20211680 Ver 1_Sketch_20211118

Duke Energy Excavation Permit Application Form
FOR DUKE ENERGY USE ONLY
Duke File No.
Application Fee $ Security Deposit $ Check # __ Date Recv'd Initials
Date of Duke Energy Lake Services, applicant and/or contractor on -site inspections Data Z(j Z.l Initials \Mix
Date Final Protection/Avoidance Area Markings Field - Verified
Initials
Approved to Start Work By * : _ _ _ _ Date
(Print) (Sign)
Date Completion Required Date of Any Approved Extension Initials
Date Passed Closeout Inspection* Initials
Any Stop Work Orders or SMG Violations*? (check one) []Yes 13No (If Yes, explain in PART V)
Date Deposit Refunded Initials _ Date Permit Database Updated Initials
* Forward copy of approved application (all pages, plus any attachments that Duke Energy changed) back to applicant
with Approval Letter and highlight any changes. File copies of Approval and Close-out Checklists and any Stop Work
n_a___ __. - ---'-------
Part I. Applicant Information (Please Print)
Name Martin Lee Telephone [phone]
Email address: [e-mail]
Lake Address
216 Canal Dr.
Statesville, NC 28677
Mailing Address (i. f different)
2058 Lake Fountain Dr.
Katy, TX 77494
Contractor Company CBC Stone & Recycling, LLC
Contractor Contact Person Janice Estep
Telephone [phone]
Contractor Email Address: [e-mail]
LAKE LOT INFORMATION
Lake Norman County Iredell
Subdivision Kale Park
City Statesville
State Nc Tax Map No.
Lot / Section No. Pt. 1 & 2
Lot Size 0.33 Acres
Duke Energy Page 4 of 13 rev 10/1/2019
Excavation Program

Duke EnerQv Excavation Permit Application Form
Are there any Co -Applicants*? (check one) OYes ®No (If Yes, include names, street
addresses or lot numbers, pier numbers, phone numbers, and email addresses in Part V —
Additional Information)
* Co -Applicants exist when the proposed work is being done under a single application, will be
performed by a single contractor as one continuous project, and is done to benefit multiple
owners / lease holders of Project -front properties within a single development. There canbe no
more than 4 co -applicants in addition to the lead applicant on any application.
Do not continue the application until an on -site inspection has been conducted between a
Duke Energy Lake Representative and the applicant and/or the excavation contractor.
NOTE. Initialling this portion of the application by a Lake Representative in no way
constitutes approval or eminent approval of the excavation or any other lake use permitting
activity.
Date of on -site inspection 10 ZC zl
Initials (Duke Energy)
(applicant/contractor)
Duke Energy Page 5 of 13 rev 10/1/2019
Excavation Program

Duke Energy Excavation Permit Application Form
Part II. Description of Project
A. Basic Information
1. Type of excavation: (check one) ❑ New excavation IZI Maintenance excavation
2. Purpose of excavation: (check one) 0 Boat Access Channel
❑ Water Intake Channel ❑ Wastewater Discharge Channel
❑ Other (specify):
Lake user category: (check one)
❑Commercial Marina
❑Other (specify):
ElPrivate ❑Residential Marina
❑Public
4. Max. Excavation Area Dimensions (ft): Length 45' Width 40' Depth 3' - 1 U Q . UU c�
(Note: include additional area dimensions if necessary so res onse to #S below equals max. area
dimensions in #4) �5_ K 30X a 5 �' Cl Vc,..rrel = `a(D3 . 8 cy
tio°' X 30' X 3 ` SMcx reel " V' 33
a00' x 30 x a' SkareCi CV)ro nnzj - qq'i. 44 cy - y = 111. It e_y
5. Volume of Excavated Material (TOTAL for the project): 874.98 Cubic yards
6. Type of material removed (applicant determines by field sample if practical):
UrUSilt
7. Excavation Site area: o . SU Acre (s) Disposal Site area: 101-18 Acre(s)
8. Total Disturbed Area (including equipment staging area): o . 5 6 Acre (s)
9. Does the project meet the requirements of the applicable General Permit? (check one)
✓ 1'es Jo
10. Do you claim title to the disposal area? (check one) ❑Yes ✓ No
11. Do you claim title to the equipment staging area? (check one) [Z]Yes vo
12. Are there any water -treatment facilities within 50 feet of the proposed excavation area?
(check one) Yes ✓ Jo
(If Yes, spec):
13. How will the excavated material be entrapped and the erosion controlled? (e.g. see attached
erosion control plan and disposal area design):
Dredge by barge, haul material off by land with permission from neighbor at 210 Canal
Dr. also having dredging done and taken to disposal site located at 1025 Lewis Ferry
Rd. Statesville, NC 28677. Shared "V" channels are split between owners of 210, 212,
216 and 220 Canal Dr.
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Duke Enemy Excavation Permit Annlication Form
14. Type(s) of excavation equipment to be used:
Long Reach Excavator
15. Will waters or wetlands be crossed in transporting equipment to or from the site?
(check one) [OYes ❑No
(If yes, explain) By barge
16. Will return water re-enter the reservoir? (Check one) ❑Yes VNo ❑N/A
(If Yes, sped points) of re-entry and show on Excavation Area Drawing)
17. Is there an existing facility (e.g. pier) that access is being maintained to by conducting the
excavation? 14Yes ❑No
(If Yes, provide the existing permit number. If No, include a scaled drawing of the proposed
facility). Permit # 3539
18. Total planned duration of the work (Include first equipment mobilization, excavation
through final mitigation measures complete):
START 7 / 22 FINISH 7 / 22
(Month) (Year) (Month) (Year)
Duke Energy Page 7 of 13 rev 10/1/2019
Excavation Program

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Duke Enerffv Excavation Permit ADplication Form
C. Applicant's Si natures
Comments: N e �h� o S ot— `v n V f-CO
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Applicant Name (print)_ I " 4 Ak T-r ) C
Applicant Signature*_ Date r
Co -Applicant Name (print)
Co -Applicant Signature* Date
Co -Applicant Name (print)
Co -Applicant Signature* Date
Co -Applicant Name (print)
Co -Applicant Signature* Date
Co -Applicant Name (print)
Co -Applicant Signature* Date
*Per my signature, the information provided in this application is correct to the best of my
knowledge.
Duke Energy Page 10 of 13
Excavation Program rev 1011I2019

Excavation Project User's Agreement Letter
(Please fill in the blanks. Please Print)
Date G, - d - 'At
TO: Duke Energy
c/o Lake Services - EC12Q
526 S. Church Street
Charlotte, NC 28202
RE: Excavation For (Subdivision and Lot #'s or Other Project Name)
alLa Can k Dy- 0+ -Pk 1 VAC k 4P"K
(Lake/County/City) &,Mcxn / 71 re.Glel l / 5.J'k Ile
(Applicant's full name) Oln f-� ,n L e hereby agrees to comply with all
recommendations, requirements and/or conditions of Duke Energy, General Permit(s) (if
applicable) and other federal, state and local agency requirements pertaining to the application to
excavate for the purpose of a � � 0.CeeaSS
In addition, I/we have read and agree to comply with Duke Energy's current Shoreline
Management Plan (SMP) or other applicable guidelines, much of which is repeated herein, and
understand that written authorization must be obtained from Duke Energy prior to beginning any
activity within the Federal Energy Regulatory Commission (FERC) project boundary or on Duke
Energy property associated with a reservoir, collectively referred to as Project Boundary. The
excavation will be completed as described in the approved application and within eighteen (18)
months from the date of written approval by Duke Energy, unless specifically noted otherwise in
the application or unless I/we obtain approval for a single, time extension (maximum of one year)
in writing from Duke Energy. Uwe understand that if the SMP or other applicable guidelines or
rules change during any extension period, 1/we will be expected to comply with the new
requirements to the maximum extent practicable. I/we also recognize that failure to complete the
excavation within this build -out period will require the filing of a new application within the then -
current SMP or other applicable guidelines and the new application must include any applicable
fees and security deposits.
1/we attest to be the owner(s) or lease holder(s) of the land immediately adjoining the Project
Boundary where the excavation activity is to take place, or if not the owner or lease holder, I/we
have included proof of title to the property and written authorization from the owner(s) or lease
holder(s) to carry out the proposal within the Project Boundary adjacent to their land.
1/we attest to be the owner(s) or lease holder(s) of the land that will be used for equipment
staging and disposal of excavated material or if not the owner or lease holder, Uwe have included
proof of title to the property and written authorization from the owner(s) or lease holder(s) to
carry out the work on their land.
Duke Energy Page 1
g Rev: 4/6/2020

1/we understand that all excavation work must be done directly in front of my/our property and as
specified in Duke Energy's approval. I/we also understand that access channels must run
perpendicular to the shoreline while within the third of the cove area that is nearest my/our
property.
I/we understand that for proposed excavations, I/we must notify the appropriate local, state and
federal agencies in advance of the activity by sending them a completed copy of Duke Energy's
Excavation Permit Application Form and other required information. I/we understand that
written authorization and/or other permits may be required by some of these agencies and such
required authorizations must be obtained before I/we submit the final application to Duke
Energy.
At FERC-licensed reservoirs, 1/we understand that except for maintenance excavations, any
excavation exceeding 2000 cubic yards of material removed or any excavation or shoreline
stabilization work needed to support an application that requires FERC review does itself require
specific review and approval by the FERC before Duke Energy can issue any approvals.
I/we agree that unless specifically approved otherwise in the application, explosives will not be
used as part of this excavation activity.
1/we understand that every reasonable effort must be made to minimize any adverse impact on
fish, wildlife and other natural resources.
I/we understand that applicants in South Carolina proposing excavations that are not covered
under the General Permit, or are greater than 150 cubic yards, must receive prior written
authorization from the South Carolina Department of Health and Environmental Control
(SCDHEC) or the US Army Corps of Engineers (as applicable) before submitting the completed
application to Duke Energy.
1/we agree that excavation activities will not occur during the months of March, April, May and
June because of the potential impacts to fish spawning areas.
I/we understand that trees and vegetation growing within or adjoining the lake play an important
role in its overall environmental condition, and the ecological benefit the vegetation has on fish
and wildlife habitat directly supports a sound and healthy lake environment. I/we also understand
that unauthorized removal of shoreline vegetation (e.g. button bushes, willows, cattails, etc.)
and/or disturbance of the shoreline buffer may result in suspension or denial of lake use
permitting requests, forfeiture of security deposits and require re-establishment of vegetation at
my/our expense, particularly if the disturbance is found to be in violation of state or local
ordinances or impacts FERC project buffers.
I/we agree all excavated material will be placed in upland areas, landward of the Project
Boundary, and confined to prevent erosion and sedimentation back into the lake or nearby
streams.
Duke Energy Page 2
Rev: 4/6/2020

Uwe agree to adequately stabilize all excavated material and all disturbed shoreline to prevent
erosion and runoff into the lake.
Uwe understand that the double handling of excavated material will not be allowed; therefore, all
excavated material must be placed above the Project Boundary in one handling.
1/we have designed the hydraulic excavation process (if any will be used) so that return water re-
enters the lake in the same general vicinity and cove as the excavation, to the maximum extent
practicable.
I/we agree that the proposed excavation will not be for the purpose of creating additional
shoreline, will not alter the Project Boundary or the full pond contour, and will not impact
threatened or endangered species, historic properties, or environmentally -important areas, unless
special public entity provisions were made in the application.
I/we recognize that it is my/our responsibility to clearly locate in the field and label on my/our
work area drawings any areas that require specific protection or avoidance during this excavation
work. Examples of these protection/avoidance areas include but are not limited to, any
Environmental Areas, Natural Areas or Impact Minimization Zones as identified by Duke
Energy; jurisdictional wetlands; historic properties; rare or threatened species; and buried gas,
water, sewer, electric or communications lines. Uwe agree to provide my/our contractor with a
copy of these work area drawings showing these areas to stress the necessary protection
measures.
Uwe agree that if any archaeological resources (e.g. pottery shards, Indian artifacts, etc.) are
discovered during the excavation, work shall be halted immediately. Uwe will then notify Duke
Energy and the State Historic Preservation Office to determine what measures, if any, I/we must
pursue to protect or salvage the archaeological resources.
I/we agree that any excavation from within the Project Boundary will not exceed the volume as
outlined in the application and will remove and disturb only what is absolutely necessary to
achieve the project's stated purpose.
1/we agree to be fully responsible for the permitted lake use and 1/we understand that this
responsibility is considered to transfer automatically along with ownership and leases of the
adjoining tract.
I/we understand Duke Energy representatives may issue Stop Work Directives for violations of
the SMP or other applicable guidelines and other consequences may result from such violations,
including but not limited to suspension or cancellation of approved permits, increases in fees,
modification or removal of non -complying structures and restoration of disturbed areas at my/our
own expense or loss of any consideration for future lake use permits. Uwe agree to immediately
comply with any Stop Work Directives, to fully cooperate with Duke Energy and other agencies
as necessary, and to perform the necessary remedial actions within the specified time frame.
Duke Energy Page 3
g Rev: 4/6/2020

I/we agree to develop any required mitigation plans and to complete any required mitigation
activities at my/our own expense within the specified time frames. I/we recognize that the
excavation work is not considered complete and deposits will not be refunded until the
mitigation requirements (if any) have been satisfactorily fulfilled.
I/we agree to notify Duke Energy by phone when the excavation is initiated and to ensure that
during the excavation period 1/we will post Duke Energy's approval letter in a clear waterproof
bag at the job site and visible from the water's edge
I/we agree to notify Duke Energy in writing when the excavation is completed (including any
required mitigation measures) and that the excavation was completed per the approved
application, so a close-out inspection can be performed.
1/we recognize security deposits will not be refunded if any violations of the SNIP, other
applicable guidelines, or this user's agreement occur.
I/we understand there will be no change in hydro project operations as a result of the excavation
and/or utilization of the excavated area.
Five agree to maintain the work area in a safe condition and to fully indemnify and save Duke
Energy harmless from any and all claims, liability, loss or damage that may arise from this
excavation project.
1/we understand that this user's agreement does not, in any way, constitute the transfer of any
rights in real property and that my/our use and enjoyment of FERC project and Duke Energy
lands and waters shall not hinder the general public's lawful use and enjoyment of the same.
Sincerely.
Applicant's Name (Print) Applicant's Signature
Co -Applicant's Name (Print)
Co -Applicant's Name (Print)
Co -Applicant's Name (Print)
Co -Applicant's Name (Print)
Co -Applicant's Signature
Co -Applicant's Signature
Co -Applicant's Signature
Co -Applicant's Signature
Duke Energy Page 4
Rey- :f6i3020

ki
Excise Tax: $ 520.00
Drafted by: Henry P. Van Hoy, II
Mail to: GRANTEES @
Parcel Id: 4701 8800 73.000
iw�Nwn�mm���rwam�
Doc ID: 009564690003 Type: CRP
Recorded: 08/29/2005 at 03:05:41 Ph
Fee Amt: $540.00 Page i of 3
Excise Tax: $520.00
Iredell County, NC
Brenda D. Bell Register of Deeds
SK1676 Pa819-821
WARRANTY DEED
THIS DEED made this 22Nay of , 2005, by and between MCIUNLEY
VAN JURNEY, SR, the GRANTOR to MAATN B. LEE, the GRANTEE:
(THE GRANTOR is a Free Trader as set forth in the Memorandum of Pre -Martial
Agreement recorded in Book 1229, Page 500 of the Iredell County Register of Deeds)
WITNESSETH:
THE GRANTOR, for valuable consideration paid by the GRANTEE, receipt of which is
acknowledged, have and by these presents do convey unto the GRANTEE in fee simple, all that
certain parcel of land situated in Fallstown Township, Iredell County, North Carolina (the
"Property') and more particularly described in the attached Exhibit "A"
THE GRANTOR acquired the property by instrument recorded in Deed Book 1165, Page
719. For further reference see Deed Book 1123, Page 1729.
TO HAVE AND TO HOLD the Property and all privileges and appurtenances thereto
belonging to the GRANTEE in fee simple.
THE GRANTOR COVENANTS with the GRANTEE, that the GRANTOR is seized of the
Property in fee simple, have the right to convey the Property in fee simple, that title is marketable
and free and clear of all encumbrances, and that the GRANTOR will warrant and defend the title

against the lawful claims of all persons whomsoever, except for the exceptions hereinafter stated.
Title to the Property is subject to the following exceptions:
Easements and restrictions of record.
2. Ad valorem taxes for 2005 and subsequent years.
The terms GRANTOR and GRANTEE as used herein include the masculine and the
feminine, the singular and the plural, as the context requires, and the heirs, successors, and assigns
of the parties hereto.
IN WITNESS WHEREOF, the GRANTOR have signed this deed the day and year first
above written.
GRANTOR
McKinle an rney, Sr.
STATE OF NORTH CAROLINA
COUNTY OF a
I, a Notary Public of the county and State aforesaid, certify that McKinley Van Jurney, Sr.,
personally came before me this day and acknowledged the execution of the foregoing instrument.
Witness my hand and official stamp or seal, this the G of July, 05
Notary Public
My commission expires: del
P
A �TA�_

.W6.
Exhibit "A"
Deed McKinley Van Jurney, Sr.
To Martin B. Lee
BEGINNING at a point in the Eastern margin of a private drive, said beginning point being
South 3° 04' West 10 feet from the Northeast corner of Lot No. I as shown on a plat
hereinafter referred to and runs thence from said BEGINNING point with the Eastern
margin of said drive North 3° 04' East 70 feet to a point; the Southeast corner of the property
formerly owned by Oliver Minton; thence with the Southern line of the former Minton
property South 96° 56' East 204.5 feet, more or less, to a point in the Eastern margin of Lot
No. 2 as shown on said plat; thence South 4° 34' West 70 feet to a point in the Eastern margin
of Lot No. 1; thence North 36' 56' West 203 feet, more or less, to the BEGINNING; and
being a portion of Lots 1 and 2 of Kalo Park, Fallstown Township, as shown on a plat thereof
duly recorded in Iredell County Registry, in Plat Book S, page 15.
FOR PARTIAL CHAIN of title, see Book 481, page 108; Book 373, page 34, Book 956,
page 795, and Book 1123, page 1729, Iredell County Registry.
FOR BACK REFERENCE see Deed Book 1165, Page 719, Iredell County Registry.
Title Exam
HPVH
XAMyFiles\Hank Van Hoy%eal EstateVumey, Ken - Martin Lee, heed, Iredell County, my i 592.24."d
NORTH CAROLINA
IREDELL COUNTY
THE CERTIFICATE OF:
IS CERTIFIED TO BE CORRECT.
BREN . ELL, REGISTER OF DEEDS
BY; 12/
./DEPUTY