20061621 Ver 1_Complete File_20060105

r' OF WA
?O? pG
? ?r
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
December 1, 2006 _
DWQ Project # 06-1621
Rutherford County
Samuel C. Sayson p ???U 1J
5710 Providence Country Club Drive 1J
Charlotte, NC 28277-2621
DEC 7 2006
Subject Property: 186 Lake Ridge Road VERANW ?Sf( °WAr S&WH
Lake Lure, NC
Approval of 401 Water Quality Certification with Additional Conditions
Dear Mr. Sayson:
You have our approval, in accordance with the attached conditions and those listed
below, to place fill within or otherwise impact 135 linear feet of shoreline for the purpose
of stabilization at the subject property, as described within your application received by
the N.C. Division of Water Quality (DWQ) on October 5, 2006. After reviewing your
application, we have decided that the impacts are covered by General Water Quality
Certification Number(s) 3492 (GC3492). The Certification (s) allows you to use
Permit(s) GP30 when issued by the US Army Corps of Engineers (USACE). In addition,
you should obtain or otherwise comply with any other required federal, state or local
permits before you go ahead with your project including (but not limited to) Erosion and
Sediment Control, Non-discharge, and buffer regulations. Also, this approval to
proceed with your proposed impacts or to conduct impacts to waters as depicted
in your application shall expire upon expiration of the 404 or CAMA Permit.
This approval is for the purpose that you described in your application. If you change
your project, you must notify us and you may be required to send us a new application.
If the property is sold, the new owner must be given a copy of this Certification and
approval letter and is thereby responsible for complying with all conditions. If total fills
for this project (now or in the future) exceed one acre of wetland or 150 linear feet of
stream, compensatory mitigation may be required as described in 15A NCAC 2H .0506
(h). This approval requires you to follow the conditions listed in the attached
certification and any additional conditions listed below.
The Additional Conditions of the Certification are:
401 Wetlands Certification Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] FAX [phone] Internet: www.ncwaterguality.org
NoorthCarolina
,./ atrlrally
An Eaual Opportunity/Affirmative Action Employer- 50% Recycled/10% Post Consumer Paper
x
Samuel C. Sayson
Page 2 of 5
December 1, 2006
1. Impacts Approved
The following impacts are hereby approved as long as all of the other specific
and general conditions of this Certification (or Isolated Wetland Permit) are met.
No other impacts are approved including incidental impacts:
Amount Plan Location or Reference
A roved (Units)
Seawall Repair 100 (linear feet) A
Seawall Replaced 35 (linear Feet) B
by Riprap
2. Erosion & Sediment Control Practices
Erosion and sediment control practices must be in full compliance with all
specifications governing the proper design, installation and operation and
maintenance of such Best Management Practices in order to protect surface
waters standards:
a. The erosion and sediment control measures for the project must be
designed, installed, operated, and maintained in accordance with the most
recent version of the North Carolina Sediment and Erosion Control Planning
and Design Manual
b. The design, installation, operation, and maintenance of the sediment and
erosion control measures must be such that they equal, or exceed, the
requirements specified in the most recent version of the North Carolina
Sediment and Erosion Control Manual. The devices shall be maintained on
all construction sites, borrow sites, and waste pile (spoil) projects, including
contractor-owned or leased borrow pits associated with the project.
c. For borrow pit sites, the erosion and sediment control measures must be
designed, installed, operated, and maintained in accordance with the most
recent version of the North Carolina Surface Mining Manual.
d. The reclamation measures and implementation must comply with the
reclamation in accordance with the requirements of the Sedimentation
Pollution Control Act.
3. No Waste, Spoil, Solids, or Fill of Any Kind
No waste, spoil, solids, or fill of any kind shall occur in wetlands, waters, or riparian
areas beyond the footprint of the impacts depicted in the Pre-Construction
Notification. All construction activities, including the design, installation, operation,
and maintenance of sediment and erosion control Best Management Practices,
shall be performed so that no violations of state water quality standards, statutes,
or rules occur.
. ,R
Samuel C. Sayson
Page 3 of 5
December 1, 2006
4. No Sediment & Erosion Control Measures w/n Wetlands or Waters
Sediment and erosion control measures shall not be placed in wetlands or waters
to the maximum extent practicable. If placement of sediment and erosion control
devices in wetlands and waters is unavoidable, they shall be removed and the
natural grade restored within. six months of the date that the Division of Land
Resources has released the project.
5. Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification
or applicable Buffer Rules, and any subsequent modifications, the applicant is
required to return the attached certificate of completion to the 401/Wetlands Unit,
North Carolina Division of Water Quality, 1650 Mail Service Center, Raleigh, NC,
27699-1650.
6. Riprap Installation
All banks shall be laid back at a 2:1 (length : height) slope and riprap applied at
the water / land interface (at full pool). Riprap shall be placed as a linear
protective measure upon the regarded slopes. Stone used in stabilization shall
be Class B riprap with occasional larger rock (-4 boulders per 100 linear feet) up
to 6 feet in diameter to provide additional wildlife habitat. The rip-rap shall be
installed over a toed in filter fabric to prevent soil erosion behid the stabilized
area. All exposed soils above the Riprap stabilized area shall be replanted in
accordance with the attached Guidelines for Riparian Buffer Restoration.
This authorization shall in no way be construed as allowing the installation of a
bulkhead or seawall.
7. Heavy Equipment
Heavy equipment should be operated from the bank whenever possible. All
mechanized equipment operated near surface waters should be inspected and
maintained regularly to prevent contamination of stream waters from fuels,
lubricants, hydraulic fluids or other toxic materials. Equipment used in stream
channel must be clean, new or low hour equipment.
8. Diffuse Flow
All constructed stormwater conveyance outlets shall be directed and maintained
as diffuse flow at non-erosive velocities through the protected stream buffers
such that it will not re-concentrate before being discharged. If this is not possible,
it may be necessary to provide stormwater facilities that are considered to
remove nitrogen. This may require additional approval from this Office.

Samuel C. Sayson
Page 4 of 5
December 1, 2006
9. Trout Buffer Tree Protection
No trees shall be removed within 25 feet of the top of water unless they are
directly within the construction access corridor. If trees are removed, forested
vegetation shall be re-established within the construction access or other
temporary impact area occurring in the protected buffer zone within the next
growing season following construction of the project.
Disturbed banks and a 25-foot vegetated zone, must be restored along the
shoreline to natural riparian conditions with native trees and shrubs (e.g.,
silky dogwood, rhododendron, dog hobble, red maple, silky willow, tag alder,
black willow, sycamore) to provide long-term bank stability and stream shading.
Note, silky dogwood, silky willow and black willow can be planted as live stakes
collected during the dormant growing season. Cuttings should be randomly
planted on four (4) foot centers from the waters edge to the top of the bank.
Trees should be planted on ten (10) to twelve (12) foot centers. Banks in these
areas should also be seeded with a native annual and perennial seed mix with a
temporary nursery crop of wheat, millet or other grain.
10. No Impacts Beyond those in Application
No waste, spoil, solids, or fill of any kind shall occur in wetlands, waters, or
riparian areas beyond the footprint of the impacts depicted in the Pre-
construction Notification. All construction activities, including the design,
installation, operation, and maintenance of sediment and erosion control Best
Management Practices, shall be performed so that no violations of state water
quality standards, statutes, or rules occur.
12. Deed Restrictions
Deed Restrictions or similar mechanisms shall be placed on all retained
jurisdictional wetlands, waters and protective buffers in order to assure
compliance for future wetland, water and buffer impact. These mechanisms shall
be put in place prior to impacting any wetlands, waters and/or buffers approved
for impact under this Certification Approval and Authorization Certificate.
Violations of any condition herein set forth may result in revocation of this Certification
and may result in criminal and/or civil penalties. The authorization to proceed with your
proposed impacts or to conduct impacts to waters as depicted in your application and
as authorized by this Certification, shall expire upon expiration of the 404 or CAMA
Permit.

Samuel C. Sayson
Page 5 of 5
December 1, 2006
If you do not accept any of the conditions of this Certification (associated with the
approved wetland or stream impacts), you may ask for an adjudicatory hearing. You
must act within 60 days of the date that you receive this letter. To ask for a hearing,
send a written petition, which conforms to Chapter 15013 of the North Carolina General
Statutes to the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh,
N.C. 27699-6714. This certification and its conditions are final and binding unless you
ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of
the Clean Water Act. If you have any questions, please contact Mr. Kevin Barnett in the
DWQ Asheville Regional Office at either Kevin.Barnett(@-ncmail.net or at 828-296-4657.
Sincerely,
Alan W. Klimek, P.E., Director
Division of Water Quality
AWK/khb
Enclosures: GC 3492
Certificate of Completion
Guidelines For Riparian Buffer Restoration
cc: Town of Lake Lure
USACE Asheville Regulatory Field Office
Cyndi Karoly, DWQ 401 Central Office
DLR Asheville Regional Office
File Copy
Central Files
Filename: 06-1621.SaysonProperty.WQ3492.Approval
Triage Check List
Date: 10/18/06 Project Name: Sayson:
Kevin Barnett, Asheville Regional Office
To:
60-day Processing Time: 10/05/06 to 12/03/06
From: Cyndi Karoly Telephone: [phone]
186 Lake Ridge Road
DWQ #:06-1621
County: Rutherford
The file attached is being forwarded to you for your evaluation.
Please call if you need assistance.
? Stream length impacted
? Stream determination
Wetland determination and distance to blue-line surface waters on USFW topo maps
? Minimization/avoidance issues
? Buffer Rules (Meuse, Tar-Pamlico, Catawba, Randleman)
? Pond fill
Mitigation Ratios
? Ditching
? Are the stream and or wetland mitigation sites available and viable?
? Check drawings for accuracy
Is the application consistent with pre-application meetings?
? Cumulative impact concern
Comments: As per our discussion regarding revision of the triage and delegation processes,
please review the attached file. Note that you are the first reviewer, so this file will need to be
reviewed for administrative as well as technical details. If you elect to place this project on hold,
please ask the applicant to provide your requested information to both the Central Office in
Raleigh as well as the Asheville Regional Office. As we discussed, this is an experimental, interim
procedure as we slowly transition to electronic applications. Please apprise me of any
complications you encounter, whether related to workload, processing times, or lack of a "second
reviewer" as the triage process in Central had previously provided. Also, if you think of ways to
improve this process, especially so that we can plan for the electronic applications, let me know.
Thanks!
i
September 28, 2006
SUBJECT: Seawall Repair at 186 Lake Ridge Road
DWQ- 4 '-
1. Thank you for your prompt review of my application. I apologize for submitting
an incorrect application. The correct application has been completed and enclosed
along with 4 copies (five total) for your review and approval.
2. 1 have attached the original. USACE applications as there is other documentation
(site plan, vicinity map, photos) that you may require or find helpful.
3. The application fee of $200 is enclosed.
Thank you for your time in this matter.
amuel Sayson MD
D @/;:?k @fl?7
T 2006
DEWR
DSAN ST Q TrR 6r gJVCy

The following is an abbreviated application form for those applying for a 401 Water
Quality. Certification to impact FERC (Federal Energy Regulatory Commission)
regulated lake shore or bottom under the U.S. Army Corps of Engineers Permit
GP30. This Application cannot be used for wetland or stream impacts. Please
provide *woh Copies of this application and supporting information as well as a
non-refundable application fee to the Division of Water Quality of $200.00 for
impacts of to lake bottom of less than 1 acre and $475.00 for impacts to aloe b om
of greater or equal to 1 acre.
Applications should be sent to:
Division of Water Quality Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
1. Applicant Information
1. Owner/Applicant Information
Name: C, , Sc?uso
Mailing Address: 5k-J-\) f'rcv c coo
CliYfLD
D
0 C T 5 2006
DENR - WATER QUALITY
AETLANDSAND STOINAWATEi BRAKH

Telephone Number: ????1o-ti?3ct Fax Number:?-oy-%A1 o-\-kA3
E-mail Address: LOP-
2. Agent Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name: A
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Fax Number:
II. Project Information
Attach a vicinity map clearly showing the location of the property with respect to
local landmarks such as towns, rivers, and roads. Also provide a detailed site
plan shninaa?nrnnPr?rty boundaries and development - plans in relation to
surrounding properties. You may use the diagram below to make a hand sketch of
your project. Also, see the example below for guidance. Both the vicinity map and
site plan must include a scale and north arrow. The footprints of all buildings,
impervious surfaces, or other facilities must be included.
1. Location
County: L" 44--Cr-r mr-I Nearest Town: "tic. l--vre.
Subdivision name or site address (include phase/lot number):_ WO 1..atp
Directions to site please include road numbers, landmarks, etc. (This is not
necessary if an adequate vicinity map is included): Ta,? q N to }? ?,.? , Tv r- U
2. Describe the existing land use or condition of the site at the time of this
4. Nearest body of water (strew.m/river/sound/ocean/lake):?
5. Describe the purpose of the proposed work: _3 S F 1- oG-a ",, Q\,` w .1\
d??e ?1? ?tfi'
&-•CA re-A.C:C1 ,,? •t?. R , rte 2Go . t Urn P E- ??- rP ;
W
7.
8.
6. List the type of equipment to be used to construct the project: 7ti`.V w? \c??f C--\
Amount of impact (including all. excavation,. backfill, rip rap, retaining walls,
etc.) below the normal pool lake level i`n' square feet or acres: _ (.o FI- X 13? F k- = 31 b
wore. f-k- r +? rC.? TAG W' c. \`,Z C??sa f\n?. C`c?4v?c7
?OZ\bv3 G.,\\ porgy \? \, ^
a. Amount of impact (including all clearing, back fill, excavation, rip rap,
retaining walls, etc.) above the normal pool lake level and 50 feet land-ward in
square feet or acres: It- L? ? k 3S F t = t ti o 4-- a X- cv c`«P iv
b. Please describe vegetation above the normal pool lake level and 50 feet land-
ward to be impacted (number of trees for instance): No.?s?\ cre? ?o
S Go n\- bc-'C' ? n h\. - 7 - Z '4. -. c
ApplieantlAg net s Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
3. Property size (acres):

Si f ?Y r' s ?.
- } t 'S T 9 ?L = ? 1 4 ?'? ' y ?L ? fit- ySL 4. s ' _ + t ? t
1I ¦¦tt 11 ?/y( _ t
VA-
ICE F; G
;[ f t
V
5Ft ???Sh??
135 ---?

-6F?x\5SF?
excuP? Z Cr
F x 3s? ?-
ad?acc?.E- tv, cde .oV?
Se.a,?,,aL\ . `
Please ximat"y sketch the foillowing formation on ttds plan
(pk m, pmvlde Owr4lons for each Rem, such as 10 ft. x 440 ft):
1) AN proposed vaWallon cl ing (provide dir n ns)
2) Location of rip rap or fill to be placed above the Ful Pond elevation
3) Incation of rip rasp or fill to be placed below the FtA Pond elevation
4) ' lion of arty proposed shuctum such as building e, retaining
lei +doccs, etc,
5) The lacafion of any excavation or dridging below the, Full Polid
elevation.
6) Location ofconstruction a corrido'ra,
&6 a-? cJC.
a

? Fill ¦ ????- 4
. ?

S r

4 T
N Y$
a

`(oF? car Cep
?:p2aP(? ?> ct ?v
?a. fA.a LOA a? \x,.1R v ?-
V4- X l od ?{-
-N? ex Co.vo.?.o??d?tcaSi^S
O 35 c-r ? s?4?1
Pam ?c?,? ,
?R,pcz?,P w:\\ ? PLctc??
?o F{- ?G 3SF{- ?.\u?
?1 F t x 3S Ft-
vn\? ZFf X 3SFt- a?-
w ? R.' ? C2a? i 0 \VP A\o C1Z chi
WO tov L \\ pw-,c , '
Plebe h the f+QtaPw?$ informa?o?t on tds plan
ago
pit Id dns for each Nam such *2 ? IL x'100 lt):
pro eta*n ckMfW (Wvdda c9mendona) .
A LOn t.d - rap or fill to be placed above the F%M Pond el"ion
3) •Lo n of r1p raps or fill to be placed below the Fei Pond elevation
4) barb of aa' prop-mod ahmcham emh as buldin Mining
. ..do ek.
6) The kcs n of any -excavation or dkidging t dow t F 1d
elevMon.
LOaMm or contra a carte,
?? ` N G

1„(.i 11n Nl?x pc&v?
APPLICATION FOR DEPARTMENT OF THE ARMY PAMIT - - I OMB APPROVAL NO. 0710-0003
/33 CFR 3251 Expires December 31, 2004
The Public burden for this collection of information Is sestimated to average 10 hours per response, although the majority of applications should require
5 hours or less. This includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Service Directorate of Information
Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302; and to the Office of Management and Budget,
Paperwork Reduction Project (0710.0003), Washington, DC 20503. Respondents should be aware that notwithstanding any other provision of law,
no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control
number. Please DO NOT RETURN your form to either of those addresses. Completed applications must be submitted to the District Engineer having
jurisdiction over the location of the proposed activity.
PRIVACY ACT STATEMENT
Authorities: Rivers and Harbors Act, Section 10, 33 USC 403; Clean Water Act, Section 404, 33 USC 1344; Marine Protection , Research and
Sanctuaries Act, 33 USC 1413, Section 103. Principal Purpose: Information provided on this form will be used in evaluating the application.for a
permit. Routine Uses: This information may be shared with the Department of Justice and other federal, state, and local government agencies.
Submission of requested information is voluntary, however, if information is not provided the permit application cannot be evaluated nor can a permit
be issued.
One set of original drawings or good reproducible copies which show the location and character of the proposed activity must be attached to this
application (see sample drawings and instructions) and be submitted to the District Engineer having jurisdiction over the location of the proposed
activity. An application that is not completed in full will be returned.
1. APPLICATION NO. 12. FIELD OFFICE CODE 13. DATE RECEIVED 4. DATE APPLICATION COMPLETED
/tr.CA#q BEI OW To ac Ctl J EJn By A001 ICdAIT
5. APPLICANT'S NAME 8. AUTHORIZED AGENT'S NAME AND TITLE (anawtismt ea,* dj

6. APPLICANT'S ADDRESS
?.?'?-fly P?u?;??..r?tp ? ,C ? ?"?V? 9. AGENT'S ADDRESS
'
L ? ?r1 u41 ? A NC -La? I-} -71,0 t
7.. APPLICANT'S PHONE NOS. W/AREA CODE 10. AGENT'S PHONE NOS. W/AREA CODE
a. Residence 1u%.t - ?, A4 u'u` l'3 `l a. Residence
b. Business
t.,`
b. Business
11. STATEMENT OF AUTHORIZATION
I hereby authorize, to act in my behalf as my agent in the processing of this application and to
furnish, upon request, supplemental information in support of this permit application.
APPLICANT'S SIGNATURE DATE
NAME, LOCATION AND DESCRIPTION OF PROJECT OR ACTIVITY
12. PROJECT NAME OR TITLE lsxirutructions! "
Sf rawat,l. 2-? pa 12 ca l 8to L??? 21 ?U? 2ora?
13. NAME OF WATERBODY. IF KNOWN /it annlN whtnl
La )4- Lyre , gmaa 2"vc, s+n
15. LOCATION OF PROJECT
( ??( e
14. PROJECT STREET ADDRESS (/apppiR?1'
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NC LIE1,48 -1N1i1'eR G i.:. i Y
COUNTY STATE I ;.nMIC,SANO$TORMWA(eNflf1/KK
16. OTHER LOCATION DESCRIPTIONS, IF KNOWN, tseeituttuctonsl
?oJ i?..a? (v2,titU?Z. °r.? 104 BSZt? °W F't?pv SS ce 03 Tczc-t S?7oo< ?4N \to-W ;B
17. DIRECTIONS TO THE SITE
U-o'Ck tie i ,? , ?,,>?, ?. La?cl n;?? t??, .
(k?
ENG R 4346, Jul 97 EDITION OF FES 94 IS OBSOLETE. (Proponent: CECW-OR).
18. Nature of Activity (Description of ppofiect, include ett features/ V v r ?n\ e.?U V 1n\? , 5 ?e ?S? ? Gi vul ??tA G? C? 5? v.
UC ^-t3??,2?. QtZOv? ?v2 `s5t f-r- rt Cc.? Kt}+a.cl °sfi??.?.\?C?ee l ?C?t ?'4t?y, i?t;n?>r tb(1?r1 4\Slr1c? .
ra•.vul \c,?o? N'.t.v? kxr? N-ttSSc?r?,?RQ?rac? -t Js "4011 WI'AN" ivi"'2aP
tLnq?> rc.?.io. ?i?,Q,i'???-v./"C-Q ?45.¢,., C? (uZ rM??c??.,,-.trS ?.Cl?.W4?, t?<????:ar'z,1G 11.??v.?-' Wt? 4. ?l?•c.t.?'"
GC CL e.C4op ltS? j 4. 1`Z r•,?i©. ICJ:<\Lt .e.-4?uC+t ?G?t l `L 1nl?d?L'Qt?? rv,:C1 IvQ.Qv?
?t?.?41?t- c4v:?,- 1S !•v?e. U???i. tp rltt 1iY'v"'k.. ??¢.:?us?, \?., f.?Qn Turr.r-c??ta\;eS2oc.t„??eu.St-r..'?I1a,••?
4j7?A-f-`a?1-7ZfaW .1
19. Project Purpose (Describe the reason or purpose of the project, see instructions;
CU c rcr ?' s.w?\1 ?i `a--> yes 4\c?. [3Ltc 44- -S{- f5 COY-005,
a110w; .5 G.'.?1 $?t3v S1e?t?t? 2>txle ?.rdu- tie, CLP2--P (.US. a ?eP?4n.L.r r ;,tl? V,ytl S
?+`2?Stcy o?-?d c.?SO.t? Q±?C'P'c? ?r,,,.-, \??.`G.t. Sf•?ca?-?.5, ?C?a?n t-? t? rlu?. \-. QQcq,,-.?(?'?.r.Jt?L?
"- o \r.\cn \F??-n1 i? \t?,n+4rer rrrl S?nUlc? AM
USE BLOCKS 20.22 IF DREDGED AND/OR FILL MATERIAL IS TO BE DISCHARGED
20. Reason(s) for Discharge p
QC' &r--ed.?e? O r ?i?1 t..aler?? 1u ?2 G?CC1 or ?szc?? tJ? ?^?xG?' ?c? ?? Lv?
21. Type(s) bf Material Being Discharged and the Amount of Each Tvne in Cubic Yards
NIA
22. Surface Area in Acres of Wetlands or Other Waters Filled fseeinstructlonsl
NIA
23. Is Any Portion of the Work Already Complete? Yes = No IF YES. DESCRIBE THE COMPLETED WORK
24. Addresses of Adjoining Property Owners, Lessees, Etc., Whose Property Adjoins the Waterbody (If more than can be entered here,
please attach a supplemental list).
1 to3 t? L?
(Z ur-t O\ ?S - t `?a L?ksz 2 +ck?e CZ?9 , (-? - , N Z?' too -Tax PIN
?cec? Va?aSn+S - 143`?I?q?1 t_n1 u CLd e, ? , LL t QC_ Z- }vito?Taj( ??n \laC;?1UU? 1 taZt=
25. List of Other Certifications or Approvals/Denials Received from other Federal, State or Local Agencies for Work D scribe¢ in This Application.
-fit Pt e r s1?c}Sq,. ?1oliG?hun 3et-? tv N•c., ?iUtstt?. OC. tnh? Qugb.{-S,t l-ot- G?rt-uv A?
AGENCY TYPE APPROVAL" IDENTIFICATION NUMBER DATE APPLIED DATE APPROVED DATE DENIED
`Would include but is not restricted to zoning, building and flood plain permits
26. Application is hereby made for a permit or permits to authorize the work described in this application. I certify that the information in this
application is omplete and accurate. I further certify that I possess the authority to undertake the work described herein or am acting as the
th e t of the applicant.
SIGNA APPLICANT DATE SIGNATURE OF AGENT DATE
The application must be signed by the person who desires to undertake the proposed activity (applicant) or it may be signed by a duly
authorized agent if the statement in block 11 has been filled out and signed.
18 U.S.C. Section 1001 provides that: Whoever, in any manner within the jurisdiction of any department or agency of the United States
knowingly and willfully falsifies, conceals, or covers up any trick, scheme, or disguises a material fact or makes any false, fictitious or
fraudulent statements or representations or makes or uses any false writing or document knowing same to contain any false, fictitious or
fraudulent statements or entry, shall be fined not more than $10,000 or imprisoned not more than five years or both.
S;vo, ?X,
l
Rutherford Co, NC 1-12 f>
Parcels
Tax PIN: 1606358
GPIN: 0642168450510000
Account No.: 15183733
Owners Namel: SAYSON SAMUEL C
Owners Name2: SAYSON CHRISTY A
Addressl: 5710 PROVIDENCE CC DR
Address2:
City: CHARLOTTE
State: NC
Zip: 28277
Property Address: 186 LAKERIDGE RD
ACAS: 0
AC_DEED:0
CALCACRE: 0.35
No. of_Bidgs: 5
Deed Bk/Pg: 837/837
Land Value: $247,500
Bldg. Value: $88,000
Defr. Value: $0
Total Value: $335,500
Sale Price: $630,000
Neighborhood Code: L30B
Neighborhood Desc.: RESIDENTIAL LAKE
Property Desc.: RES LAKE RIDGE RD
Zoning:
Map/BIk/Lot: 504 1 55 A
Nbr Land Seg.: 1
Stamps: 1260.00
Land Use:
Page 1
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ie://C:\DOCUME-1\Owner\LOCALS-1\Temp\MPK9YST6.htm 9/10/20(
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' 7 a=
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PHOTOS Seawall Repair at 186 Lake Ridge Rd, Lake Lure NC 28277-2621, Samuel C Sayson
Owner
Fig,. I Seawall to be replaced - Approximately 35' in length, located to the north of boathouse
structure; wall will be removed and replaced with RipRap. (SEE Items 18 and 19 of ENG FORM
4345 Jul 97. as well as Mv 1, ' olc -ii 1 1
J
iv
Fig. 2 Seawall to be supported with RipRap - approximately 100' in length to include the wall
adjacent to boathouse as well as the wall located to the south of the boathouse structure; wall base
with be supported to the water line (approximately 3' in height). SEE Items 18 and 19 of ENG
FORM 4345 Jul 97, as well as Map #1, Note #2)
All
`• ?.• .'"'til. ' '':-:`'._•: ?'':'<- .?'':, : ?8'•;, .•? ...?•.-. '!
41
?%?,r• , ?; ?'''.',4'••-. '^?•^l.. ?• ,,,may:! --
1

PAGE 12
UNITED SERVICES AUTOMOBILE ASSOCIATION MAIL-GENR-I
A RECIPROCAL INSURANCE EXCHANGE
9800 Fredericksburg Road - San Antonio, Texas 78288
USAA® HOMEOWNERS POLICY DECLARATIONS
Named Insured and Residence Premises Policy Number
SAMUEL C SAYSON AND CHRISTY A SAYSON USAA 00331 88 74 94A
5710 PROVIDENCE COUNTRY CLUB DR
CHARLOTTE, MECKLENBURG, NC 28277-2621 CO-INSURANCE CONTRACT
POLICY PERIOD From: 05/28/06 To: 05/28/07
(12:01 A.M. standard time at location of the residence premises)
COVERAGES AND LIMITS OF LIABILITY
SECTION I A. Dwelling $657,000
C. Personal Property $459,900
D. Loss of Use $131,400
SECTION II E. Personal Liability - Each Occurrence $1,000,000
F. Medical Payments to Others - Each Person $1,000
---------------------------------------------------------

------------
Your premium has already been reduced by the following:
FIRE/BURGLARY CREDIT $151.00 CR
BASIC PREMIUM $1,505-00
OTHER COVERAGES AND ENDORSEMENTS
Form and Endorsements are printed on the following page. $179.00
DEDUCTIBLES (SECTION I ONLY)
We cover only that part of the loss over the deductible stated.
WIND AND HAIL $1,000
ALL OTHER PERILS $1,000
DEDUCTIBLE CREDIT $212.00

TOTAL POLICY PREMIUM $1,472.00

THIS IS NOT A BILL. MORTGAGEE WILL BE BILLED.

FIRST MORTGAGEE:
CCO MORTGAGE CORP LOAN NR 0016535379
ITS SUCCESSORS AND/OR ASSIGNS, ATIMA
PO Box 5204
GLEN ALLEN, VA 23058-5204
In Witness Whereof, this policy is signed on 03/07/06
-/C
Robert G. Davis
Attorney-in-Fact
REFER TO YOUR POLICY FOR OTHER COVERAGES, LIMITS AND EXCLUSIONS.
COPYRIGHT, NORTH CAROLINA RATE BUREAU, 1986
HO-D1 (04-93)
PAGE 13
UNITED SERVICES AUTOMOBILE ASSOCIATION
us?® HOMEOWNERS POLICY DECLARATIONS
Policy Number Policy Term: 05/28/06 05/28/07
USAA 00331 88 74 94A Inception Expiration
SECOND MORTGAGEE:
CHARTER ONE BANK, N.A.
ITS SUCCESSORS AND/OR ASSIGNS, ATIMA
ATTN: POST CLOSING EV950-7, 65/75 ERIEVIEW-7TH FL
CLEVELAND,OH 44114
LOAN NUMBER 9932251047
LEGAL DESCRIPTION: LOT 150
SUBDIVISION: PROVIDENCE COUNTRY CLUB
SECTION II - OTHER INSURED LOCATION(S):
168 LAKE RIDGE RD
LAKE LURE, RUTHERFORD, NC 28746-0000 $10.00
SPECIFICALLY LISTED BELOW ARE THE DECLARATIONS AND PREMIUMS FOR ENDORSEMENTS MADE A
PART OF THIS POLICY AT THE TIME OF ISSUE. THE ENDORSEMENTS ARE ATTACHED STATING
TERMS AND CONDITIONS.
QR3NC 04 05 QUICK REFERENCE HO 00 03
HO 00 03 10 00 HOMEOWNERS 3 SPECIAL FORM
HO 04 98 10 00 REFRIGERATED PROPERTY COVERAGE
HO 32 01 06 05 SPOUSE ACCESS ENDORSEMENT
HO 32 18 05 03 INFLATION GUARD ENDORSEMENT
HO 04 16 10 00 PREMISES ALARM OR FIRE PROTECTION SYSTEM
HO 32 96 05 03 NO LIABILITY COVERAGE FOR HOME DAY CARE
HO 04 90 10 00 PERSONAL PROPERTY REPLACEMENT COST $76.00
HO 24 70 10 00 ADDITIONAL RESIDENCE RENTED TO OTHERS $47.00
HO 32 20 05 03 SPECIFIED ADDITIONAL LIMITS COVERAGE A $30.00
HO 32 27 12 05 ADDITIONAL COVERAGE - JEWELRY & FURS $16.00
0111110
COPYRIGHT, NOORTHH1CAA20LINA RATE BUREAU, 1986
HO-D2 (04-93) bb
-c

1650 Mail Service Center
Raleigh, NC 27699-1650
September 28, 2006
Division of Water Quality Wetlands Unit r
LL
F'.. __:?L11
SUBJECT: Seawall Repair at 186 Lake Ridge Road
DWQ-
1. Thank you for your prompt review of my application. I apologize for submitting
an incorrect application. The correct application has been completed and enclosed
along with 4 copies (five total) for your review and approval.
2. I have attached the original USACE applications as there is other documentation
(site plan, vicinity map, photos) that you may require or find helpful.
3. The application fee of $200 is enclosed
Thank you for your time in this matter.
amuel Sayson MD
l '-
t
ED
The following is an abbreviated application form for those applying for a 401 Water
Quality Certification to impact FERC (Federal Energy Regulatory Commission)
regulated lake shore or bottom under the U.S. Army Corps of Engineers Permit
GP30. This Application cannot be used for wetland or stream impacts. Please
provide,sqvia
(Ai)5?opies of this application and supporting information as well as a
non-refundable application fee to the Division of Water Quality of $200.00 for
impacts of to lake bottom of less than 1 acre and $475.00 for impacts to aloe b om
of greater or equal to 1 acre.
Applications should be sent to:
Division of Water Quality Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
1. Applicant Information
1. Owner/Applicant Information
Name: _?a r.,,Q\ C , ?cauSO n
Mailing Address:-S;4-\y')
c c?4 n cn
r.-_j rrZ, r-13
OCT 5 2006
bENR - WATER QUALITY
F A
NDS AJdD ST04tCZ"TER ERMCH
r

Telephone Number:1o-\-?39 Fax Number: }c??-%`t
E-mail Address: `; o lan. V o o-4 ° y ck .-.u o , Lu On
2. Agent Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name: rJ A
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
H. Project Information
Attach a vicinity map clearly showing the location of the property with respect to
local landmarks such as towns, rivers, and roads. Also provide a detailed site
plan shntvino_ ,r,rnn try boundaries and davelopment plans in redatiAn to
surrounding properties. You may use the diagram below to make a hand sketch' of
X
your project. Also, see the example below for guidance. Both the vicinity map and
site plan must include a scale and north arrow. The footprints of all buildings,
impervious surfaces, or other facilities must be included.
Location
County: LAA-e,??w4"S-o? Nearest Town: L-ak.Q- .
Subdivision name or site address (include phase/lot number): 1 ?b \_a.`L (Z.?d.ele. CLA
Directions to site please include road numbers, landmarks, etc. ('This is not
necessary if an adequate vicinity map is included):Ta\c e n N to )-\A y3, Tv r- U
2. Describe the existing land use or condition of the site at the time of this
W
4. Nearest body of water (stream/rivedsound/ocean/lake): n.? \.-vNZ-
5. Describe the purpose of the proposed work: 3 S F \ v L- Sea",, --V w : \1
6. List the type of equipment to be used to construct the project: 7?.?y?,,\ Ica bcaf? r?
r????.?
7. Amount of impact (including all . excavation,. backfill, rip rap, retaining walls,
etc..) below the normal pool lake level in square feet or acres; Co f7-k- X 13? F k- _ $1 b
7 AOrE. t' ('G -A Z ?1 SR. rI-Ar% t''aj c-?)
8. a. Amount of. impact (including all clearing, back fill, excavation, rip rap,
retaining walls, etc.) above the normal pool lake level and 50 feet land-ward in
square feet or acres:_ 3 C-?- k 3S P t = 1 ti o a F cv ' c`GP 10
(-q 4 cO?n um e \ r? o Nc T1,? S t,_ c a ?? 1 •.) h o c c\ e n
3S
?fPrvY?.-vebe ?St1 Z FEXFt
b. Please descri vegetation above the normal pool lake level and 50 feet land-
ward to be impacted` (number of trees for instance); \ ?o c?c
? CQn ?'" ?? C'v S V? O4\\\, _ 7 - Z --v--t .t t" I.% .-),A-' - 4r/? C_L ? ;ir-T z n ? . _A\ L
3. Property size (acres): O (4 c rt-c
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
A

t 4_ Y I? t -- d ?
y ?
y +} i
i C !? J
M5i
?zt
15
5Ft- ?tias?.t?
"
fit- n^G
+-?9 ?
1351
-el
or-
Q"AP
\35 F\-
?.1 u ? F•?,11 pay-,?Q
F x 35 Ft- abou¢
L\
S6 C\Qw-goy; o?.a ?c?v? c?.?
adja?EC{.? t? de?V??
cz P czGQ ,
Please ap cimat sketch the fig informant on this plan
provide r lons for each kvm, such 10 ft. x 100 ft)=
1) proposed station clearing (provide dimensions)
2) Location of rip rap or fill to be placed aaoye the P Pond elevation
3) -Low of rip rap or fill to to placed below the Pull! Pond elevation
4) The loc4dion of any proposed str to h buildings, rctalning
mss, dockei etc.
6) Ttte ration of any excavation or € dging below On Full Potid
elevation. -
6) Lena n of construcUm acs corridors. &,c, NC.

-}?
T

M
1
C
_L
IK'
`Y
?P??
x ??r F ?- e
5
'pox Ho
(2t p2aPC ?'_1> ? t ?
?. (?\c? tst cA ar lx.? ?-
bQ.1oa P,\\ Pun-?l
-No
2+ P 2? e e r- o\?erea t-i ???,
CQ 35 C-r o? Seo??\\
CR,p\,C,UXA w : .?
p'> ?-.of
4.414
? Ft k 3SF?- fie.\u?
y F i- X 3S Ft- ubo?-
Fu1\
U?.\? ZFt- X 35Ft- vC-
4 WA\?e. c?s?r2?
\L?fP(1ae ?j 10 \CP
Rtew app! +axiNyeh the felarwing itdorntan on t[i plan
04 -am p lde dko ns for eaO Men, such *2 "ft. x 100 R):
1) preposod +re at n e i (pride came lore) .
.2) .Lo .of rip IMP or f'dl to be placed alaovo the tM Pond eie lon
3) Login ufffp or M to he placed below the Fei Pond elevation
4) ion of any proposed structum h as bugdtn retaining
?da?a?, gta.
6} The location of any excavation or drudging tae t FuB Amid
elevation.
e) LocaMm of +cermtrui acem corm,
\...akst ??. i N G
S?atz,? tv Sc,:?•?, .

APPLICATION FOR DEPARTMENT OF THE
/33 CFR 325/
M
PERMIT

OMB APPROVAL NO. 0710-0003
Expires December 31, 2004
The Public burden for this collection of information is sestimated to average 10 hours per response, although the majority of applications should require
5 hours or less. This includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Service Directorate of Information
Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302; and to the Office of Management and Budget,
Paperwork Reduction Project (0710-0003), Washington, DC 20503. Respondents should be aware that notwithstanding any other provision of law,
no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control
number. Please DO NOT RETURN your form to either of those addresses. Completed applications must be submitted to the District Engineer having
jurisdiction over the location of the proposed activity.
PRIVACY ACT STATEMENT
Authorities: Rivers and Harbors Act, Section 10, 33 USC 403; Clean Water Act, Section 404, 33 USC 1344; Marine Protection , Research and
Sanctuaries Act, 33 USC 1413, Section 103. Principal Purpose: Information provided on this form will be used in evaluating the application for a
permit. Routine Uses: This information may be shared with the Department of Justice and other federal, state, and local government agencies.
Submission of requested information is voluntary, however, if information is not provided the permit application cannot be evaluated nor can a permit
be issued.
One set of original drawings or good reproducible copies which show the location and character of the proposed activity must be attached to this
application (see sample drawings and instructional and be submitted to the District Engineer having jurisdiction over the location of the proposed
activity. An application that is not completed in full will be returned.
1. APPLICATION NO. 12. FIELD OFFICE CODE 13. DATE RECEIVED
4. DATE APPLICATION COMPLETED
I/TFMS RF/ QW TQ APF// IM RV dPP/ lC N-n
5. APPLICANT'S NAME 8. AUTHORIZED AGENT'S NAME AND TITLE lensoewisme ad ed,
C, S'A'esooj
6. APPLICANT'S ADDRESS [t11 9. AGENT'S ADDRESS

7.. APPLICANT'S PHONE NOS. W/AREA CODE 10. AGENT'S PHONE NOS. W/AREA CODE
a. Residence U? t -?llc 'u? l`3 `1 a. Residence
b. Business b. Business
1 1 . STATEMENT OF AUTHORIZATION
I hereby authorize, to act in my behalf as my agent in the processing of this application and to
furnish, upon request, supplemental information in support of this permit application.
NIA
APPLICANT'S SIGNATURE DATE
NAME, LOCATION AND DESCRIPTION OF PROJECT OR ACTIVITY
12. PROJECT NAME OR TITLE (see#wrucrions,
AWQLk- 9A 12 C,- l8(a LAY.L 21 DCrE 2oF?c?
13. NAME OF WATERBODY. IF KNOWN tit Andi,Ylhw
Lake_
15. LOCATION OF PROJECT
COUNTY STATE
14. PROJECT STREET ADDRESS I%lte?p/wcablel ^ ? ?w ??
"\e-L Lv ? I NC 1,61"A 1D 0
SEP 2 5 2006
16. OTHER LOCATION DESCRIPTIONS, IF KNOWN, tseeinstrucvi )
DENR • WATER
C_o-'CAI ? i?Z?1o?Z °rJ 104'dSz, °W j Prt?ptt- Size ?U,?3r?:,cs°e.s?TaX P,t?l ?lo-?b3?g
17. DIRECTIONS TO THE SITE
fct" , Cj@ Cl 0?1?14e j?v? t 'taw. La1c? ?ti?t ??cxa
? ? Mu S?? ? ?. ??` ?`' ?tc,' `1•Q? CZ?r.? . \?, Ic 1,-ra`?c. 2 ca ?? 1? ?1i S '?t? 1 ? ?' ? • vu ??
1A ,
ENG R 4346, u 7 EDITION OF FES 94 IS OBSOLETE. (Proponent: CECW-OR).
w'
?i ??^? V? ?ivlt e9 R G C? ?RneJ{?
18. Nature of Activity (Description ofproject, include 0features) V CUrr qr?? 'R??w<1?? 1--s
GC ?1??? e?21. t?r?v. a4*Q a I C.A rtiULt c?t??'? yCfa? \???2k ('U r <a(??. (?? nt7r- so,AJkt c? tlS.artc?
riz?SSa??,d?Rej acc 1?.i5 v?nll Wi`t i???2?f? V?.?,•? 4 1.-I-
\'O"S C
1??r51.1- CiC- Q;e(41, `.J?i1r y `. ?•Zr..?cp, CJ ,.\?l n-G?:?G` ?G\ r/' ti 1r?4?<?\tCC?? rJU t?GC?l1l1
?.yrt?r n -1- i S 4v 1e ?.,t,.'A _ to halt l 'k 1v ?e c\w?e b?\ ?Qn ?tM rr`c? Sn\?ca tZuc.IL C?,.St.?u\ ?h \
J ? lA-31rrt }
19. Project Purpose rDescribethe reason or purpose of the project, see instructions) `? ??,?L 1 1$ :.L 'as --\n OW. ?Lc. r? 'mss{ A
- F.'-65
zllaw,%.?, 4.;11 ?jc!-A Slu?,at.,l 2rtx??. w`c?f' \?ai.e, 2p 2sp ?,US. G t?4?Lc?4n ?.-.\?' c.,?)\} ?y,ll 51?..`?i?1'?
ll-?Slc-v- 6,DSoxN;) Ps,( r? ?rt,r l"\C-'L v1a?S, Repo.,, A•ca t rl.?r.ci ?-, D2?M?e!" v31
{-1.n \a\cr \@lu+1 i! \r? nt?r2? ey rr- S?hv ?c? 1-n D 1`1. i?kS tr--> cu o? .
USE BLOCKS 20-22 IF DREDGED AND/OR FILL MATERIAL IS TO BE DISCHARGED
20. Reason(s) for Discharge C\", '&Z l ry GC ^ 1 `
vtr4?4-' Q0
21. Type (s) 6f Material Being Discharged and the Amount of Each Tvoe in Cubic Yards
N10,
22. Surface Area in Acres of Wetlands or Other Waters Filled rseeinstructionsl
N?A
23. Is Any Portion of the Work Already Complete? Yes No IF YES. DESCRIBE THE COMPLETED WORK
24. Addresses of Adjoining Property Owners, Lessees, Etc., Whose Property Adjoins the Waterbody (If more than can be entered here,
please attach a supplemental list).
a (Z v? l- O,c?S - t 16': 2c? , t-1-, NC Z-8 tb - -V,4-4 P?N ! 1a31a 1-'6
?ja?calnr S 1v6hgv1 !._oAa CLd e, 9-al LL r QC- -2 g??to"TaX ??n ?loC?lt?u(1I-aZ$?'?
25. List of Other Certifications or Approvals/Denials Received from other Federal, State or Local Agencies for Work Describe m This Application.
- Pre?r.sl?cl?i?r? aJOl?Gcal?u.. Jwx-?- to N•c, ???tsretr. Qc- Watt'-Wuo:{? ttr- CAerC'Uva ?
AGENCY TYPE APPROVAL' IDENTIFICATION NUMBER DATE APPLIED DATE APPROVED DATE DENIED
'Would include but is not restricted to zoning, building and flood plain permits
26. Application is hereby made for a permit or permits to authorize the work described in this application. I certify that the information in this
nita. I further certify that 1 possess the authority to undertake the work described herein or am acting as the
t of the applicant.
GNATUR APPLICANT DATE SIGNATURE OF AGENT DATE
The application must be signed by the person who desires to undertake the proposed activity (applicant) or it may be signed by a duly
authorized agent if the statement in block 11 has been filled out and signed.
18 U.S.C. Section 1001 provides that: Whoever, in any manner within the jurisdiction of any department or agency of the United States
knowingly and willfully falsifies, conceals, or covers up any trick, scheme, or disguises a material fact or makes any false, fictitious or
fraudulent statements or representations or makes or uses any false writing or document knowing same to contain any false, fictitious or
fraudulent statements or entry, shall be fined not more than $10,000 or imprisoned not more than five years or both.
Rutherford Co, NC M" P `

f?I it
ILizlic
9?; r
? i
(X
it aQ ?` 'rf
77
O rJ' N l ?„J I
}
'J
I
Parcels
Tax PIN: 1606358
GPIN• 0642168450510000
Page 1 of
Account No.: 15183733 x)ur ?
Owners Namel: SAYSON SAMUEL C C)Sz(.kWALk- to «E.. 24 UnTA
Owners Name2: SAYSON CHRISTY A
?.At? Tcvvrt' lacar-c-ier- ?1r ?+r ?'O?
Addressl: 5710 PROVIDENCE CC DR CL\
Address2:
City: CHARLOTTE ©S?pw?u ?As? ?0 Sup
State: NC
Zip: 28277
Property Address: 186 LAKERIDGE RD
ACAS: 0
AC_DEED: 0
CALC_ACRE: 0.35
No. of Bidgs: 5
peed Bk/Pg: 837/837
Land Value: $247,500
Bldg. Value: $88,000
Defr. Value: $0
Total Value: $335,500
Sale Price: $630,000
Neighborhood Code: L30B
Neighborhood Desc.: RESIDENTIAL LAKE
Property Desc.: RES LAKE RIDGE RD
Zoning:
Map/Bik/Lot: 504 1 55 A
Nbr Land Seg.: 1
Stamps: 1260.00
Land Use:
:e://C:\DOCUME-I\Owner\LOCALS-I\Temp\MPK9YST6.htm 9/10/20(

? -+etY4 ; Y? _ -

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Alt

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T 5 C?
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t.
4

PHOTOS Seawall Repair at 186 Lake Ridge Rd, Lake Lure NC 28277-2621, Samuel C Sayson
Owner
Fig.] Seawall to be replaced -Approximately 35' in length, located to the north of boathouse
structure, wall will be removed and replaced with RipRap. (SEE Items IS aInd I () or FNG FORM
4345 Jul 97, as well as Map 91. Note #1) .

•;k?1.ti•' •.1. "r• jar.
t S . ?? ? ?l1? • L ??? pia. ?_? - ?.R'.. ?1f_'..
Fig. 2 Seawall to be supported with RipRap - approximately 100' in length to include the wall
adjacent to boathouse as well as the wall located to the south of the boathouse structure; wall base
with be supported to the water line (approximately 3' in height). SEE Items 18 and 19 of ENG
FORM 4345 Jul 97, as well as Map fl. , Note #2)
.• J1
Ii
PAGE 12
UNITED SERVICES AUTOMOBILE ASSOCIATION MAIL-GENR-I
A RECIPROCAL INSURANCE EXCHANGE
1 9800 Fredericksburg Road - San Antonio, Texas 78288
USAA® HOMEOWNERS POLICY DECLARATIONS
Named Insured and Residence Premises Policy Number
SAMUEL C SAYSON AND CHRISTY A SAYSON USAA 00331 88 74 94A
5710 PROVIDENCE COUNTRY CLUB DR
CHARLOTTE, MECKLENBURG, NC 28277-2621 CO-INSURANCE CONTRACT
POLICY PERIOD From: 05/28/06 To: 05/28/07
(12:01 A.M. standard time at location of the residence premises)
COVERAGES AND LIMITS OF LIABILITY
SECTION I A. Dwelling
C. Personal Property
D. Loss of Use $657,000
$459,900
$131,400
SECTION II E. Personal Liability - Each Occurrence
F. Medical Payments to Others - Each Person
------------------------------------------ $1,000,000
$1,000
---------------

------------
Your premium has already been reduced by the following:
FIRE/BURGLARY CREDIT
$151.00 CR
BASIC PREMIUM $1,505-00
OTHER COVERAGES AND ENDORSEMENTS
Form and Endorsements are printed on the following page. $179.00
DEDUCTIBLES (SECTION I ONLY)
We cover only that part of the loss over the deductib le stated.
WIND AND HAIL $1,000
ALL OTHER PERILS $1,000
DEDUCTIBLE CREDIT $212.00

TOTAL POLICY PREMIUM $1,472.00

THIS IS NOT A BILL. MORTGAGEE WILL BE BILLED.

FIRST MORTGAGEE:
CCO MORTGAGE CORP LOAN NR 0016535379
ITS SUCCESSORS AND/OR ASSIGNS, ATIMA
PO BOX 5204
GLEN ALLEN, VA 23058-5204
In Witness Whereof, this policy is signed on 03/07/06
Robert G. Davis
Attorney-in-Fact REFER TO YOUR POLICY FOR OTHER COVERAGES, LIMITS AND EXCLUSIONS.
COPYRIGHT, NORTH CAROLINA RATE BUREAU, 1986
HO-D1 (04-93)

UNITED SERVICES AUTOMOBILE ASSOCIATION
USAA® HOMEOWNERS POLICY DECLARATIONS
Policy Number Policy Term: 05/28/06 05/28/07
USAA 00331 88 74 94A Inception Expiration
SECOND MORTGAGEE:
CHARTER ONE BANK, N.A.
ITS SUCCESSORS AND/OR ASSIGNS, ATIMA
ATTN: POST CLOSING EV950-7, 65/75 ERIEVIEW-7TH FL
CLEVELAND,OH 44114
LOAN NUMBER 9932251047
LEGAL DESCRIPTION: LOT 150
SUBDIVISION: PROVIDENCE COUNTRY CLUB
SECTION II - OTHER INSURED LOCATION(S):

168 LAKE RIDGE RD
LAKE LURE, RUTHERFORD, NC 28746-0000 $10.00
SPECIFICALLY LISTED BELOW ARE THE DECLARATIONS AND PREMIUMS FOR ENDORSEMENTS MADE A
PART OF THIS POLICY AT THE TIME OF ISSUE. THE ENDORSEMENTS ARE ATTACHED STATING
TERMS AND CONDITIONS.
QR3NC 04 05 QUICK REFERENCE HO 00 03
HO 00 03 10 00 HOMEOWNERS 3 SPECIAL FORM
HO 04 98 10 00 REFRIGERATED PROPERTY COVERAGE
HO 32 01 06 05 SPOUSE ACCESS ENDORSEMENT
HO 32 18 05 03 INFLATION GUARD ENDORSEMENT
HO 04 16 10 00 PREMISES ALARM OR FIRE PROTECTION SYSTEM
HO 32 96 05 03 NO LIABILITY COVERAGE FOR HOME DAY CARE
HO 04 90 10 00 PERSONAL PROPERTY REPLACEMENT COST $76.00
HO 24 70 10 00 ADDITIONAL RESIDENCE RENTED TO OTHERS $47.00
HO 32 20 05 03 SPECIFIED ADDITIONAL LIMITS COVERAGE A $30.00
HO 32 27 12 05 ADDITIONAL COVERAGE - JEWELRY & FURS $16.00
PAGE 13
COPYRIGHT, NORTH CAgOLINA RATE BUREAU, 1986
HO-D2 (04-93) 03/07/0
b
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
September 25, 2006
Rutherford County
CERTIFIED MAIL: RETURN RECEIPT REQUESTED
Samuel C. Sayson
5710 Providence CC Drive
Charlotte, North Carolina 28277-2621
Subject Property: Lake Lure: Sea wall repair
Incorrect application submission
? REQUEST FOR MORE INFORMATION
? PERMITTING FEE MISSING/INCORRECT
® RETURN OF APPLICATION PACKAGE

OCT i; 200
Dear Dr. Sayson: W? AT "R 6
Q.
STO,6q?y UA `
On September 21, 2006, the Division of Water Quality (DWQ) received your application d
September 19, 2006 for the above referenced project. The DWQ has determined that your application
was incomplete and/or provided inaccurate information as discussed below. The DWQ will require
additional information in order to process your application to impact protected wetlands and/or streams on
the subject property. Therefore, unless we receive five copies of the additional information requested
below, we will have to move toward denial of your application as required by 15A NCAC 2H.0506 and
will place this project on hold as incomplete until we receive this additional information. Please provide
the following information so that we may continue to review your project.
Additional Information Requested:
? Water Quality Certification, See I. Processing, Item 2.. Please state which Permit
(Nationwide, Regional or General) number you intend to use. You may want to contact the
U.S. Army Corps of Engineers (USACE) to determine which permit they will allow you to
use.
? DWQ requires the name of an individual shown as "Owner/Applicant" to set up the project.
? The PCN Application failed to contain the Applicant/Agent's Signature and Date. See last
page of application. (Agent's signature is valid only if an authorization letter from applicant is
provided).
? Water Body information not stated. See III Project Information, Item 7.
? Incorrect and/or missing wetland, intermittent-perennial stream and/or buffer impacts.
DWQ is unable to review this project without noted or corrected impacts reflected.
NOO?tltCaroly
401 Oversight/Express Review Permitting Unit NRtllClll?
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: httD://h2o.enr.state.nc.us/ncwetlands
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper
? Lack of permitting fee. Please note that beginning January 1, 1999, the N.C. General
Assembly passed legislation requiring payment of a fee for all 401 applications. The fee for
applications is $200 for projects impacting less than an acre of wetland and less than 150
linear feet of streams. For projects impacting one or more acres of wetland or 150 or more
feet of streams, the fee is $475.
? Incorrect permitting fee amount. Please see above item. Your check # for $
is herein enclosed for fee correction. DWQ does not retain any payment unless it is in the
correct amount.
? A request for a modification of an issued permit requires re-submission of five (5) application
sets and appropriate fee. We have herein returned your modification request.
? Application was missing pages or sections of information.
® OTHER: Enclosed you will find the correct permit application for completion and submission
to DWQ for your sea wall repair on Lake Lure at 186 Lake Ridge Road. Please submit one (1)
original and four (4) copies along with the appropriate fee for the review and approval process.
Please contact the DWQ within three weeks of the date of this letter to verify that you have received this
letter and that you remain interested in continuing to pursue permitting of your project and will be
providing the DWQ the requested information at a later date. Please contact this office in writing and
Kevin Barnett of the DWQ Asheville Regional Office. If we do not hear from you within three weeks,
we will assume that you no longer want to pursue this project and we will consider the project as
withdrawn.
This letter only addresses the application review and does not authorize any impacts to wetlands, waters
or protected buffers. Please be aware that any impacts requested within your application are not
authorized (at this time) by the DWQ. Please call Mr. Ian McMillan or Ms. Cyndi Karoly at 919-733-
1786 if you have any questions regarding or would like to set up a meeting to discpss this matter.
Sin i ly,
Cyndi Karoly, Supervisor
401 Oversight/Express Review Permitting Unit
CBK/ljd
Enclosures: Return of correspondence and Individual Permit
Check # 6357 for $200
GP30 FERC Lake Dwellers Permit
cc: Kevin Barnett, DWQ Asheville Regional Office
USACE Asheville Regulatory Field Office
File Copy + check copy
Filename: Ssayson(Rutherford)_Retu_[ncorrectAppl_Fee
,40F W ATF9 Q Michael F. Easley, Governor
`0 G William G. Ross Jr., Secretary
r North Carolina Department of Environment and Natural Resources
.r Alan W. Klimek, P.E. Director
Division of Water Quality
September 25, 2006
Rutherford County
CERTIFIED MAIL: RETURN RECEIPT REQUESTED
Samuel C. Sayson
5710 Providence CC Drive
Charlotte, North Carolina 28277-2621
Subject Property: Lake Lure: Sea wall repair
Incorrect application submission
? REQUEST FOR MORE INFORMATION
? PERMITTING FEE MISSINGANCORRECT
® RETURN OF APPLICATION PACKAGE
Dear Dr. Sayson:
On September 21, 2006, the Division of Water Quality (DWQ) received your application dated
September 19, 2006 for the above referenced project. The DWQ has determined that your application
was incomplete and/or provided inaccurate information as discussed below. The DWQ will require
additional information in order to process your application to impact protected wetlands and/or streams on
the subject property. Therefore, unless we receive five copies of the additional information requested
below, we will have to move toward denial of your application as required by 15A NCAC 2H.0506 and
will place this project on hold as incomplete until we receive this additional information. Please provide
the following information so that we may continue to review your project.
Additional Information Requested:
? Water Quality Certification, See I. Processing, Item 2.. Please state which Permit
(Nationwide, Regional or General) number you intend to use. You may want to contact the
U.S. Army Corps of Engineers (USACE) to determine which permit they will allow you to
use.
? DWQ requires the name of an individual shown as "Owner/Applicant" to set up the project.
? The PCN Application failed to contain the Applicant/Agent's Signature and Date. See last
page of application. (Agent's signature is valid only if an authorization letter from applicant is
provided).
? Water Body information not stated. See III Project Information, Item 7.
? Incorrect and/or missing wetland, intermittent-perennial stream and/or buffer impacts.
DWQ is unable to review this project without noted or corrected impacts reflected.
Noc Carolina
401 Oversight/Express Review Permitting Unit
UfllCQ??lf
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: http://h2o.enr.state.nc.us/ncwetlands
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper
L
? Lack of permitting fee. Please note that beginning January 1, 1999, the N.C. General
Assembly passed legislation requiring payment of a fee for all 401 applications. The fee for
applications is $200 for projects impacting less than an acre of wetland and less than 150
linear feet of streams. For projects impacting one or more acres of wetland or 150 or more
feet of streams, the fee is $475.
? Incorrect permitting fee amount. Please see above item. Your check # for $
is herein enclosed for fee correction. DWQ does not retain any payment unless it is in the
correct amount.
? A request for a modification of an issued permit requires re-submission of five (5) application
sets and appropriate fee. We have herein returned your modification request.
? Application was missing pages or sections of information.
® OTHER: Enclosed you will find the correct permit application for completion and submission
to DWQ for your sea wall repair on Lake Lure at 186 Lake Ridge Road. Please submit one (1)
original and four (4) copies along with the appropriate fee for the review and approval process.
Please contact the DWQ within three weeks of the date of this letter to verify that you have received this
letter and that you remain interested in continuing to pursue permitting of your project and will be
providing the DWQ the requested information at a later date. Please contact this office in writing and
Kevin Barnett of the DWQ Asheville Regional Office. If we do not hear from you within three weeks,
we will assume that you no longer want to pursue this project and we will consider the project as
withdrawn.
This letter only addresses the application review and does not authorize any impacts to wetlands, waters
or protected buffers. Please be aware that any impacts requested within your application are not
authorized (at this time) by the DWQ. Please call Mr. Ian McMillan or Ms. Cyndi Karoly at 919-733-
1786 if you have any questions regarding or would like to set up a meeting to disc} ss this matter.
Sin r ly,
Cyndi Karoly, Supervisor
401 Oversight/Express Review Permitting Unit
CBK/Ijd
Enclosures: Return of correspondence and Individual Permit
Check # 6357 for $200
GP30 FERC Lake Dwellers Permit
cc: Kevin Barnett, DWQ Asheville Regional Office
USACE Asheville Regulatory Field Office
File Copy + check copy
Filename: Ssayson(Rutherford)_Retu_IncorrectAppl_Fee
SAMUEL C. SAYSON, M .D.

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CHARLOTTE, NC 28277
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OF N A
gel
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
September 25, 2006
Rutherford County
CERTIFIED MAIL: RETURN RECEIPT REQUESTED
Samuel C. Sayson
5710 Providence CC Drive
Charlotte, North Carolina 28277-2621
Subject Property: Lake Lure: Sea wall repair
Incorrect application submission
? REQUEST FOR MORE INFORMATION
? PERMITTING FEE MISSINGIINCORRECT
® RETURN OF APPLICATION PACKAGE
Dear Dr. Sayson:
On September 21, 2006, the Division of Water Quality (DWQ) received your application dated
September 19, 2006 for the above referenced project. The DWQ has determined that your application
was incomplete and/or provided inaccurate information as discussed below. The DWQ will require
additional information in order to process your application to impact protected wetlands and/or streams on
the subject property. Therefore, unless we receive five copies of the additional information requested
below, we will have to move toward denial of your application as required by 15A NCAC 2H.0506 and
will place this project on hold as incomplete until we receive this additional information. Please provide
the following information so that we may continue to review your project.
Additional Information Requested:
? Water Quality Certification, See I. Processing, Item 2.. Please state which Permit
(Nationwide, Regional or General) number you intend to use. You may want to contact the
U.S. Army Corps of Engineers (USACE) to determine which permit they will allow you to
use.
? DWQ requires the name of an individual shown as "Owner/Applicant" to set up the project.
? The PCN Application failed to contain the Applicant/Agent's Signature and Date. See last
page of application. (Agent's signature is valid only if an authorization letter from applicant is
provided).
? Water Body information not stated. See III Project Information, Item 7.
? Incorrect and/or missing wetland, intermittent-perennial stream and/or buffer impacts.
DWQ is unable to review this project without noted or corrected impacts reflected.
Nom` Carolina
401 Oversight/Express Review Permitting Unit ?utuCa??J?
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: h!W://h2o.enr.state.nc.us/ncwetlands
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/ 10% Post Consumer Paper
? Lack of permitting fee. Please note that beginning January 1, 1999, the N.C. General
Assembly passed legislation requiring payment of a fee for all 401 applications. The fee for
applications is $200 for projects impacting less than an acre of wetland and less than 150
linear feet of streams. For projects impacting one or more acres of wetland or 150 or more
feet of streams, the fee is $475.
? Incorrect permitting fee amount. Please see above item. Your check # for $
is herein enclosed for fee correction. DWQ does not retain any payment unless it is in the
correct amount.
? A request for a modification of an issued permit requires re-submission of five (5) application
sets and appropriate fee. We have herein returned your modification request.
? Application was missing pages or sections of information.
® OTHER: Enclosed you will find the correct permit application for completion and submission
to DWQ for your sea wall repair on Lake Lure at 186 Lake Ridge Road. Please submit one (1)
original and four (4) copies along with the appropriate fee for the review and approval process.
Please contact the DWQ within three weeks of the date of this letter to verify that you have received this
letter and that you remain interested in continuing to pursue permitting of your project and will be
providing the DWQ the requested information at a later date. Please contact this office in writing and
Kevin Barnett of the DWQ Asheville Regional Office. If we do not hear from you within three weeks,
we will assume that you no longer want to pursue this project and we will consider the project as
withdrawn.
This letter only addresses the application review and does not authorize any impacts to wetlands, waters
or protected buffers. Please be aware that any impacts requested within your application are not
authorized (at this time) by the DWQ. Please call Mr. Ian McMillan or Ms. Cyndi Karoly at 919-733-
1786 if you have any questions regarding or would like to set up a meeting to discuss this matter.
Sincerely,
Cyndi Karoly, Supervisor
401 Oversight/Express Review Permitting Unit
CBK/Ijd
Enclosures: Return of correspondence and Individual Permit
GP30 FERC Lake Dwellers Permit
cc: Kevin Barnett, DWQ Asheville Regional Office
USACE Asheville Regulatory Field Office
File Copy
Filename: Ssayson(Ruthcrford)_Rctu_IncorrcctAppl