NCC223212_FRO Submitted_20220915

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
EXPRESS PERMITTING OPTION
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 Environmental Quality. Submit the completed form to the appropriate
Regional Office. (Please type or print and, if the question is not applicable or the e-mail address or phone
number is unavailable, place NIA in the blank.)
Part A.
1. Project Name Camp Kanata 230kV Substation
2. Location of land -disturbing activity: County Wake City or Township Unincorporated
NCSR 1922 (Camp Kanata) 35.9841-78.5752
Highway/Street Latitudetae��ma�a�re�s� ,Longitude{ded��d��g�._
3. Approximate date land -disturbing activity will commence: January 2023
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Electrical Substation
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 17.43
6. Amount of fee enclosed 3,800.00 . The Express Permitting application fee is a dual charge.
The normal fee of $100.00 per acre (rounded up to the next acre) is assessed without a ceiling amount.
In addition, the Express Permitting supplement is $250 per acre up to eight acres, after which the Express
Permitting supplemental fee is a fixed $2,000.00 (Example: 8.10-acre application fee is $2,900). Checks
should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes ❑ Enclosed[]x No ❑
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Nuwan Wijesunya E-mail Address [e-mail]
Phone: Office # 919-546-2090 Mobile # [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Duke Energy Progress, LLC
Name Phone: Office # Mobile #
411 Fayetteville Street 410 S. Wilmington Street
Current Mailing Address Current Street Address
Raleigh, NC 27601 Raleigh, NC 27601
City State Zip City State Zip
10. Deed Book No.13974 Page No. 1520 Provide a copy of the most current deed.

Part B.
1. Company(ies) who are financially responsible for the land -disturbing activity (Provide a comprehensive list
of all responsible parties on accompanied page.) If the company is a sole proprietorship or if the landowner(s) is
an individual(s), the name(s) of the owner(s) may be listed as the financially responsible party(W).
Duke Energy Progress, LLC
Company Name
410 S. Wilmington Street
Current Mailing Address
Raleigh NC 27601
City state Zip
[e-mail]
E-mail Address
410 S. Wilmington Street
Current Street Address
Raleigh NC
city
State
Phone: Once # 919-546-2090 Mobile # [phone]
27601
Zip
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner(s signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
CT Corporation (Karen Rozar) [e-mail]
Name of Registered Agent E-mail Address
160 Mine Lake Court, Suite 200 160 Mine Lake Court, Suite 200
Current Mailing Address Current Street Address
Raleigh NC 27615-6417 Raleigh
City State Zip City
Phone: Office # 919-844-8360 Mobile #
Karen Rozar
Name of Individual to Contact (if Registered Agent is a company)
NC 27615-6417
State Zip
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
Name of Registered Agent
Current Mailing Address
City
Phone: Office #
State Zip
E-mail Address
Current Street Address
City State Zip
Mobile #
Name of Individual to Contact (if Registered Agent is a company)
(c) If the Financially Responsible Party is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General

Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
Company DBA Name
(d) If 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:
Dewberry Engineers
Engineering firm or other consultant
Frederic D. Rash
frash�dewberry.com
E-mail Address
919-424-3748 919-427-9430
Individual contact person (type or print) Phone: Office # Mobile #
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(s)
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 Party). I agree to provide
corrected information should there be any change in the information provided herein.
Nuwan Wijesuriya
Type or print name
Signature
Lead Transmission Permitting Manager
Title or Authority
,3 Za
oZ O��L
Date
i,_ avnz Lkf(e Y , a Notary Public of the County of . rse
rl -
State of North Carolina, hereby certify that Nd ji�c,(;ur %. 41 appeared personally
before me this day and being duly sworn acknowledgedhabove orm was executed by him/her.
� 11
Witness my hand and notarial seal, this of K� , 20
My commission expires a V .;v424

BK09397090 520
WAKE COUNTY. NC 132
LAURA M RIDDICK
REGISTER OF DEEDS
PRESENTED & RECORDED ON
0611V2010 AT 12:12:55
STATE OF NORTH CAROLINA
REAL ESTATE EXCISE TAX: $2900
BOOK:013974 PAGE:01520 - 01525
NORTH CAROLINA GENERAL WARRANTY DEED
Instrument prepared by and after recording return to:
Smith Anderson Law Firm, Box IS (MDR)
Brief Description for Index: Camp Kanata Road, Wake County, NC
Revenue Stamps: S 2,900.00
Parcel Identifier No. 1821.04 52 9967
STATE OF NORTH CAROLINA
COUNTY OF WAKE
THIS GENERAL WARRANTY DEED, is made and entered into as of this 15th day of
June, 2010, by and between SANFORD W. THOMPSON, III and wife, NANCY B.
THOMPSON ("Grantor") and CAROLINA POWER & LIGHT COMPANY, a North
Carolina public service corporation d/b/a PROGRESS ENERGY CAROLINAS, INC., with
its principal mailing address being Carolina Power & Light Company d/b/a Progress Energy c/o
Penney Develle (MACX: PEF 131) Post Office Box 14042, St. Petersburg, Florida 33733
("Grantee");
The designation Grantor and Grantee as used herein shall include the parties, their heirs,
successors, and assigns, and shall include singular, plural, masculine or neuter as required by
context.
WITNESSETH:
That Grantor, for 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 those certain lots or parcels or land situated in Wake County, North Carolina and
more particularly described as follows:
SEE EXHIBIT A ATTACHED HERETO AND MADE A PART HEREOF
#icsi159_t.00c

U013970001521
The property hereinabove described was acquired by Grantor by estate filed in Will Book b,
Page 194, Wake County Clerk of Court. Also see deed recorded in Book 908 Page 90, Wake
County Registry.
TO HAVE AND TO HOLD the aforesaid property and all privileges and
appurtenances thereto belonging to the Grantee its successors and assigns, in fee simple, forever.
Grantor covenants with Grantee, its successors and assigns, that it is seized of the above -
described parcels of land in fee simple and has the right to convey the same in fee simple; that
the same are free and clear from all encumbrances, except for property taxes not yet due and
payable, and any encumbrances of record or those readily disclosed by a current survey of said
parcels of land, including but not limited to road, railroad, utility, or other rights of way and/or
easements of record; and that it will warrant and forever defend the title thereto against the
claims of all persons whomsoever, except for the exceptions hereinabove stated.
[THE REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK]

BK,093970001522
IN WITNESS WHEREOF, Grantor has caused this Deed to be signed in its name as of
the day and year first above written.
SA ORD W. THO SON, III
F/Rom B. - _. «A,IP`. nl�
STATE OF NORTH CAROLINA
COUNTY OF I
I, ��L��'i� a Notary Public for Eje4mKt_iN County,
North Carolina, do hereby certify that SANFORD W. THOMPSON, III and NANCY B.
THOMPSON personally appeared before me this day and each acknowledged the due execution
of the foregoing General Warranty Deed.
Witness my hand and official seal this the/,day of June, 2010.
``0`�5 L` 1�/Z!
MOTA�Y =
put-%jc
.p ��� My commission expires: 6)d4aS7—
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BKO13974PGO1523
EXHIBIT A
(Description of the Property)
Being all that certain parcel or tract of land located in New Light Township, Wake County,
North Carolina and being more fully described as follows. All coordinates herein are based on
the NC Grid (NAD 83):
BEGINNING at an existing iron pipe at a control corner in the northern line of property owned,
now or formerly, by the United States of America c/o US Army Corps of Engineers (see Book
2377, Page 290, Wake County Registry) said point having N. C. Grid Coordinates of N =
811,824.06 and E = 2,126,380.00, said point also being located North 60"48'58" East 1,565.93
feet (Horizontal Ground Distance) from NCGS monument "HORSE" having N. C. Grid
Coordinates of N = 811,060.53 and E = 2,125,012.93; thence along said northern line of the said
United States of America property North 75°21'27" West 693.23 feet to an existing iron pipe in
branch said point being a southeasterly corner of a tract of land owned , now or formerly, by
Raymond R. Ray, Jr. and Samuel K. Ray (see Book 11872, Page 244, Wake County Registry)
and being located South 75°12'27" East 108.10 feet from an existing concrete monument "2-
38R"; thence along said branch and with the eastern line of said Ray tract and the eastern line of
property owned, now or formerly, by James M. Adams, Sr. (see Book 12530, Page 835, Wake
County Registry) the following courses and distances: North 18°40'09" West 25.50 feet to a
point; North 63°48'00" West 13.00 feet to a point; North 33°15'03" West 53.94 feet to a point;
North 43°22'13" East 15.59 feet to a point; North 59°46'32" West 29.90 feet to a point; North
19"50'44" East 33.44 feet to a point; North 109Y55" West 20.66 feet to a point; North
45°29'25" West 22.52 feet to a point; North 0721'58" West 35.44 feet to a point; North
43°38' 16" West 43.36 feet to a point; North 06°54'51" West 33.46 feet to a point; North
33°00'03" West 15.02 feet to a point; North 81°06'59" West 11.31 feet to a point; North
84°06'57" West 16.96 feet to a point; North 37°32'20" West 14.14 feet to a point; North
85°03'24" West 22.08 feet to a point; North 05°13'27" East 51.13 feet to a point; North
03°12'07" West 17.51 feet to a point; North 26°12'04" East 4095 feet to a point; and North
45°30'54" West 15.79 feet to an existing iron pipe in branch; thence leaving said branch and
continuing along the eastern line of said Adams property North 09"15' 15" West 1,242.43 feet to
an existing iron pipe (Disturbed) in the eastern right of way of Camp Kanata Rd. (NCSR No.
1922); thence along the eastern right of way line of said Camp Kanata Rd. North 36°28'39" East
629.48 feet to an iron pipe set; thence along the southwestern line of property owned, now or
formerly, by Peggy A. Harding et al (see Book 9230, Page 1580, Wake County Registry) South
62"11'04" East 5 19. 11 feet to an existing iron pipe set, said point having N. C. Grid Coordinates
of N = 813,903.45 and E = 2,126,174.98; thence continuing along the said Harding western
property line South 09017'22" East 1,084.73 feet to an iron pipe set in the southwest corner of
said Harding tract and the northwest corner of a tract of land owned, now or formerly, by
Millridge Investments, Inc (see Book 7583, Page 1, Wake County Registry); thence along the
western line of said Millridge tract the following courses and distances: South 09°57' 12" East
100.00 feet to an iron pipe set; thence South 19°57' 12" East 330.00 feet to an iron pipe set; and
thence South 31 °57' 12" East 559.39 feet to an iron pipe set in the northern line of said United
States of America property; thence along and with the northern line of said United States of
America property South 72°23'24" West 415.49 feet to the POINT AND PLACE OF

BK013974PG01524
BEGINNING, containing 43.188 acres, more or less, as shown on plat entitled "Survey for
Progress Energy Carolinas, Inc. "S. W. Thompson Tract" New Light Township, Wake County,
North Carolina", and bearing PEC Drawing No. L-G-10351, prepared by Smith and Smith
Surveyors, dated May 13, 2010, and recorded in Book of Maps 2010, Page 542, Wake County
Registry.

BKO13974PGO1525
BOOK:013974 PAGE:01520 - 01525
Yellow probate sheet is a vital part of your recorded document.
Please retain with original document and submit for rerecording.
Wake County Register of Deeds
WAKE Laura M. Riddick
COUNTY Register of Deeds
NORTH CAROLInA
This Customer Group
# of Time Stamps Needed
This Document
New Time Stamp
# of Pages Q I,
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