20120585 Ver 1_401 Application_20120612

20120585
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 five (5) copies of this application and supporting
information as well as a non refundable application fee to the Division of Water Quality of $240 00
for impacts to lake bottom of less than 1 acre and $570 00 for impacts to lake bottom of greater or
equal to 1 acre
Applications should be sent to
Division of Water Quality 401 Oversight/Express Review Permitting
1650 Mail Service Center
Raleigh, NC 27699 1650
Applicant Information t
Owner /Applicant Information
Name o Gr %z Pte/`
Mailing Address Zl/ ¢a 1 Tu.1 4/te,
JUN 012
Telephone Number _�!`�- %03- 1 Fax Number '— DRAW
nda a st ��LITY
E mail Address -- ede a;er 8ranrq,
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 /d6 ei4c4-/ �)eeoe/"
Company Affiliation 'Zdo %0017f- u *cl/e a-
Mailing Address $68 MN/tsmaa" we's y Ile. �C Z -25117
Telephone Number 7,01/-w'4Y- 91/ 7 '2%- Fax Number ?S 6r( -GY7- Pf67 9
E mail Address .0U/&Vaf a,��n�, Cdr
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 showing property 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

�-� �
r
l � > >�y4�

Location
County Z&A e, !/ Nearest Town ,.es., Ile—
Subdivision name or site address (include phase /lot number)
Directions to site please include road numbers landmarks etc (This is not necessary i an adequate
vicinity map is included) ." �j7 %g f
2 Describe the existing land use or condition of the site at the time of this application
3 Property size (acres) / t9 9
4 Nearest body of water ( stream /aver /sound/ocean/lake) La
5 Describe the purpose of the proposed work b./'i.G- YA a
ZS B/'odWQ
6 List the type of equipment to be used to construct the project s o,- AdA cSk`d 3*el-
7 Amount of impact (including all excavation backfill np rap retaining walls etc ) below the
normal pool lake level in square feet or acres 610 Lry'
8 a Amount of impact (including all clearing back fill excavation np rap retaining walls etc )
above the normal pool lake level and 50 feet land ward in square feet or acres
" X LIV cK /y so 4 r
8 b Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance) �i�� S/,Jrtaf ft es &4.L
Mks 5jeg, sf' Wd14 -
if4A
bUop-
Applicant/Agent Signature Ow4er`
(Agent s signature is valid only if an authorization 1i
all 7— -
/ Date' '
from the applicant is provided )

o�OF W ATF9OG
O Y
20120585
Office Use Only
Corps action ID no
DWQ project no
Form Version 1 3 Dec 10 2008
Page 1 of 10
PCN Form – Version 1 3 December 10 2008 Version
Pre - Construction Notification PC Form
A Applicant Information
1
Processing
la
Type(s) of approval sought from the
Corps
�, Section 404 Permit El Section 10 Permit
1 b Specify Nationwide Permit (NWP) number or General Permit (GP) number
1c
Has the NWP or GP number been verified by the Corps?
❑ Yes
❑ No
1d
Type(s) of approval sought from the DWQ (check all that apply)
❑ 401 Water Quality Certification – Regular j,Non-404 Jurisdictional General Permit
❑ 401 Water Quality Certification – Express ❑ Riparian Buffer Authorization
1 e
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification
❑ Yes IN No
1 For the record only for Corps Permit
❑ Yes ❑ No
If
Is payment into a mitigation bank or in lieu fee program proposed for mitigation
of impacts? If so attach the acceptance letter from mitigation bank or m lieu
fee program
El Yes
( No
1g
Is the project located in any of NC s twenty coastal counties If yes answer 1h
below
❑ Yes
No
1 h
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
X No
2
Project Information
2a
Name of project
��.. 45; Aaz e/•
2b
County
Vol de,l
2c
Nearest municipality / town
/Lled/'GS Ile-
2d
Subdivision name
2e
NCDOT only T I P or state
project no
3
Owner Information
3a
Name(s) on Recorded Deed
t rc
3b
Deed Book and Page No
7
3c
Responsible Party (for LLC if
applicable)
/>%/`i4
3d
Street address
G
3e
City state zip
a d Y A G Z �!
3f
Telephone no
ewIr - ION — `t 6
3g
Fax no
—
3h
Email address
Page 1 of 10
PCN Form – Version 1 3 December 10 2008 Version

4
Applicant Information (if different from owner)
4a
Applicant is
,Agent ❑ Other specify
4b
Name
G
4c
Business name
(if applicable)�,�/6
�� e
4d
Street address
U/
4e
City state zip
rGscA G G
0
Telephone no
7~— .043— 3Y7
4g
Fax no
gkG _ 6f7 _ A 7
4h
Email address
/1'i Aer c�
5
Agent/Consultant Information (if applicab e)
5a
Name
Sm� 4 .r.
5b
Business name
(if applicable)
5c
Street address
5d
City state zip
5e
Telephone no
5f
Fax no
5g
Email address
Page 2 of 10
PCN Form — Version 1 3 December 10 2008 Version

B Project Information and Prior Project History
1 Property Identification
1a Property identification no (tax PIN or parcel ID)
77q 7 WY g5'
1b Site coordinates (in decimal degrees)
Latitude 3s a 0-3 17-'W Longitude $d 31Z &L
(DD DDDDDD) ( DD DDDDDD)
1c Property size
p acres
2 Surface Waters
2a Name of nearest body of water (stream river etc) to
proposed project
/
2b Water Quality Classification of nearest receiving water
2c River basin
Cafn,�ba.
3 Project Description
3a Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application Y7<e 15 !ab►d a f Wlie, ul feq - c/u4+a)CW,7 171. B,CrS S/w/a /.ne
1 :,� V.04
3b List the total estimated acreage of all existing wetlands on the property
O ®Lz;, AG /C,5
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
/Ui4
3d Explain the purpose of the proposed project
54" ) zG `rye ev. m stwo s --a /va wtv5 w4
3e Describe the overall project in detail including the type of equipment o be used
t►.�l/ R 51� �i1i %� c !� . d ai emwq5o/'
4 Jurisdictional Determinations
4a Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the pasty
Comments
❑Yes ❑ No Unknown
4b If the Corps made the jurisdictional determination what type
of determination was made?
❑ Preliminary ❑ Final
4c if yes who delineated the jurisdictional areas?
Name (if known)
Agency /Consultant Company
Other
4d If yes list the dates of the Corps jurisdictional determinations or State determinations and attach documentation
5 Project History
5a Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑ Yes l"sa No ❑ Unknown
5b If yes explain in detail according to help file instructions
6 Future Project Plans
6a Is this a phased project?
❑ Yes
No
6b If yes explain
Page 3 of 10
PCN Form — Version 1 3 December 10 2008 Version

C Proposed Impacts Inventory
1 Impacts Summary
la Which sections were completed below for your project (check all that apply)
❑ Wetlands ❑ Streams tributaries Buffers
Open Waters ❑ Pond Construction
2 Wetland Impacts
If there are wetland impacts proposed on the site then complete this question for each wetland area impacted
2a
2b
2c
2d
2e
2f
Wetland impact
Type of jurisdiction
number —
Type of impact
Type of wetland
Forested
(Corps 404 10
Area of impact
Permanent (P) or
(if known)
DWQ — non 404 other)
(acres)
Temporary T
W1 ❑ P [:IT
❑ Yes
❑ Corps
❑ No
❑ DWQ
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g Total wetland impacts
2h Comments
3 Stream Impacts
If there are perennial or mtermitten stream impacts (including temporary impacts) proposed on the site then complete this
question for all stream sites impacted
3a
3b
3c
3d
3e
3f
3g
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number
(PER) or
(Corps 404 10
stream
length
Permanent (P) or
intermittent
DWQ — non 404
width
(linear
Temporary (T)
(INT)
other)
(feet)
feet)
S1 ❑ P [--IT
❑ PER
❑ Corps
❑ INT
❑ DWQ
S2 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S3 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h Total stream and tributary impacts
31 Comments
Page 4 of 10
PCN Form — Version 1 3 December 10 2008 Version

4 Open Water Impacts
If there are proposed impacts to lakes ponds estuaries tributaries sounds the Atlantic Ocean or any other open water of
the U S then individually list all open water impacts below
4a
4b
4c
4d
4e
Open water
Name of waterbody
impact number —
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P) or
Temporary T
01 ❑ P [IT
rfiaA
5 /` tf
La lee,
02 ❑P ❑T
03 ❑P ❑T
04 [:1 POT
4f Total open water impacts
4g Comments
5 Pond or Lake Construction
/IA
If and or lake construction proposed th eVn complete the chart below
5a
5b
5c
5d
5e
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose
(acres)
number
of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f Total
5g Comments
5h Is a dam high hazard permit required
❑ Yes ❑ No If yes permit ID no
51 Expected pond surface area (acres)
5j Size of pond watershed (acres)
5k Method of construction
6 Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer then complete the chart below If yes then individually list all buffer impacts
below If any impacts require mitigation then you MUST fill out Section D of this form
6a
❑ Neuse ❑ Tar Pamlico ❑ Other
Project is in which protected basin?
5& Catawba ❑ Randleman
6b
6c
6d
6e
6f
6g
Buffer impact
-
-
number —
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet)
(square feet)
Temporary T
impact
required?
B1 ❑ P ;5T
/
❑ Yes
fe,X5V = 6-ye,
l6xw = 3aa
Ique55
a a lea.
No
B2 ❑P ❑T
El Yes
❑ No
B3 ❑P ❑T
El Yes
❑ No
6h Total buffer impacts
S"YO
30v
61 Comments -r Qce �� evI gty
Page 5 of 10
PCN Form — Version 1 3 December 10 2008 Version

D Impact Justification and Mitigation
1 Avoidance and Minimization
1a Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
C ' G 9 rL
2 Compensatory Mitigation for Impacts to Waters of the U S or Waters of the State �'�
2a Does the project require Compensatory Mitigation for
impacts to Waters of the U S or Waters of the State?
❑ Yes Po
2b If yes mitigation is required by (check all that apply)
❑ DWQ ❑ Corps
2c If yes which mitigation option will be used for this
project?
❑ Mitigation bank
❑ Payment to in lieu fee program
❑ Permittee Responsible Mitigation
3 Complete if Using a Mitigation Bank
3a Name of Mitigation Bank Alk
3b Credits Purchased (attach receipt and letter)
Type
Quantity
3c Comments
4 Complete if Making a Payment to In lieu Fee Program AIA
4a Approval letter from in lieu fee program is attached
❑ Yes
4b Stream mitigation requested
linear feet
4c If using stream mitigation stream temperature
❑ warm ❑ cool ❑cold
4d Buffer mitigation requested (DWQ only)
square feet
4e Riparian wetland mitigation requested
acres
4f Non riparian wetland mitigation requested
acres
4g Coastal (tidal) wetland mitigation requested
acres
4h Comments
5 Complete if Using a Permittee Responsible Mitigation Plan
5a If using a permittee responsible mitigation plan provide a description of the proposed mitigation plan
Page 6 of 10
PCN Form — Version 1 3 December 10 2008 Version
1e;1

6 Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation?
❑ Yes �KNO
6b If yes then identify the square feet of impact to each zone of the riparian buffer that requires mitigation Calculate the
amount of mitigation required
Zone
6c
Reason for impact
6d
Total impact
(square feet)
Multiplier
6e
Required mitigation
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1 5
6f Total buffer mitigation required
6g If buffer mitigation is required discuss what type of mitigation is proposed (e g payment to private mitigation bank
permittee responsible riparian buffer restoration payment into an approved in lieu fee fund)
6h Comments
Page 7 of 10
PCN Form — Version 1 3 December 10 2008 Version

E
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1
Diffuse Flow Plan
la
Does the project include or is it adjacent to protected riparian buffers identified
Yes ❑ No
within one of the NC Riparian Buffer Protection Rules?
1 b
If yes then is a diffuse flow plan included? If no explain why
❑Yes XNo
Comments
ABf- ' -Oe Y4-s S p, m-P ulov- k
2
Stormwater Management Plan
2a
What is the overall percent imperviousness of this project?
O %
2b
Does this project require a Stormwater Management Plan?
❑ Yes [ &No
2c
If this project DOES NOT require a Stormwater Management Plan explain why
`lao / zrr
2d
If this project DOES require a Stormwater Management Plan then provide a brief narrative description of the plan
❑ Certified Local Government
2e
Who will be responsible for the review of the Stormwater Management Plan?
❑ DWQ Stormwater Program
❑ DWQ 401 Unit
3
Certified Local Government Stormwater Review 1'
3a
In which local government s jurisdiction is this project?
❑ Phase II
3b
Which of the following locally implemented stormwater management programs
❑ NSW
❑ USMP
apply (check all that apply)
❑ Water Supply Watershed
❑ Other
3c Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
4 DWQ Stormwater Program Review
❑ Coastal counties
❑ HQW
4a
Which of the following state implemented stormwater management programs apply
❑ ORW
(check all that apply)
❑ Session Law 2006 246
❑ Other
4b
Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes ❑ No
5 DWQ 401 Unit Stormwater Review AIA
5a
Does the Stormwater Management Plan meet the appropriate requirements?
❑ Yes ❑ No
5b Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No
Page 8 of 10
PCN Form — Vernon 1 3 December 10 2008 Version

F
Supplementary Information
1
Environmental Documentation (DWQ Requirement)
la
Does the protect involve an expenditure of public (federal /state /local) funds or the
❑ Yes[
No
use of public (federal /state) land?
1 b
If you answered yes to the above does the protect require preparation of an
❑ Yes
❑ No
environmental document pursuant to the requirements of the National or State
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c
If you answered yes to the above has the document review been finalized by the
State Clearing House? (if so attach a copy of the NEPA or SEPA final approval
❑ Yes
❑ No
letter )
Comments
2
Violations (DWQ Requirement)
2a
is the site in violation of DWQ Wetland Rules (15A NCAC 2H 0500) Isolated
❑ Yes
Wetland Rules (15A NCAC 2H 1300) DWQ Surface Water or Wetland Standards
MNo
or Riparian Buffer Rules (15A NCAC 2B 0200)?
2b
Is this an after the fact permit application?
❑ Yes
XNo
2c
If you answered yes to one or both of the above questions provide an explanation of the violation(s)
3
Cumulative Impacts (DWQ Requirement)
3a
Will this protect (based on past and reasonably anticipated future impacts) result in
❑ Yes
No
additional development which could impact nearby downstream water quality?
3b
If you answered yes to the above submit a qualitative or quantitative cumulative impact analysis in accordance
with the
most recent DWQ policy If you answered no provide a short narrative description
4
Sewage Disposal (DWQ Requirement)
4a Clearly detail the ultimate treatment methods and disposition (non discharge or discharge) of wastewater generated from
the proposed protect or available capacity of the subject facility
Page 9 of 10
PCN Form — Version 1 3 December 10 2008 Version

5 Endangered Species and Designated Critical Habitat (Corps Requirement)
5a Will this project occur in or near an area with federally protected species or
Xf Yes �00
habitat?
5b Have you checked with the USFWS concerning Endangered Species Act
❑ Yes P6 No
impacts?
❑ Raleigh
5c If yes indicate the USFWS Field Office you have contacted
❑ Asheville
5d What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
6 Essential Fish Habitat (Corps Requirement)
6a Will this project occur in or near an area designated as essential fish habitat?
❑ Yes f XNo
6b What data sources did you use to determine whether your site would impact Essential Fish Habitat?
"Iwks S A'! s
7 Historic or Prehistoric Cultural Resources (Corps Requirement)
7a Will this project occur in or near an area that the state federal or tribal
governments have designated as having historic or cultural preservation
❑ Yes No
status (e g National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b What data sources did you use to determine whether your site would impact historic or archeological resources?
Ca b g� ea ftb
8 Flood Zone Designation (Corps Requirement)
8a Will this project occur in a FEMA designated 100 year floodplain?
O Yes ❑ No
8b if yes explain how project meets FEMA requirements S!& lu 5-&-,6, a w
8c What source(s) did you use to make the floodplain determination? QXS
&-, C-
61, //Z
Applicant/Agents Printed Name
Applicant/A'91-
(Agents signature is valid only if an authorization letter from the applicant
Date
is provided
Page 10 of 10
PCN Form — Version 1 3 December 10 2008 Version

IlU E ENERGY LAKE MANAGEMENT, EC12 -Q
P O BOX 1006
CULOTTE, NC 28201 -1006
704- 382 -1567 or TOLL FREE 1- 800 - 443 -5193
APPLICATION FOR PERNUT TO STABILIZE THE S1iORELrNE IN NORT�I CA ETNA
Please type or pant and fill in all blanks If information is not applicable so indicate b3 placing a N/A in blank
PLEASE SUBMIT APPLICATION AND APPROPRIATE DUKE ENERGY FILING FEE PAYABLE TO DUKE
ENERGY TO ABOVE ADDRESS
L Applicant Information
4 ]Tame
B Iviailmg Address
f �/ (L 281 I
C Telephone
II LOcation of Proposed .Project
A Lake
B Street Address
C County /ail c
D CIty/Towu/Commumty or Landmark
E Section
Eat #� S
F Directions to Property by road 5-1.- ub � in CL
P �
kf
OA of kris/ �Q °
o at f
G Lati de and Longitude for the pro ect site
Please submit a p J SET; ATTACHED MAP
map showing the coordinates or a detailed map (US
map etc }showing the exact locati GS quad map city
on of the project site (NOTE Latitude/Longitude
coordinates can be found on internet site www mapblast com )
Description of Project
A- Length of wall S-5,
B Material G t R
C Distance from Property Imelshorchne S �•?e
IV Intended Use of project Area
A Private
B Commercial
V Applicant s Signature
PLEASE NOTE THE FOLLOWING Date G /Z
A COPY OF THE COMPLETED APPLICATION WITH A ROAD MAP SHOWING LOCATION OF THE
PROPERTY MUST BE SUBMITTED TO US ARMY
ROOM 208 ASHEVH LE NC 2g8o1 5006 CORPS OF ENGINEERS 151 PATTON AVE
A COPY OF TIM DUKE ENERGY APPLICATION FOR PERMIT TO STABILIZE THE SHORELINE IN
NORTH CAROLINA AND SEVEN (7) COPIES OF THE COMPLETED WC DIVISION OF WATER
QUALITY PRE - CONSTRUCTION NOTIFICATION APPLICATION" MUST BE SUBRg= WITH
THE DIVISION OF WATER QUALITY APPLICATION FEE TO
NC DIVISION OF WATER QUALITY
ATTENTION CYNDI KAROLY
PARKVIEW BLDG 2321 CRABTREE ROAD
RALEIGH NC 27604 -2260
1/1 o/oossb [phone]
IA

PbDuke Duke Energy Carolinas LLC
Duhe Energy Lake Servic s
Energy, PO Box 1006 / EC12
PRIVATE hACILITIES USER'S (?
Charlrtte NC 28 ')01
Carolinas AGREEMENT LETTER
(You may use this letter and fill in the requested information Please, Pint)
Date ul I Z
TO Duke Cnei gy
c/o Like Sei,, ices EC12Q
PO Box 1006
Charlotte NC 28201 1006
RL (Pi ojcet Name) C /' G (1 /4 z-e
(1 ake Addi e s s)
(Applicant s fill/ namc) (� \�- C_ � �� ���� hereby agrees to comply
with all requirements and conditions set forth by Duke Eneigy s Lake Services office of
any federal state of local agencies pertaining, to our Private Facilities application to
construct and /or mlmtam a �r 8, Sea
on Lake t In addition I/we have lead and agree to comply with Duke
EnL.i gy s Slioi elme Management Guidelines (SMG) and understand that written
authorization must be obtained ftorn Duke s Lake Services office prior to beginning any
activity /construction within the Pioject boundary The construction will be completed as
described in the approved private facilities program application and within twelve (12)
months following the date of approval by Lake Services I'ailuie to complete construction
within the twelve month build out period Kill require the applicant to file a new
application within the then current guidelines The filing will include any applicable fees
,ind security deposits
1/ri c attest to be the owner or lease holder of the tract of land immediately adjoining the
Pioject boundary where thL. proposed private facility is to be constructed
Ywc understand that the structures to be installed and /or maintained are Illy /oill piopert)
and Ilwe therefore agree to be fully responsible for the permitted reseivott use including
maintaining structures in good repair If the prrvlte facility is deemed unsafe by a Lake
Services Representative Ave agree to repair of remove the private facility at my /our own
expense and within the specified timefiame set by Lake Services Phis responsibility is
considered to transfer automatically along with ownership and leases of the adjoining
tract
P -ige 1 of 5
11)d I A srU A6 d I m I 11 es U A6 C%k Kr f 1 1 12 08 1 h d
1 v r dl ke energy con
R 1 10

Ave agree to fully disclose all nlfoimation iegatdmg the approved private facility to any
prospective buyer /leaseholder of the property and any new owner /leaseholder 1 /we agree
to notify Duke Energy Lake Services immediately of any sale /transfer of the property,
including the name and address of the new owner and to transfer the permit to the new
owner /leaseholder
1 1we understand that unless the private facility was permitted by I ake Services before
June 1 1996 no more than (1) pier /dock or one Common Use boat slip per waterfront lot
will be considered for approval Ownership /interest in a Common Use I acrlity or
residential marina eliminates the option of having a separate private facility on any other
owned or leased lot within the affected subdivision
1/we understand that Lake Services' approval of the requested reservoir use in no way
constitutes assignment of an interest in real property (r a land rights) The approval is
granted and maintained solely at Duke s discretion Ave also understand that the
permitted use may be revoked at any time by Duke Energy or its successors for any
reason whatsoever If the approval is revoked 1 1we agree to remove the facility at my /our
own expense within the specified trmeframe set by Lake Services
1/we specifically waive any claim for consequential damages arising out of or relating to
this application Duke s approval or denial of it, or Duke s subsegltent revocation of
approval and Ave specifically understand and acknowledge that because Duke Energy
can revoke the permitted use at any time 1/we are not entitled to reliance damages
1/we understand during drought conditions Duke Energy may request reduced usage or
discontinued usage of any water withdrawal or related systems until such drought
conditions improve failure to do so may cause possible removal of the system and /or
any other permitted facilities that Ave may have and any costs associated with removal
of the facilities will be assessed to the lot owner
1/rvc understand that this lake was constructed as a working hydropower reservoir for the
primary purpose of producing cost effective electric energy and that this remains as the
lake s primary purpose 1 /we understand that the lake and its associated hydropower
station are operated by Duke Energy Lake Services under the terms of a license issued by
the federal Energy Regulatory Commission (FERC) and that there will be no change in
hydro project operations as a result of the construction and /oi use of any facilities that
I /we may be allowed to place within the ) LRC Project boundary of on Duke Energy Lake
Services owned property
1/we understand that the proposed private facility will be used only for the purposes
described in the information submitted for approval by Lake Services and other
appropriate governing bodies
Ave understand that this lake is open for use by the general public and that maintaining
safe and lawful public use is one of the primary lake management objectives of Duke
Energy Lake Sei vices
Page 2 of S
H d Wk s1U A m III I iv? b e l t Us i% C%% KT f 1 1 12 08 1 d It 7 21 10

I/A e understand that the use for which we aie applying is a piivate use and it should not
interfere with the general public s safe and lawful use of the lake
1/4,e understand that every reasonable effort must be made to minimize any adverse
impact on fish wildlife and other natural resources
Ave understand that trees and vegetation growing within the Project boundary play an
important role in the overall environmental condition of the lake The ecological impact
the vegetation has on the fish and wildlife habitat is necessary to ensure a sound and
healthy lake environment Ave also understand that unauthorized removal of shoreline
vegetation (r e button bushes willows cattails etc ) and /or disturbance of the shoreline
buffer may result in suspension or denial of lake use permitting requests and require
me /us to re establish the vegetation if the disturbance is found to be in violation of the
state or county watershed buffer regulations or Duke Energy s Vegetation Management
Requirements
(Foi construction on Lake Keowee) Ave agree that if land disturbing activities are to
occur within the Project boundary prior review /approval from Duke Energy Lake
Services the State Historic Preservation Office and the Eastern Band of the Cherokee
Indians is requned prior to work beginning
I /we agree that if any historic of archaeological resources are discovered during
construction of an approved activity the applicant must stop work immediately and
contact Duke Energy Lake Services I/we understand that in the event that anyone
discovers a potential site of archaeological or historic significance including any
gravesrte within the Project the individual must immediately notify Duke Energy Lake
Services
1/we agree to notify Lake Services when construction is completed During the
construction period the weather proof Duke Energy Approved Lake Use Activity sign
(to be provided by Duke Energy) must be posted at the fob site visible from the water s
edge
Ave agree to notify Lake Services if the property is sold and provide the name and
addr ess of the new owner
1 /we have included a check for any applicable filing fees security deposits and copies of
all other necessary permits
1 /we agree that if any action is taken by Duke Energy to enforce any plovrsron covenant
or agreement contained in this user agreement or Duke Energy Lake Services SMG or if
Duke Energy is requned to retain an attorney to enforce any provision covenant or
agreement contained in this user agreement or SMG (including without limitation the
payment of fees due hereunder or the removal of am encroachment constructed in
violation of this user agreement or SMG) then Duke Energy shall be entitled to recover
all of its reasonable costs associated with such an action including but not limited to
attorneys' fees and court costs incurred in such action and /or enforcement
Page 3 of 5
1i d 1 1, sN sA tit P te1P r it U A t UV K i r 1 1 12 06 1 d R 7 21 10

I /we understand that Lake Services' repiesentatives may issue Stop Woik Directives fol
any violations of the SMG o, engagement in prohibited acts or actiN itics on Duke Energy
Lake Services property as specifically identified in the SMG I /we understand that
persons found to be in violation will be subject to Duke Energy Lake Seivrces sanctions
which can include 1) restoration of the impacted area at the person s expense 2) loss of
consideration of any future lake use permitting activities for up to five yeais for improper
vegetation removal or until vegetation is satisfactorily ie established (even if there is a
change in property ownership) 3) revocation of a previously issued permit and loss of
consideration of any future lake use permitting activities and /or reinstatement of the
revoked permit 4) increases in fees 5) modification of removal of non complying
structures and /oi 6) further legal action being taken by Duke Energy Lake Services
1/we understand that certain activities specified in the SMG are prohibited because of
environmental concerns boating capacity limitations safety considerations and other
reasons
1 /we understand that ownership /interest in a Common Use Facility eliminates the option
for ine /us to also have a separate facility on any other lot within the affected subdivision
that Ave own of lease
Ave understand that this lake is open for use by the general public and that maintaining
safe and lawful public use is one of the primary lake management objectives of Duke
Energy Lake Seivrces
Ave understand lake use permit holders have the authority to prevent others from
trespassing on the structures they have built Ave also understand that I/we however do
not have any authority to impede anyone from pursuit of the lawful public recreation
enjoyment of rERC Project lands and waters Except as specified otherwise in the SMG
of other Duke Energy Lake Services documents (e g Public Safety Plans) anyone may
fish around /under structures built by others may walk /wade /fish within the FERC Project
boundary or any Duke Energy Lake Sei vices owned peripheral sti rp boat in the lake s
waters etc without having to get anyone s permission to do so Boaters may not block
ingress /egress to piers /docks
1/we agree to exercise all care and due diligence to preserve and maintain the character of
the Duke Energy Lake Services s adjacent property 1/wc agree to comply with the Duke
Energy Lake Seivrces Vegetation Management Requirements 1 /We agree further to not
allow sewage including discharge fiom septic tanks (oi similar facilities) or boat holding
tanks, garbage trash or other waste material to be discharged of dumped into the
reservoir tributaries of adjacent property
1/we understand that as an adjoining property owner 1/we can make no change in land
form of land within the FERC Project boundary of land owned by Duke Energy Lake
Services such as grading excavation or filling without prior written approval by Lake
Services
1 1we agree for myself /ourselves members of my/our family guests and invitees that Ave
assume all risks of personal rnjuiy of property damage incident to my/our occupancy and
Page 4 of 5
H d 1 ti s7U sn to r iur r it u n w t CW KT r 1 1 12 os 1 dm R 7 21 10

use of the premises including but not limited to any personal injuiy of pioperty damage
which may be sustained as a result of flood waters or in connection with the rise and fall
of water in the reseivon as a result of floods or of the operation of Duke Eneigy s hydro
electric facilities 11we as the adjoining property owner further agree that 1 1we will
indemnif3 protect, defend and save harmless Duke Energy from any and all loss cost
claims damages expenses, judgments and causes of action fol all injuiies and damages
sustained by the members of my/ow family guests, and invitees arising or claimed to
have arisen in connection with then occupancy or use of the Duke Energy Lake Services
permitted facility(s)
Ave acknowledge that Duke Energy Lake Services has the right to charge reasonable
user s fees for private use of its properly and that failure to pay any applicable user s fees
in a timely mannei can result in the suspension or cancellation of any previously
approved lake use permit
1/we recognize that Uwe have the continuing responsibility to ensure that the constructed
structures are maintained in good repair including but not limited to maintenance of the
dock and boat slips and proper erosion control within the permit area and along the
shoreline and agree to take all reasonable steps necessary to meet this responsibility 1 1we
agree to maintain all structures within the Piglect boundary on Duke Energy Lake
Services owned property in a sound condition and in a neat appearance and pay all costs
for said maintenance
Sincerely
(Applicant s Name)
Z/l 'zz �, / 7,,� L
Lake Street Address
�4 e-> f, l/e "- //�
City /State /Zip Code
Yq/— 7'1'7S
Lake Phone Number
(Designated Duke Energy Agent)
Page 5 of 5
AppliNnt s Signature
Hoene Sheet Addiess
City /State /Zip Code
Home Phone Number
Date
Date
It dot I. N A tit P eA t r it s u %" t Cat KT f 1 1 12 09 h d R 7 21 10

DEUCE ENERGY DIRECTIONS BY ROAD FORM
Lake Use Pei mit Applicants and Conti actors Case of locating the pi oposed pi olect site can have a big
impact on peiinit piocessmg time Please complete this foim and letuin it along N,,rth Your completed
peunft application to
DUKE ENERGY
C/O LAKE MANAGEMENT EC 12 Q
P O BOX 1006
CHARLOTTE NC 28201 1006
1 800 443 5193
Applicant sNamc Eric Glazer Tip fP mtReo td
Circle
Stieet Addiess (at lake) 211 Pintail Run Lane Private Factlio
Lake Name
Subdi\ ision Name
PropeitN Section
Cit) Mooresville
State Noi th Carolina
Telephone [phone]
Commercial Facthtj
Lake Norman Excavation
Stabilization
Mallard Head Comejance
Miscellaneous Uses
Lot # 1
County Iredell
Zip
28117
Directions (fiom m-iloi load of highwa)) Fiom Brawley School Road turn left on Canvasback
Road Tui n Right on Old Squaw Trail Tui n Lefton Billy Joe Road Turn Right on Pintail
Run Lane House � %ill be on vour left
DesciipLne SOuctule on Piopert% (i e biick gal age white fence mobile home etc)
N t PI d I k f tl f f 1 it I
m pt th i
GPAL /1 AhCMGNIT /LMPPM /DIRECTIONS DOC Eff D 11/14/98

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Latitude and Longitude of a Point Page 1 of 1
ITOB.iCtlMap Maps I Country Stal Places I Google Earth Cities I Earthquakes I I Am Her- I Lat Long
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To find the latitude and longitude of a point Click on the map Drag the marker or enter the
> Address 211 Pintail Run Lane Mooresville NC Go
Map Center Get Address Land Plat Size Street View Google Earth 3D Area Photographs
Try out the Google Earth Plug in Google Earth gives you a 3D look of the area around the center of the map
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Latitude and Longitude of a Point
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a point and want to see where on the map the point is
Use $ for N Lat or E Long -for S Lat or W Long
Get the Latitude and Longitude of a Point Example [phone] 044636
Note Your entry should not have any embedded spaces
When you click on the map move the marker or enter an
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Decimal Deg Latitude
are Inserted in the boxes below
Decimal Deg Longitude
Latitude 35 563128
i Show Point
Longitude 80 892668
Example [phone] for 34N 40 5012
Degrees Minutes Seconds
Degrees Minutes Seconds
Latitude
Latitude 35 33 472602
Longitude
Longitude 80 53 336048
Show Point I
O iTouchMap corn 2007 2012
httn //itouchman com /latloni? 1=1
6/7/2012

Pt opet t-\ Data
Tredell County
Property data
Parcel Numbed IG 67512 C0
3nqu11-y Datc 61112011
Page 1 of 2
Disclaimer While every effort is made to keep information provided over the internet accurate and up to date the County does not
certify the authenticity or accuracy of such information No warranties express or implied are provided for the records and /or mapping
data herein or for their use or interpretation by the User
Property Map
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Tax Account Number 77478485
Old Parcel Number
Owner Name GLAZER ERIC +MEREDITH
Mailing Address 211 PINTAIL RUN LANE MOORESVILLE NC 28117
Property Location PINTAIL RUN LN
Lot Number 1
Legal Description THE HAMMOCKS AT MALLARD HEAD PB46 44
Municipal Information
Township Code 17
City Code Null
Neighborhood Code 17003
htt„ / /wf h? 1-nnh11e311 com /h edellRenort /report aspx9PIN= 4636751253 000 6/7/2012

Pi opertN Data
Value Inrorniat'on CUllenl Year Propelt� Record Card (PRC)
Building Value 460870
Other Budding Features 14100
Land Value 315000
Tax Assessed Value 789Q70
Deferred 0
Land Infob ii -cation Register of Deeds Online Search
Date Recorded Document Type Deed Book Deed Page
20120210 WD 2158 2387
Tax Inforenatoon
Plat Book & Page Land Area Land Type Zoning
46 44 109 AC R20
Exemption Tax Code 1 Tax Code 2 Tax Code 3 Tax Code 4
Null Null Null Null
Current Zoning Contact Info
Iredell County
704 878 3118
Harmony
704 878 3118
Love Valley
704 878 3118
City of Statesville
704 878 3575
Town of Troutman
704 528 7600
Town of Mooresville
704 662 7040
Village of Davidson
704 892 7591
Tax Code 5
Null
Page 2 of 2
httn / /weh2 mohlle3l 1 con /IredellRenort/report asnx ?PIN= 4636751253 000 6/7/2012

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