NCC215545_FRO Submitted_20211006

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
EXPRESS PERMITTING OPTION 08012007
No person may initiate any land -disturbing activity on one or more acres as covered by the Act before this
form and an acceptable erosion and sedimentation control plan have been completed and approved by the
Land Quality Section, N.C. Department of Environment and Natural Resources. (Please type or print and, if
the question is not applicable or the e-mail and/or fax information unavailable, place N/A in the blank.)
Part A.
1. Project Name UNIT 5 INACTIVE ASH BASIN - CLOSURE EXCAVATION PHASE 2
CLEVELAND AND
2. Location of land -disturbing activity: County RUTHERFORD City or Township CLIFFSIDE/MOORESBORO
Highway/Street MccRAW ROAD Latitude35° 12' 20.6" NLongitude 81° 46' 10.8" W
3. Approximate date land -disturbing activity will commence: Q3 2021
4. Purpose of development (residential, commercial, industrial, institutional, etc.):INDUSTRIAL
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 6.0 ACRES
1,890
6. Amount of fee enclosed: $ (1,500+390) . The Express Permitting application fee is a dual charge.
The normal fee of $65.00 per acre is assessed without a ceiling amount. In addition, the Express
Permitting supplement is $250.00 per acre up to eight acres, after which the Express Permitting
supplemental fee is a fixed $2,000.00 (Example: 9 acres total is $2,585). NOTE: Both fees are
rounded up to the next whole acre and need to be paid by separate checks to NCDENR.
7. Has an erosion and sediment control plan been filed? Yes No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name ELIZABETH GLENN E-mail Address [e-mail]
Telephone [phone] Cell# Fax# NA
9. Landowner(s) of Record (attach accompanied page to list additional owners):
DUKE ENERGY CAROLINAS, LLC 864-642-8833
Name Telephone Fax Number
400 SOUTH TRYON STREET, SUITE 30C 400 SOUTH TRYON STREET, SUITE 30C
Current Mailing Address Current Street Address
CHARLOTTE NC 28202 CHARLOTTE NC 28202
City State Zip City State Zip
10. Deed Book No. 2149 Page No. 0006 Provide a copy of the most current deed.
Part B.
1. Person(s) or firm(s) who are financially responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet):
DUKE ENERGY CAROLINAS, LLC
Name E-mail Address
400 SOUTH TRYON STREET, SUITE 30C 400 SOUTH TRYON STREET, SUITE 30C
Current Mailing Address Current Street Address
CHARLOTTE NC 28202 CHARLOTTE NC 28202
City State Zip City State Zip
Telephone [phone] Fax Number

2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina Agent:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
(b) If the Financially Responsible Party is a Partnership or other person engaging in business under an
assumed name, attach a copy of the Certificate of Assumed Name. If the Financially Responsible
Party is a Corporation, give name and street address of the Registered Agent:
CT CORPORATION SYSTEM
Name of Registered Agent
E-mail Address
150 FAYETTEVILLE STREET
150 FAYETTEVILLE STREET
Current Mailing Address
Current Street Address
RALEIGH NC 27601
RALEIGH NC 27601
City State Zip
City State Zip
Telephone 919 - 821- 713 9
Fax Number
(c) In order to facilitate Express Permitting, it is
necessary to be able to contact the Engineer or other
consultant who can assist in providing any necessary
information regarding the plan and its preparation:
WOOD ENVIRONMENT AND
INFRASTRUCTURE SOLUTIONS, INC.
[e-mail]
Engineering Firm or other consultant
E-mail Address
Ken Daly
704-222-1438 704-357-8638
Individual contact person (type or print)
Telephone Fax Number
The above information is true and correct to the best of my knowledge and belief and was provided by me
under oath (This form must be signed by the Financially Responsible Person if an individual or his attorney -in -
fact, or if not an individual, by an officer, director, partner, or registered agent with the authority to execute
instruments for the Financially Responsible Person). I agree to provide corrected information should there be
any change in the information provided herein. ((
Type or print namez Title or Authority
,20 2- 0
Sign Date
//'� , a Notary Public of the County of C ��'�'✓�P
State of S� mil, ereby certify that C 1= L `i . t� nnS�"��'� appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him.
Witness my ha�qfqpQotarial seal, this day of S mc.r- 20 2�
-4 PUg�% Notary
N My commission expires V r Z Zee 6
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Doc ID: 002888800008 Type: CRP
Recorded: 08/10/2007 at 09:38:15 AM
Fes Aat: $26.00 Page 1 of 8
Exclse Tax: $0.00
Instrp 200700002143
Rutherford County, NC
Faye N. Nuskey Register of Deeds
sx940 PD93-97
L— Excise Tax`00— — Recording Time, Book and Page
Tax Lot No.: _ Parcel Identifier Nos. 916311, 913489, 913490, 906650, 9155B8, 9155B9, 1621577, 1620186
1637972, 1638146, 1637974, 911071, 1642600, 1642601; portions of 916312 and 903249; and Rutherford County
portion of Cleveland County Tax Parcel No. 312.
Verified by County on the _ day of August, 2007 by
Mail after recording to: & Grant Whitney. Jr Parker Poe Adams & Bcrostmn L.L.P. Three Wachovta Center.
Suite 3000 Charlotte NC 28202
This instrument was prepared by: Parker. Poe Adams &Bornstein L.L.P. (A Grant Whiln:� Jr.)
Brief Description For The Index:
182.47 acres, Plat Book , Page — Rutherford County Public Registry 777-71
NORTH CAROLINA NON -WARRANTY DEED
THIS DEED made this _LO— day of August, 2007, by and between
GRANTOR GRANTEE
DUKE ENERGY CAROLINAS, LLC I DUKE ENERGY CAROLINAS, LLC
a North Carolina limited liability company a North Carolina limited habihty company I
Address:
400 South Tryon Street
ST30C
Charlotte, North Carolm 28201
Enter - appropriate block for each party: name. address, and, if appropAate character of entity, e.g. corporaf on or partnership.
CLT 1006660v

The designation Grantor and Grantee as used herein shall include said parties, their heirs. successors and asvgns,
and shall include singular. plural, masculine, feminine or neuter as required by context
WITNESSETH, that Grantor, for a valuable consideration paid by Grantee, the receipt of which is hereby
acknowledged, has and by these presents does grant, bargain, sell and convey unto Grantee in fee simple, all that
certain lot or parcel of land situated in High Shoals Township, Rutherford County, North Carolina and more
particularly described as follows:
See EXHIBIT tl attached hereto and incorporated herein by this reference (the "Property').
The sole purpose of this deed is to recombine into one tract the Property described on EXHIBIT A which contains
182.47 acres.
The property hereinabove described was acquired by Grantor by instrument recorded in
A map showing the above described property is recorded in Plat Book alb . Page Rutherford County
Public Registry.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto
belonging to the Grantee in fee simple.
The Grantor snakes no warranty, express or implled, as to title to the property hereinabove described.
IN WITNESS WHEREOF, the Grantor has caused this instrument to be duly executed under seal, the day and year
first above written.
(SEE SIGNATURE AND NOTARY ACKNOWLEDGMENT ON FOLLOWING PAGE)
CLT 10066600

EXHIBIT A
LEGAL DESCRIPTION
ALL of that certain 182.47 acres shown plat entitled "DUKE ENERGY CAROLINAS, LLC
RECOMBINATION PLAT" recorded in Plat Boob, Paged, Rutherford County Public Registry.
CLT 1006660v3

G"NTOR:
DUKE ENERGY CAROLINAS, LLC
a North Carolina limited liability company
Title:
STATE Or
COUNTY OF Irwa- i u-Jos,.
1, - ckyarj T. C a Notary Public of SAat� County, State of lU e..1•L C ..l w. , certify that
_ (the "Signatory"), l ti of DUKE ENERGY CAROLINAS,
LL , a North Carolina limited liability company. personal y came before ate this day and by authority duly given
acknowledged the due execution of the foregoing instrument on behalf of the limited liability company.
1 certify that the Signatory personally appeared before me this day, and
(check one of the following)
✓ (1 have personal knowledge of the identity of the Signatory); or
(1 bave seen satisfactory evidence of the Signatory's identity. by a Laurent state or federa�
identification with the Signatory's photograph in the form of
(check one of the following)
_ a driver's license or
_ in the form of ); or
(a credible witness has sworn to the identity of the Signatory).
The Signatory acknowledged to me that he voluntarily signed the foregoing document for the purpose
stated therein and in the capacity indicated.
Witness my hand and official stamp or seal this Z day of August, 2007.
Notary Pub'tc
OFRCIAL SEAL Print Name:__~ AL",,j& e. — l k
Notary Public, North Carolina (Note. Notary Public must sign exactly as on notary seal)
ImCounlyotShinly MyCommrssionExpires: Z_i 009
NOW EDWARD T. CONNELL
My Ootrerdsslau Feb. 12, 2009
"a [NOTARY SEAL; (MUST BE FULLY LEGIBLE)
The foregoing Certificate(s) of
Is/am certified to be correct. This instrument and certificate are duly registered at the date and time and in the Book
and page shown on the fast page hereoE_Register of Deeds for Rutherford County.
By: Deputy/Assistant — Register of Deeds
CLT 10066600

DUKE ENERGY CORPORATION
ASSISTANT CORPORATE SECRETARY CERTIFICATE
I, Sue C. Harrington, Assistant Corporate Secretary of Duke Energy Corporation,
do hereby certify that the Board of Directors of Duke Energy Corporation on April 4,
2006, approved and adopted the Approval of Business Transactions Policy Statement,
which provides in relevant part that any direct report to the President and Chief
Executive Officer of Duke Energy Corporation may approve, or delegate the authority to
approve, business transactions (including acquisitions and divestitures) involving
amounts of $50 million or less.
I further certify that Christopher C. Rolfe, Group Executive and Chief
Administrative Officer, Duke Energy Corporation, is a direct report to the President and
Chief Executive Officer of Duke Energy Corporation, who, pursuant to the authority
granted by the Approval of Business Transactions Policy Statement, has delegated to
Angeline M. Clinton, Vice President, Enterprise Operations Services, Duke Energy
Corporation, the authority to approve amounts up to $10,000,000 for capital projects,
commitments to buy products or services, equity investments (including acquisitions,
partnerships, joint ventures, etc), divestitures, operating leases, and termination of
commodities contracts; and subsequently, Angeline M. Clinton, in accordance with the
Delegation of Authority for Enterprise Business Services, has delegated to Dennis F.
Wood, Ill, General Manager for Real Estate Services, Duke Energy Business Services,
LLC, the authority to approve up to $5,000,000 for land acquisitions and divestitures and
building rent; and subsequently, Dennis F. Wood, III, in accordance with the Delegation
of Authority for Enterprise Business Services: Enterprise Operations, has delegated to
R. Steven Bodenheimer, Director of Transaction Management, and George E. Taft,
Director of Land Services, the authority to approve $1,500,000 to execute deeds, leases,
and similar real estate documents on behalf of Duke Energy Corporation and its affiliates
for land and facility acquisitions and divestitures, which authority includes the
authorization to execute any contract, lease, deed, easements, rights of way or other
instruments related to the authorized transaction; and to George W. Christian, Jr.,
Manager, Real Estate Acquisitions and Valuations Harold L. Glorius, Jr., Supervisor,
Engineering Support; and Christopher E. Arbuckle, Supervisor, Engineering Support, the
authority to approve up to $750,000 to execute deeds, leases and similar real estate
documents on behalf of Duke Energy Corporation and its affiliates for land and facility
acquisitions and divestitures, which authority includes the authorization to execute any
contract, lease, deed, easements, rights of way or other instruments related to the
authorized transaction
IN WITNESS WHEREOF, I have hereunto set my hand and affixed the
Corporate Seal of said Duke Energy Corporation th's 20th day of July, 2007.
Assistant Corpora scretary