20181377 Ver 1_Shoreline Stabilization_20181005

2 p 1 g 1 3 T T Statg of North Carolina
Department of DWR Environment`and`9atiftl'R�esources
DivSn of Water Resources ...
Division of Water Resources 15A NCAC 02H .0500 - Water Quality Certification, Shoreline Stabilization
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
1617 Mail Service Center Ttt
tRaleigh, NC 27699-1617 V ll
I. Applicant Information [15A NCAC 02H .0502(a)] I
1. Owner Information //1� I
Name: .rev -Y1 !' 1'-lm&A � le.rne n+
Mailing Address: ra0( 0;115 P W0(nd Ln
Telephone Number: got4 - qq I - 1556 Fax Number:
E-mail Address: 0.rnu . C 1e mn e YJ+ _ re S Co m
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.pdf) must be attached if the Agent has signed this application form.
Name:
Compar
Mailing
Telephone Number: Fax Number: rJyy - () - 5q q.
E-mail Address: Cb[! SeLLL0cJ IS �l�„nd rPn M 10e+- t_
Person to receive the Certification Approval: 3 niG2 L3�e t-�
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)
County: �� P C _�2;h Nearest Town: _- r neJ i Q S
Subdivision name or site ad ress (include phase/lot number): Qp��� h_ 1�ocd L n .
H
Directions to site - please include road names and numbers, landmarks, etc.:
'`1'`l I A +O e -X I+ Q p rrae_ On�Q US - a k laJ / C0. JY1 k\je
-TUr n r % 4 hk oy)A-c, In .\ we od L,rch Ra 0- +ken 4yrf-)_
k v i nock Ln
Latitude (in decimal degrees)_�15 _ H qQ (A5 Longitude (decimal degrees) — [j(7, q0 -L 50
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): den-�u 0
6. Property size (acres):
7. Lake/ river/ ocean adjacent to property: &o r nno'n
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): mcedae � -or nPi,) dock,
"r'-14- a.r r.eSS _
9. Will work be conducted from land? V From water? El
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:
. 0 `l
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:
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): +rues
v erY1 ov ed m; ri. ,r Yl n l d i slur e -}-n ge tr'
or i t j15A NCAC 02H .45QZ f)1 Date
Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSCP 10-2013
Page 2 of 3

Full Pond/
Normal Water Level
Shor
�'eline'''
La ke
(At Full Pond/ Normal Water Level)
50`
O'
(>_" r` CYC N
,.
3
i
V t`- �-(f E"
,�d VAtIij L°.ttv.t-it-►,7-.
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ftx 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
a

9/27/2018
Go gle Maps 20625 Bethelwood Ln
20625 Bethelwood Ln - Google Maps
20625 Bethelwood Ln
Comelius, NC 28031
https:/lwww.goog!e.condmaps/placeJ2o625+Bethdwood+Ln+Cornelius,+NC+28031/@35.4906247,-80.9049389,93m/data=!3m1!1e3!4m5!3m4lls0)6856ac0404aee139:0)64c76e9cf4f93aefl8m2!3d3.54_Am7nrAidrit;n 1/9

CAT MBA RIPARIAN BUFFER NOTIFICATION FORM
Project Nameladdress:
St-c"AE x D.County:
ner•___N,{,}
Pr.
Contractor/agent-
11V
The approval is for the purpose and design described in your application. Impacts not indicated in the
application is a violation of the Buffer Rule. Site specific work should be provided in the application. [15A NCAC
02H .0506 and 15A NCAC 02B .0243(8)]
Trees are not allowed to be removed from Zone 1 of the Buffer (within 30 ft of the full pond elevation), unless
approved. Exception, those trees that are severely undermined along the immediate shoreline can be removed.
Minimal shaping and sloping along the immediate shoreline is allowed. 115A NCAC 02B .0243(6)]
Benching, grading in the buffer is not allowed. Excessive disturbance of ground cover. 115A NCAC 02B.0243 (6)]
Beaches, impervious patios, impervious walkways, etc. are not allowed in the buffer unless specifically approved
by the Division. There are limitation on size for decks. [15A NCAC 02B .0243(4) and (6)]
Work to be conducted from land must indicate an access and indicate any trees that are to be removed. The
work corridor should be described. The approved access corridor shall be restored. Staging, spoil, construction
material must be outside the buffer. [15A NCAC 02H .0502 and 15A NCAC 02B.0243 (4), (6), (8)]
Stormwater cannot be piped or channeled for direct discharge to the lake. All constructed stormwater
discharges must be at the natural elevation and discharged prior to entering the buffer directed as diffuse or
sheet flow at non-erosive velocities to the lake. [15A NCAC 02B.0243(5), (6)]
Acknowledgement of Notification
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.
re (owner); _ Date: C.
State, of North CarcAna t Ervi,�rnirntai:?ua'sity ivalcr €tescurces
`il N. SaIL-' m'Y Stt uct ; 1611 i ,'A S l" ce ^ewer , i tc cti.. PaC 2 � 3�n ibis

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Date=q-�'1�

DREDGE SPOIL DISPOSAL FORM
Project Name/address: a0L n'15 &AV] LXXxfi Lr)- -ern (1 0S.county: Memlen
Location Address:al cSr6- : 638(' -ikriche garm (;wu eLas,�J1e. NL 1611
Parcel #: _14(ALQ I A R U UL4 ?,
Parcel/lot size (, . L4 q -AcreS
Disposal area required (sq ft and/or acreage) 100" is 10o"
Acknowledgement of Notification
I, _F=. 'am aware that the site must adhere to all state regulations
and rules regarding se invent and erosion control and water quality. And give permission for
Name of Individual and -Company
to dispose of their dredge material at the above stated location
Owner:
Along with form, please provide:
Aerial of parcel/lot (County GIS)
Photo of proposed spoil site
Identified proposed spoil site

9/27/2018 lredell.ComectGIS
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Go gle Maps 638 Oakridge Farm Hwy
638 Oalvidge Farm Hwy- Google Maps
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Duke Energy Excavation Permit Application Form
DUKE ENERGY USE ONLY
Duke File No.
Application Fee $ Security Deposit $ Check 4 Date Recv'd
Initials
Date of Duke Energy Lake services, applicant and/or contractor on-site inspections DateQq- Z9 -1,R Locals
Date Final Protection/Avoidance Area Markings Field - Verified
Initials
Approved to Start Work By * : f
(pl int)Date
(sign)
Date of Any Approved Extension Initials
Date Passed Closeout Inspection*
Date Completion Required
Initials
Any Stop Work Orders or SMG Violations*? (check ate) ❑Yes 13 No (ff Yes, explain i,, PART V)
Date Deposit Refunded Initials Date Permit Database Updated___ Initials
* Forward copy of approved application (all pages, plus any attachments that Duke Energy changed) back to applicant
with Approval Letter and highlight any changes. File copies of Approval and Close-out Checklists and any Stop Work
Orders with application.
Part I. Applicant Infwwmwmmww�ormation (Please Print)
Name_&yen Telephone l" I I - 15519
Email address:cSno rn
AddressLake
Jnu --1—oncl Ln.
W-TaMt"MKOW-31WIM
Contractor Company
Mailing Address (if different)
`50-pne
--
Contractor Contact Person _T n c _ L'Mm +->— Telephone (j,,.4 -SII I
Contractor Email Address: (' �ri - �,�n , �,,, (jS t �•nrl s -t r
LAKE LOT INFORMATION
Lake p County 04hCity _L ehiL5, _ State -ELC, Tax Map No.
Subdivision Lot / Section No. 60 112133Lot Size 1. Acres
Duke Energy Page 4 of 14
Excavation Program rev'716117

Duke Ener Excavation Permit Ar► licatlon Form
Are _there any Co -Applicants* . (check one) []Yes o (If Yes; include_ names, addresses or
lot ntunbe� s, p{lone nuinbers, lot sizes in PART V – ADDITIONAL INFORII'IATION
* 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
-front properties within a single development. The check for the
owners / lease holders of Project
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 Representative and the applicant and/or the excavation contractor.
NOTE. Initializing this portion of the application by a Lake Representative an no way
constitutes approval or eminent approval of the e-rcavation or any other lake use permitting
activity.
Date of on-site inspection L LU—1.
Initials (Duke Energy) 0014111_
(applicant/contractor) 07
Duke Energy Page 5 of 14
Excavation Program rev J6t (7

Duke Energy Excavation Penn* Application Form
Part II. Description of Project
A. BASIC INFO
1. Type of excavation: (check one) ISI New excavation O Maintenance excavation
2. Purpose of excavation: (check one) M Boat Access Channel
O Water Intake Channel O Wastewater Discharge Channel
1P Other (spec): Rett �eK
3. Lake user category: (check one) O'Frivate Mesidential Marina
❑Commercial Marina 13Public
❑Other (specify):
4. Max. Excavation Area Dimensions (ft): Length 50 r Width L� b
Depth 1 _ K
(Note: include additional area dimensions if necessary so response to #5 below equals max. area
dimensions in #4)
5. Volume of Excavated Material (TOTAL for the project): 1 _ ( Cubic yards
6. Type of material removed (applicant determines by field sample if practical):
7. Excavation Site area: 0- Acre (s) Disposal Site area: a. a 9 Acre
(s)
8. Total Disturbed Area (including equipment staging area): O. 0 'i Acre (s)
9. Does the project meet the requirements of the applicable General Permit? (check one)
Rf Yes ONo
10. Do you claim title to the disposal area? (check one) ®'''es ONo
11. Do you claim title to the equipment staging area? (check one) OYes 10'To
12. Are there any water- eatment facilities within 50 feet of the proposed excavation area?
(check one) OYes to
(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):,10=
Duke Energy Page 6 of 14 rev Z/6It7
Excavation Program

Duke Energy Excavation Permit Application Form
14. Type(s) of excavation equipment to be used: ex Cwia -vo r
15. Will waters or wetlagds be crossed in transporting equipment to or from the site?
(check one) OYes NrNo
(If yes, explain)
16. Will return water re-enter the reservoir? (Check one) Oyes 0<0 E]N/A (If Yes, sped
points) of re-entry and show on Excavation Area Drawing)
17. Is there an ex> ting facility (e.g. pier) that access is being maintained to by conducting the
excavation? Wes [No
(If Yes, specify the ex ting permit member. If No, include a scaled drawing of the proposed
facility). Permit # _#� 5_ ''1
18. Total planned duration of the work (Include first equipment mobilization, excavation
through final mitigation measures complete):
START 1— / J_ FINISH
(Month) (Year) (Month) (Year)
Duke Energy Page 7 of 14
Excavation Program rev 2!6/17

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:
Protection/Avoidance Areas
(check all that apply)
Aaprox
Acre
Identification
Method *
Avoid (A) or Mitigate (M)
Field ID
Work Area Dwg. ID
a. Marshland, swamp, ponds, beneficial
aquatic vegetation or other potential wetlands
(circle all that apply)
N /tq
b. Buffer Zones (spec6 width & source
of requirement),
lot �,tcle access
O.O 1
l..
1��rr
`n.i-
Mal A ls-kJ rn.V'Y'a
c. Environmental Areas as identified by
Duke Energy
1 V I A
l
d. Natural Areas as identified by Duke
Energy
I /A
'4
e. Historic properties (speci6 j
!Y liq
f. Rare or threatened species (sped)
Duke Energy Page 8 of 14 rev 2/6117
Excavation Program

Duke Enemy Excavation Permit Auolication Form
Protection/Avoidance Areas Aaprox I Identification Method M
(check all that annly) I Arra I T2.1 J —
e. Buried gas, water, sewer,
communications or electric lines (circle) I Y 1A
h. Impact Minimization Zones as
identified by Duke Energy
IA-
L Other areas requiring specific N
avoidance, protection or mitigation (sped)
x /14
Avoid (A) or Miti ata (h»
* 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
Duke Energy Page 9 of 14
Excavation Program rev 2/6/17

Duke Energy Excavation Permit Aanlication Form
C. APPLICANT'S SIGNATURES
Comments: Ae,►ah6nc- -v�r1 I
- � �►S c+�.n ��nrw{� �P���.S1�5
- ao'1p 1 ►,- 01 ,
r,
-(print) �,
��-�SI.ot py j o�i 135
- -
` Date l
(print) 7` 1111�t
�"
Lot #'III
l.(K. �Q
{I.� 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)
Co -Applicant Signature*
Lot #
Date
*Per my signature, the information provided in this application is correct to the best of my
knowledge,
Duke Energy Page 10 of 14
Excavation Program

Excavation Project User's Agreement Letter
(Please fill in the blanks. Please Print)
Date IoLIJ15_
TO: Duke Energy
c/o Lake Services - EC12Q
526 S. Church Street
Charlotte, NC 28202
RE: Excavation For (Subdivision and Lot #'s or Other Project
Name)—EivVe F _J. mii O lov,no,r..l..
Applicant's full name)
or
con hereby agrees to comply with all
�
requirements and/con tions of Duke Energy Lake S
recommendations, ervices, General
Permits) (if applicable) and other federal, state and local a ency requirements pertaining to the
application to excavate for the purpose of a
-� r►rp �c
In addition, Ihve have read and agree to comply with Duke's current Shoreline Management Plan
(SMP), much of which is repeated herein, 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 not 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.
I/we understand that if the SMP or other applicable rules change during any extension period,
[Ave will be expected to comply with the new requirements to the maximum extent practicable.
t/we also recognize that failure to complete the excavation withinthis build out period will
require the filing of a new application within the then -current SMP and the new application must
include any applicable fees and security deposits.
Ihve attest to be the owner(s) or lease holder(s) of the landimmediately 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.
Ihve 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, Ihve have included
Duke
Ery Page 1
Rdv- U18/17

proof of title to the property and written authoriza
carry out the work on their land. tion from the owner(s) or lease holder(s) to
Ilive 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 Ave have written authorization from the owners) 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 mylour property.
Ili.ve understand that for proposed excavations, Uwe must notify the appropriate local, state and
federal agencies in advance of the activity by sending them a completed copy of Duke's
written authorization and/or other permits may be required by some of
Excavation Permit Application Form and other required information. I/we understand that
these agencies and such
required authorizations must be obtained before Mve submit the final application to Duke
Energy Lake Services.
1/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.
Ilwe agree that unless specifically approved otherwise in the application, explosives will
used as part of this excavation activity. not be
I/we understand that every reasonable effort must be made to mi
fish, wildlife and other natural resources. nimize any adverse impact on
lAve understand that applicants in South Carolina proposing excavations that are not covered
under the General permit, or are greater than 150 cubic yards, malth an ust receive prior written
authorization from the South Carolina De
(SCDHEC) or the US Army Corps of Engine�erse(as apnt of plicable) ble) efore Environmental
bmitting thecom le
application to Lake Services. completed
"'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 spawnin
areas. g
I/vve understand that trees and vegetation growing within or adjoining the lake play an im octant
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. et at on hasalso n fish
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
nzy/our expense, particularly if the disturbance is found to be in violation of state or local
ordinances or impacts FERC project buffers.
Duke EncW
Page 2
Rev: 3/19/17

[live 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.
!five 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.
Ihve 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.
1/1ve recognize that it is my/our responsibility to clearly locate in the field and label on my/occr
work. Examples of these protection/avoidance areas include but are not limited to, any work area drawings any areas that require specific protection or avoidance during this excavation
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. Live agree to provide my/our contractor with a copy of
these work area drawings showing these areas to stress the necessary protection measures.
I/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 determine what measures, if
any, 1/we must pursue to protect or salvage the archaeological resources.
I/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 nl w t 's absolutely nec_ e_ ssary to
achieve the project's stated purpose.
Ihve 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 Duke Energy representatives may issue Stop Work Directives for violations of
the SMP and 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
°uk" ate. Page 3
Rev: Slbr17

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.
Uwe agree to develop any required mitigation plans and to complete any required mitigation
activities at my/our own expense within tate specified time frames. 1/we 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. will post Duke Energy's approval letter in a clear waterproof
ba -g at the lob site and visible from the water's edge
I/we agree to notify Lake Services in writing whenthe 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.
1/we recognize security deposits will not be refunded if any violations of the SMP or this user's
agreement occur.
1/we understand there will be no change in hydro project operations as a result of the excavation
and/or utilization of the excavated area.
1/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.
.11we 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,
Lot #
06112135
Lot #
*Co -Applicant's Name (Print) Lot g
*Co -Applicant's Name (Print) Lot #
7�
Applicant's Signature
NIV AM �- Ukirt4ct—
C`� o -Applicant's Signature
*Co -Applicant's Signature
*Co -Applicant's Signature
Duk" RneW Page 4
Rev: k1&11

*Co-Applicant'sName (Print) L —
*Co-Appiicant'sSlgnature
* 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 Performed
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.
D4*C &any
Page S
Rw. S;IV17

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D W. LONG. P S
18335 OLD STATESVILLE ROAD
SUITE A
CORNELIUS, N.C. 28031
(7D4)765-5134
_J '&RrURLWOOD LANE
60' PUBLIC R/W
DU — 13U 13l18' EP TO EP
:�—�
�--- S 2 OU OU 13U OU
pE ONLY) '38 E 181.21
— t E 183`04. EDGE OF PA I9vr rD
J C) (TIE ONLY)
S 22'29'31' E `� N 22'19'20" W
I DISTANCE a _ 179.59' 12 50. 9' --�
001-121.34
LOUIS DEJESUS
JEANETTE DEJESUS
DB. 29911, PG. 652
MB. S8, PG. 426
% oNrsETeA� r
r
ID
M l
1 K,
�l—sae' — a far a
a4 • I
21.0'
LJp; $�
M� --\A a KLapp AEOt
to n. v I 3
LO I PAib ! �'�' ATI e
FIRE PRco
Z 8 AREA IN ROAD R/W f
0.124 Acres Ig
5,413 Sq.Ft. 4 ro
W AREA OUT SIDE R/W +k
9 1.669 Acres p
al 72,700 Sq.Ft, 16�
TOTAL AREA
NOTES: r'nj 1.793 Acres
78,713 Sq.FL
1. NO NCGS MONUMENT FOUND WITHIN 2000'. _O
2. PROPERTY MAY BF. SUBJECT TO OTHER W WALX4:
COVENANTS, RESTRICTIONS, EASEMENTS OR to PATIO
RIGHTS-OF-WAY THAT MAY BE OF RECORD.
Y 5�.�r
3. THE PROPERTY IS CURRENTLY ZONED "GR" �--� VP 50 R FROM
WITH THE CORNELIUS PLANNING OF PT. � to
SETBACKS AREA AS FOLLOWS:
25' FRONT Z
IO'SIDES L10 L9
50' FROM 760' CONTOUR LINE ( REAR)
ADD101NER'S
ACCESSORY STRUCTURE SETBACKS SEAWALL IS OFF LINE
SHOULD BE
WOOD PIER,/ f
a ACCESSORY STRUCTURES LESS
RAMP,&
THAN 600 SQ. FT.
�J
BOAT DOCK
10' SIDE, 50' FROM THE 76M
•
CONTOUR LINE
Surveyors, Inc.
b. ACVESSORY STRUCTURES 600 SQ.
Sf
FT. OR MORE IN SmE. SO -FROM
LAKE NORMAN
THE 760 CONTOUR L.LNF.
4, PROPERTY MAY BE SUBJECT TO TILE DEED
RESTRICTIONS RECORDED IN DB. 4085, PG. 757
AND AMENDED IN DR. 4941. PG. 467 OF THE
MECKLENBURG COUNTY REGISTRY.
5. CONSULT WITH GOVERNING AGENCY FOR Gnpluc Sale
PREVAILING LAND DEVELOPMENT AND 60 30 0 60
70NING REQUIREMENTS PRIOR TO DESIGN
OR CONSTRUCTION OF ANY IMPROVEMENTS. Scale OrDrawing I Inch 60 Feet
001-121-37
ALECK G. KILGOUR
GINA M. KILGOUR
DB. 9010, PG. 873
APPROXIMATE LOCATION OF
SOD YEAR FLOOD UNE PER
FEMA & MECKLENBURG COUNTY GIS
3 ADDJOINER'S
. SEAWALL IS OFF UNE
FIELD LOCATED 760 CONTOUR
77jr4211;
LO" IRON PIPE FOUND
Professional
/4 REBAR FOUND
O
/4 REBAR SET
COMPUTED POINT
•
UHUTY PEDESTAL
Surveyors, Inc.
UTIUTY POLE
Sf
LIGHT POLE
{�
GUY MARE
)
SUBACT PROPERTY UNE
Cornelius, N.C. 28031
ADJOINER PROPERTY UNE
BUILDING SETBACK
— —
OVERHEAD UTILITIES
DU
PHYSICAL SURVEY OF 1.793 ACRES PER DEED 13UUK "1451 S, ru. 12-1
Professional
Property of-
p
Site Address:
Surveyors, Inc.
As Recorded in:
20625 BETITELWOOD LANE
18335 Old Statesville Road Ste. A
STEVEN D. CLEMENT
DB. 24515, PG. 127
CORNELIUS, NC 28031
Cornelius, N.C. 28031
AMY K. CLEMENT
MECKLENBURG COUNTY
704-765-5134 Phone/Fax
Film License: C-3666
053018-02
T ME
2 1: 10 000 11=60'
Error o— f bosure . Drawin Scale
001-121-35 1 20625 BETH
Tax Parcel NOmber Draw1�e Nam
loft 6162018
teeS�NumRe Date
Job No.
• Pre Bred B

Polaris 3G Map — Mecklenburg County, North Carolina
0.0.005).01 0.02 Miles
l
Date Printed: 9/27/2018 1:50:2
WI

9(27/2018
20625 Bethelwood Ln - Goog le Maps
Google Maps 20625 Bethelwood Ln
20625 Bethelwood Ln
Comelius, NC 28031
X25 Bethelwood Lane
0 Desig
Map data 02018 Google loo Rr
https:/AmmN.google.corrgrnaps/placeQW25+Bedid ood+Ln,+Cornelius,+NC+28031/@35.4913829,-80.905446,laz/data=!405!3ni4!1s0)6856ac0404aeel39:0)64c76e9cf4f93aeft&n2!M.'IgAcm7nF4te,Lunonn.nmkr

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25 Iwood Lane .
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9!27/2018
MyTopo Map Print
4 0 0.5 Mi
0 3000 Ft Map provided by MyTopo,com
http://►mp-pass.nTAopo.corNmaps/print nlytopo.asp?print=20&scale=2.5&IaWr=DRG&layer=HILLSHADE&Iat=35.490834711323494&lon=-80.904193849999%&Ori&rt—lgrr.-=lda

rOR REG[STRgTfOM J Dqv ID GgpNpEptIT
2 MA�Bt�pe e0tN�511e
1000 PMR 04 10 ?9 00 M
BX 24516 VC 127,1]0 F'EE t20 00
IM8T0UIENT 1 2009020120
Excise Tax 50.00 Rig Time, Book and Page
Tax Lot No. 001-121-35
Verified by County an the day of
20
by
Mail after recmdutg to Hora& Talley Pharr and Lowndm, PA. Cheryl D Stedt Esq., 2600 One Wadtovia Center. 301 S. College
Street, Charlotte, NC 28202-6038 iRn Boz 8194
This instrument was prepared by Horack Talley Pharr & Lowndes. PA, CDS/ses 032.2
Brief Description for the index 20625 Bl?l HMWOOD LN CORNELIUS
NORTH CAROLINA GENERAL WARRANTY DEED
tate 17th day of Febnuuy, 2009
GRANTOR
STEVEN D. CLEMENT
GRANTEE
STEVEN D. CLEMENT and
AMY K. CLEMENT
husband and wife
20625 Bethelwood Lane
Cornelius, NC 28036
Enter is appropriate block for each party namq ad&=, and, ifWnVruft character of emtty. a g.. corporation or partnership.
The designation Grantor and Grantee as used heroin shall include said parties, their heirs, successors, and assigars, and shall
include singular, plural, masculine, feminine or neater as required by oont=L
WITNESSETH, that the Grantor, for a valuable consideration paid by the Cranage, the receipt of which is hereby
acknowledged, has and by these presents does grand, bargain, sell and coam unto the Grfee in fee simple, all hurt certain
lot or parcel of land situated in the City of , Mecklenburg County, North Carolina and more particularly
described as follows
See Exhibit A attached hereto
The title to tins property was not ezamined by the attorney who prepared this Deed, and Haid attorney has not
expressed any opinion about the title to the property or the legal description of the property contained in this Deed
HTPU 380409 0 /

The VroPertY berehmbove desm"ced was acquired by Grantor by msmuoeat reoordod in Bock 9384 at Page 500 in the
iMe*kaburg Comy Pubfic R6A'y.
A mop sbowtog the above deam bed property h recorded Map Book ___, at page _ in the Me*bt b n County Public
ltppstry.
TO HAVE AND TO HOLD the afia=W lot or pamd of land and alt Privileges ad apputumo a tbecaoo botooigLg to the
Gkan-PA be The simple.
And fhe CA=w wveomb wish the Grantee, that Oranmr is seined of dw pkemiaes in the simple, bas the d*a tD convey the
same in he dmpte, that We is =dMble and fm and clear of all metw* anew, and that Graam. will "nag aad defied
die fide against the lawful c W= of an Imr ms whomsoever incept for the mcoepdm herdoafbee seated. Tide to the
property fuuvbmbove desmibed is subject to do fobnft mcepdm..
AU valid and mfft+ceable reatrietiont, mveamts, eondbwm, and sameaft of recoed and the Has of ad
valormc prapakty taxes.
IN WITNESS WHEREOF, the Grantor has ha wdo set Iris hand and seal, or if wrpmm, fns ca=W this fikluu=W to
be s4pod in its cokpotate name by its duty autbn dnd of6c>em and its seal to be hemmoo affixed by udwi ty of its Board
of Dkcc win the day and year first above written.
North Carolina, c mty
SICAL.BTAMP
I, a Notary Public 60� County,
North Caro do hereby that Stem D. Clem= personally appeared
before me this day sad acimow tie due etoecudw of the foregoing
h mmumt.
Witness my hand and offidal sal this the A6
2009.
My coots expires:&L0
erreyasaos.t
day of

EXHIBIT A
BEGINNING at a point which is S 21-57-13 W 44.46 feet from a PK nail found in the center of
the 60' right of way of Bethelwood Lane; and from said point of BEGINNING S 22-32-36 E
181.50 feet to a point in the right of way of Bedzlwood Lane; thence S 67-37-46 W 433.16 feet
to an iron; thence S 67-56-33 W 8.82 feet to an iron; thence N 50-21-02 W 20.76 feet to an iron;
thence N 24-0944 W 24.61 feet to an iron; thence N 62-07-28 W 8.62 feet to an iron; theom N
50-40-47 W 21.82 feet to an iron; thence N 25-33-37 W 10.81 feet to an iron; thence N 24-03-17
W 11.30 feet to an iron; thence N 49-51-17 W 19.27 feet to an iron; thence N 24-59-45 W 17.48
feet to an iron; thence N 33406-56 W 35.32 feet to an iron; thence N 68-52-28 E 9.19 feet to an
iron; thence N 68-43-45 E 109.58 feet to an iron; thence N 63-56-06 E 367.03 feet to the point of
BEGINNING, all as shown on the Physical Survey for Steve dt Lynne Clement, dated November
26,1997, by Thomas D. Von Canon, NCRLS.
1//09.
99
f-

9/27/2018
Go gic, Maps 20625 Bethelwood Ln
20625 Bethelwood Ln - Google Maps
20625 Bethelwood Ln
Comelius, NC 28031
https://wwwgoogle.corrJmaps/place/20625+Bethelwood+Ln,+Cornelius+NC+280311@35.4906247,-80.9049389,93m/data=!3m1!1e3!4m5!3m411cn�ut �nar���ao•nc, �� , n_.l --

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Steve and Amy Clement
20625 Bethelwood Ln.
4
Cornelius, NC 28031

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1.6$LIN 13141 MM ) rc!de t i 4.,11141 t y a N.C. nand MART FRANCES CAFM Ht
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