l7
Telephone: '704 - Lo-77 F5 1 1
Directions (from major road or highway): aroavJ e G X100
'From -1:--l-7 t4b -X-cJ,e exi+ 35. Turn 1 e-F+ onto y
Road. Coy-\-H nue on 1�- rawley xhoa 1 �cl. h4 o-i4o
Turn ZC�-Ke-r CrcS+ �Oad. -PrOper+ 5 on ce ri h�:
stone m y �
Descriptive Structure(s) on Property (i.e. brick garage, white fence, mobile
home, etc.) �Y'G�J e 6r j,re'W0.y . i�' l U e '�"0.YYl e_ is fru �tlure .
*Note: Please use the back of this form if desired to draw us a map to the site.

LAKE NORMAN NORTH QUADRANGLE
USW U.S.DEPARTMENT F HE INTERI
.S.GEOLOGICAL
A1N.YW NDRTN CAROLINA
A..d.�...N VEY US Topo 7.5-MRNNE Sam
\ '
\ , ptTLEBORO PL
Vlilliamson $.
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IAILFOp
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_ 80, G3-fgc
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0
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OR,
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....m.n.�m«.,..�..,o.e..ns.....<.o..... "°"'"" LAKE NORMAN NORTH,NC
2016

Blackham
138 Stonemarker Road
Excavation Neighbors and Disposal Neighbors (75%)
Brown R. Kent +Jamie R
132 Stonemarker Rd
Mooresville, NC 28117
Mailing Address: 2100 Foxcroft Woods Lane, Charlotte, NC 28211
Descoteaux Rene J + Lynn W
116 Tiger Lane
Mooresville, NC 28115
Mailing Address: P.O. Box 1321, Mooresville, NC 28115
Disposal Neighbors (25%)
Finley William M III +Jeanne T Revoc TR ETA
1178 River Highway
Mooresville, NC 28117
Hager Sidney B + Hallie
139 Robinson Road
Mooresville, NC 28117

�•� DUKE Lake Services
ENERGYR Duke Energy
526 South Church Street
Charlotte,NC 28202
Mailing Address.
Ek-120 r PC Bo: 1006
Charlotte,NC 28201-1006
EXCAVATION PROJECT USER'S AGREEMENT LETTER
(Please fill in the blanks. Please Print)
Date �0_I U- Q
TO: Duke Energy
c/o Lake Services - EC12Q
P. O. Box 1006
Charlotte,NC 28201-1006
RE: Excavatio For(Subdivision and Lot #'s or Other Project
Name)
(Lake/County/City) a_l )r -de LL—1 DY'eSVt P.
(Duke File No.)
(Applicant's full name) �YYIt'_� �e� f �Q hC eby agrees to comply
with all recommendations, requirements and/or conditions of Duke Energy Lake
Services, General Permit(s) (if applicable) and other federal, state and local agency
requirements pertaining to the application to excavate for the purpose of a
In addition, Uwe have read and agree to comply with Duke's current Shoreline
Management Guidelines (SMG), much of which is repeated hearin, and understand that
written authorization must be obtained from Duke Energy Lake Services prior to
beginning any activity within the FERC project boundary or on Duke Energy land. The
excavation will be completed as described in the approved application and within
eighteen (18) months from the date of written approval by Lake Services, unless
specifically noted otherwise in the application or unless I/we obtain approval for a single,
time extension (maximum of one year) in writing from Duke Energy Lake Services. 1/we
understand that if the SMG or other applicable rules change during any extension period,
Uwe will be expected to comply with the new requirements to the maximum extent
practicable. Uwe also recognize that failure to complete the excavation within this build-
out period will require the filing of a new application within the then-current SMG and
that the new application must include any applicable fees and security deposits.
www.duke-energy.corn

I/we attest to be the owner(s) or lease holder(s) of the land immediately adjoining the
project boundary or Duke-owned peripheral strip where the excavation activity is to take
place, or if not the owner or lease holder,I/we have included proof of title to the property
and written authorization from the owner(s)or lease holder(s) to carry out the proposal
within the project boundary adjacent to their land.
I/we attest to be the owner(s) or lease holder(s) of the land that will be used for
equipment staging and disposal of excavated material or if not the owner or lease holder,
I/we have included proof of title to the property and written authorization from the
owner(s) or lease holder(s) to carry out the work on their land.
I/we understand that all excavation work must be done directly in front of my/our
property and within the third of the cove nearest my/our property or within any middle
third of the cove that Duke Energy owns, or I/we have written authorization from the
owner(s) or lease holder(s)to carry out the proposal within the project boundary adjacent
to/on their land. I/we also understand that access channels must run perpendicular to the
shoreline while within the third of the cove area that is nearest my/our property.
I/we understand that for proposed excavations , I/we must notify the appropriate local,
state and federal agencies in advance of the activity by sending them a completed copy of
Duke's Excavation Permit Application Form and other required information. I/we
understand that written authorization and/or other permits may be required by some of
these agencies and such required authorizations must be obtained before I/we submit the
final application to Duke Energy Lake Services.
I/we understand that except for maintenance excavations, any excavation exceeding 2000
cubic yards of material removed or any excavation or shoreline stabilization work needed
to support an application that requires Federal Energy Regulatory Commission(FERC)
review does itself require specific review and approval by the FERC before Duke Energy
can issue any approvals.
I/we agree that unless specifically approved otherwise in the application, explosives will
not be used as part of this excavation activity.
I/we understand that every reasonable effort must be made to minimize any adverse
impact on fish, wildlife and other natural resources.
I/we understand that applicants in South Carolina proposing excavations that are not
covered under the General Permit, or are greater than 150 cubic yards,must receive prior
written authorization from the South Carolina Department of Health and Environmental
Control (SCDHEC) or the US Army Corps of Engineers(as applicable)before
submitting the completed application to Lake Services.
Duke Energy Page 2 Rev:9/15/06
Effective Date:11.15/98
EXCAVATION APPLICATION
GpaVLAKEMGMT/Package Information'NC C-W Dredge/Excagre9.15.06.doc

I/we agree that excavation activities in North Carolina and South Carolina will not occur
during the months of March, April, May and June because of the potential impacts to fish
spawning areas.
1/we understand that trees and vegetation growing within or adjoining the lake play an
important role in its overall environmental condition, and the ecological benefit the
vegetation has on fish and wildlife habitat directly supports a sound and healthy lake
environment.I/we also understand that unauthorized removal of shoreline vegetation(e.g.
button bushes, willows, cattails, etc.) and/or disturbance of the shoreline buffer may
result in suspension or denial of lake use permitting requests, forfeiture of security
deposits and require re-establishment of vegetation at my/our expense,particularly if the
disturbance is found to be in violation of state or local ordinances or impacts FERC
project buffers.
I/we agree that all excavated material will be placed in upland areas, landward of the
project boundary, and confined to prevent erosion and sedimentation back into the lake or
nearby streams.
I/we agree to adequately stabilize all excavated material and all disturbed shoreline to
prevent erosion and runoff into the lake.
I/we understand that the double handling of excavated material will not be allowed;
therefore, all excavated material must be placed above the project boundary in one
handling.
I/we have designed the hydraulic excavation process (if any will be used) so that return
water re-enters the lake in the same general vicinity and cove as the excavation, to the
maximum extent practicable.
I/we agree that the proposed excavation will not be for the purpose of creating additional
shoreline, will not alter the project boundary or the full pond contour, and will not impact
threatened or endangered species,historic properties, or environmentally-important areas,
unless special public entity provisions were made in the application.
I/we recognize that it is my/our responsibility to clearly locate in the field and label on
my/our work area drawings any areas that require specific protection or avoidance during
this excavation work. Examples of these protection/avoidance areas include but are not
limited to, any Environmental Areas,Natural Areas or Impact Minimization Zones as
identified by Duke;jurisdictional wetlands; historic properties; rare or threatened species;
and buried gas, water, sewer, electric or communications lines. I/we agree to provide
my/our contractor with a copy of these work area drawings showing these areas to stress
the necessary protection measures.
1/we agree that if any archaeological resources (e.g. pottery shards, Indian artifacts, etc.)
are discovered during the excavation, work shall be halted immediately. I/we will then
notify Duke Energy Lake Services and the State Historic Preservation Office to
Duke Energy Page 3 Rev:9/1506
EXCAVATION APPLICATION Effective Date:I 1115/98
Gpal/LAKEMGMT/Package Information/NC C-W Dredge/Excagre9.15.06.doc

determine what measures, if any, 1/we must pursue to protect or salvage the
archaeological resources.
1/we agree that any excavation from within the project boundary will not exceed the
volume as outlined in the application and will remove and disturb only what is absolutely
necessary to achieve the project's stated purpose.
I/we agree to be fully responsible for the permitted lake use and I/we understand that this
responsibility is considered to transfer automatically along with ownership and leases of
the adjoining tract.
I/we understand that Lake Services representatives may issue Stop Work Directives for
any violations of the SMG and that other consequences may result from such violations,
including but not limited to suspension or cancellation of approved permits, increases in
fees, modification or removal of non-complying structures and restoration of disturbed
areas at my/our own expense or loss of any consideration for future lake use permits.
I/we agree to immediately comply with any Stop Work Directives, to fully cooperate with
Duke Energy Lake Services and other agencies as necessary and to perform the necessary
remedial actions within the specified time frame.
1/we agree to develop any required mitigation plans and to complete any required
mitigation activities at my/our own expense within the specified time frames. Ywe
recognize that the excavation work is not considered complete and deposits will not be
refunded until the mitigation requirements (if any)have been satisfactorily fulfilled.
I/we agree to notify Lake Services by phone when the excavation is initiated and to
ensure that during the excavation period the weather-proof "Duke Energy Approved
Lake Use Activity" sign (to be provided by Duke Energy)remains posted at the iob site
and visible from the water's edge.
I/we agree to notify Lake Services in writing when the excavation is completed
(including any required mitigation measures) and that the excavation was completed per
the approved application, so a close-out inspection can be performed.
I/we have included a check for the applicable filing fee and security deposit, and copies
of all other necessary permits. I/we recognize that security deposits will not be refunded
if any violations of the SMG or this user's agreement occur.
I/we understand that there will be no change in hydro project operations as a result of the
excavation and/or utilization of the excavated area.
I/we agree to maintain the work area in a safe condition and to fully indemnify and save
Duke Energy harmless from any and all claims, liability, loss or damage that may arise
from this excavation project.
Duke Energy Page 4 Rev:9/15/06
EXCAVATION APPLICATION Effective Date:11/15/98
GpaVLAKEMGMT/Package Information/NC C-W Dredge/Ezcagre9.15.06.doc

Fwe understand that this user's agreement does not, in any way, constitute the transfer of
any rights in real property and that my/our use and enjoyment of FERC project lands and
waters shall not hinder the general public's lawful use and enjoyment of the same.
Sincerely,
q'44eJ- b01C&CLVY) 1 q
Applicant's Name(Print) Lot# Applicant's
*Co-Applicant's Name(Print) Lot# *Co-Applicant's Signature
*Co-Applicant's Name(Print) Lot# *Co-Applicant's Signature
*Co-Applicant's Name(Print) Lot# *Co-Applicant's Signature
*Co-Applicant's Name(Print) Lot# *Co-Applicant's Signature
*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.The check for the application filing fee and security
deposit should be from the party shown as Applicant and not several checks from the Applicant and Co-
Applicants.By signing this agreement,Co-Applicants are in fact recognizing and agreeing to the same
conditions as is the party signing as Applicant.
Duke Energy Page 5 Rev:9'19/06
EXCAVATION APPLICATION Effective Date:11'15'93
Gpal/LAKEMGMT%Package Information,NC C-W Dredge Excagre9.15.06.doc

CONSTRUCTION SITE EROSION CONTROL PLAN
Property Owner: Peter Blackham
Mailing Address: 126 Stonemarker Rd.
Mooresville, NC 28117
Phone: [phone]
E-mail: [e-mail]
Contractor: Lancaster's Custom Dock & Lift Systems, Inc.
1156 Perth Road
Troutman, NC 28166
Phone: [phone]
E-mail: [e-mail]
Project Information
Lake Address: 138 Stonemarker Rd.
Mooresville, NC 28117
Lake Lot Description: Lake: Norman County: Iredell City: Mooresville State: NC
PIN: 4624393195
Subdivision/Lot/Section: Crescent Lake and Timber/#1691/#6
Size: 1.63 Acres
Project Description
Dredge approximately 1293 cubic yards of material for the purpose of boat slip access.
Disposal of dredge materials will be two fold. Approximately 1000 cubic yards of
material will be placed on property for use in creating landscaping berms (6'w X 1-2'h).
These berms will be located outside the buffer/setback area as delineated on the
attached survey. The remaining 293 cubic yards of dredged material will be loaded into
hoppers and transported to Midway Marina for offloading to dump trucks and
transported to an approved disposal site.
Purpose
This erosion control plan shall be implemented to protect soils exposed during
construction activities to prevent offsite movement of sediment and prevent pollution of
waters of the state. Waters of the state include street gutters, storm sewer catch
basins, natural streams, drainage ditches, road ditches, drainage tile intakes, wetlands
and lakes. Both contractors and landowners are responsible for installing and
maintaining erosion control practices, during all phases of construction, until the final
stabilization of the site occurs.

CONSTRUCTION SITE EROSION CONTROL PLAN
Perimeter Protection
Silt fences shall be placed along the toe of all slopes where sediment and
nutrients may move offsite. Silt fences shall be trenched into the ground to ensure water
does not undercut the material. Silt fences shall be inspected weekly and after each
rainfall event of .5 inches or more. Silt fences shall be maintained and sediment
accumulations removed in a manner that keeps sediment from moving offsite. Silt
fences will be replaced, supplemented or repaired when they become non-functional or
sediment reaches 1/3 of the height of the fence. If construction operations require, the
silt fences may be removed or altered as needed, but shall be restored to serve their
intended function at the end of each day.
Erosion Protection
Erosion control mats, filter logs, rock checks, durable much or a combination there
of shall be used in areas where concentrated water flow is likely to occur to prevent soil
movement.
Disturbed areas shall be re-vegetated or mulched permanently or temporarily if it
can be reasonably anticipated that significant additional grading will not occur within 21
calendar days. Temporary or permanent mulch shall be disc-anchored and applied at a
uniform rate. Temporary vegetative cover consisting of a suitable, fast-growing, dense
grass seed mix shall be placed if the cover is to remain in place beyond one growing
season.
Soil stock piles shall be protected to prevent erosion and the off-site deposition of
sediment. A silt fence or bales shall be placed 8 feet from the toe or the stock pile shall
be seeded with dense grass-seed mix.
Pollution Prevention
Soils tracked from the site by motor vehicles shall be cleaned daily (or more
frequently, as necessary) from paved roadway surfaces throughout the duration of
construction.
Culvert protection, on the inlet side of the pipe, shall be installed to prevent
sediment from being transported offsite.
Storm drain inlet protection and tile intake protection shall be installed to prevent
sediment from entering catch basins or subsurface drainage systems. Practice may

include sandbags, rock logs, compost socks, and silt fences. Practices shall remain in
place until final stabilization of the site occurs.
Final Stabilization
When construction is completed, a permanent vegetation cover consisting of sod,
a suitable grass-seed mixture, or a combination thereof, must be established in all areas
that are not protected by buildings, hard surface cover or landscaping practices.
Seeded areas shall be either mulched or covered by fibrous blankets to protect seeds
and limit erosion.

TABLE FOR PROPERTY UNE
TABLE
Q LINE TABLE ND Il 1.,111101 '� 1
1)TIM proprty may a emMt to my eoeemnM ma/a THIS SURVEY 15 OF EXISTING
CATEOORY.i A SUCH AS DE
yy LINE BEARING LENGTH Th.ads
pIpo of fare. RECOMBINATION OF EXM71 PARCELS,A COURT-ORDERED Dao Iy OItM77°00001 TW:1 W
MMrLr �g L1 S 03'21' 5 76' 2)TM tla puRNR.of Uh plat Y to mmga tlIe reaareed 50 eeleaat me SURVEY.OR OTHER EXtIP110N ro TIE DEFINITION OF Meore.e:my2V20t6 w o2:11:60 Pn
vee AAtew:at.m v
]Uloat AOAo 50•Wlfar to mvlM Ue fMe Minted 780'cmtaw Tina SUBDIVISION. Ir.0e11 Ceuntv.IIC�f eI f
L2 5 88'05'00'E 24.73' S)A rot.m metol to 0 1O'Utility ano OraMoq.ea.wnwlL IMt:hw 3.TteCe11""tet"or aed.
L3 N 5543'00"E 105.46' 10 fwt m aam Mee of the praprty INe. —_ ,1
L4 N 17'17'00" 25. a)Pop Fty eonee:R-2D me m s—IdMq proprtlee. -64 -94
PROFESSIONAL35'Fmt LAND SURVEYOR
L5 TOT. 5)MInFMm BuWlnB SelbOck Pr Cmnty Zmi1g:50'LAKE(50'Lose Buffer Line)
S 1'11'28" 28.71'
35'REAR SETBACK
VICINITY MM NO SCALE 15'SKIMTABLE FDR 760 CONTOUR
n'caRNFR SIDE
UNE TABLE .NOTE- 50'Lake BuNr Une baeee m Papa Rede lomted 760 cmtaa Ikle OWNER CERTIFICATE FOR EXCEPTION PLATS
UNE BEARING VLENGNL6 7• 'NOTE' IredaO minty eon not mfaa a Mterpral tl.e0 rsetrictlone. STATE OF MORIN CARCUNA KNOWMLYETIBYMESE PRESENTS.MAT OF NEA®Y
L7 S]9 1•E 7)Tee proarty M located N DAVIDSON Twp..IroMO Cm.N.C. COUNTY IREDFIL CERMr TWAT I AY(WE ARE)T0:OIRBTt(5)OF TME
LB N 65'00' T)Tw PaaM P(*nwnpa) M24393185 PROPERTY I(WE)HER®SH AOAND DESE BED HIEREON THRPur ANO 0 NATENr
LSI N 3214'147 6)Deed n/.. TJTO/1300 I,Mil-I&M M.1� I Lel JIEVIEW OFFICER OF IREDELL8)No geoeetic mo MIt Io-d Nft,2000'of mY properly. COUNTY.CERTIFY THAT THE YAP OR PUT TOlO BE MY FREE ACiLTO N 71' ' 10)The=a b IMr mum me Y eeeE n t'loaw•Hame Omwe Anxbtiow LARCH TRS CERTIFICATI N IS MFlXED MEETS 3�14M.
S 5111' or ted"Rett of ReVIee CommMtn prbr to my nw omtl u tlan. ALL STATUTORY REQUIREMENTS FOR RECORDING.
b/ r DATE
D2fE REVIEW OFFICER z • %I N//(.
/ LOT 56 1 DATE OWNER
KENT BROWN NORM CAROLINA
1
PIER
949\1524 I IREDELL COUNTY
,�Gi.
50232'33"W 257.16 I,HEREBY CERTIFY MAT THIS RAT FOR RECORDATION IS A NOTARY PUBLIC FOR SAID
COUNTY MID STATE,
IS'SIDE SEieACK I AN COUNTY.
TO�NABDINSION ORDINANCE OF IRFDEU. DO HEREBY CERTIFY TUT
CY _
`� h JAMES P.BLACWW!VEAOIICA C.BUO(NAY
WELL OWNER(S)PERSONALLY APPEARED WORE 4E 1M5 DAY.
�PI AND ACKNOWLEDGED ME EXECUTION OF THE FOREGOING
SUBDIVISIONAOMINIS1RAlIN �NSIRUMEIJT. MI7�55 MY •AND OFFICIAL SEAL,
LAKE ) — — 49.s r to I s cy D
NORMANm y' NOTARY PUBLIC `
Arc CW I" I YY CdAY15SON EXPIRES
�
m COUNTY.CO1Y.NORM CAROLINA 9 r�
780 CMTWR PER •�'' I .>.'.�...M..•:•Y�.
ACTUAL FIELD SURVEY Cp�J �, I g `' ' THE LOT SHOW ON THIS PLAT TO ME BEST OF MY KNOWLEDGE ��• �;,
LIES WITHIN THE M
NS-IV CRITICAL AREA OF THE +y t 7# B
b n FEMA FL I LAKE NORMAN/CATAWIBA WATERSHED AS DESIGNATED BY THE
NORM CAROLINA gVISION OF ENVIRONMENTAL
Lt $AQ ./
MANAGE TENT AND AS APPEARS ON THE ``'rr'•_ /f
1069 1 I ;r 3 WATERSHED PROTECTION MAP OF RTEDELL COUNTY. .t.L,,•C. .V
h ry ' VV o�w zm�--
�• I '�,�o I DA SIlBOVI510N ADMINISTRATOR SURVEYORS CERTIFICATION r
Z I•WtWAM M.ALLEN CERTIFY MAT MIS MM WAS DRAWN
\ I UNDER MY SUPERVISION FROM M ACTUAL SURVEY MADE
UNDER MY SUPERVISION DEED DESCRIPTION RECORDED
IN BOOK—PAGE�THAT THE RAM OF
{,, YIAOOOO. THAT T14E BOUNDARIES NOT
PRECISION AS CALCULATED MI
BY LATITUDES D
DEPARTURES IS_ .. .' �'p� L�cl5 e- NRVEYED DARE SHOWN
N S BROKEN LINESPLOTTED FROM
TAWAS PREP
CS47-30. SYENDE. NMQ
\�\ '. �.• MIF I I LJ;V ! YY INDAAND SEAL THIS�DAY OF
GG .D.2016.
LOT 1692 I 3 $ O 4 PRSSI RENE J. DESCOTEAUX
1197\604
'� i Irk Oi` tTmcuLFF��,, L�3
\ I& ^ JOOP.t,.Hyt:'3' OY� asTR Bvt
1� Y"7-6 6 LONA .
O 3 -ry,•n fill.,
LEGEND
t P.P.:POWER POLE y"r r^ EXCEPTION PLAT
s POWER TRANS. ` J C
GF
E.I.P. -EXISTING IRON FOUND 200
`` Z I CRESCENT iA ND & TMER CORP., SECTION 6
I.P.S._ /4 RESAR SET (60-P,44tJ*—P IAT 1691
R/W-RIGHT-OF-WAY gLlC. I
CP s COMPUTED POINT Rt'i (PLAT HK 18 PG. 55)
1 oAlnoson nlrsn.MEmL CO..rILa
SCALE: 1' SO' DATE SURVEYED: FEB.1 2016PLATTED:DATE PLATTED: MARCH 14.2018
PK MALL
OWNER: JAMES P. & VERONICA C. BLACKHAM
D 140 STONEMARKER R0.
DON ALLEN ! ANAs S OCIATES P. A. MOORE$VILLE N.C. 28117
'Since 1971'
Cant ..W a R.Wd ted a MartQape Survey.`Muhl-F—ly A PORTION OF THE SUBJECT PROPERTY IS LOCATED WITHIN A
Cmetructim StakMB SuIMNMWon DWp a Topographical SPECIAL FLOOD HAZARD AREA ACCORDING TO FLOOD 0 25' 50' 100'
131 Cw
alake Pak Or1.e-91Me 102• MaaneAe.N.C.21"17 INSURANCE RATE MAP-COMMUNITY PANEL/3710/62400K
[phone] (704)ee4-6041 Fa EFFECTIVE DALE:03/02/2008 �1
SCALE N FEET
aaanNytFYNebgn.nt
FILE NAME: CLT 1691-TWO -- 13107Arg

10/27/2016 ((""��P p e ConnectGIS Feature Report
V I ��1��ei w Iredell
Printed October 27,2016
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CL
he maps prepared for this website are generated from recorded deeds,plats,and other public records.Users of these maps are hereby notified that the information provided herein should be verified.Iredell County assumes no
egal responsibilities for any of the information contained on this site.Users are advised that the use of any of this information is at their own risk.All maps on this site were prepared using a 1000AE-Grid based upon the North
Carolina State Plane Coordinate System from the 1983 North American Datum.The delinquent real property tax overlay is updated monthly.The information presented is not intended to be used or relied upon as official notice of
ax liens.For additional information regarding delinquent taxes,contact the Iredell County Tax Collector's Office.
http:/!redell.conriectgis.com/DownloadFile.ashx?i=_ags_map3d470475366d498d9OdO3l4fl08ce337x.htm&t=print
111