20230426 Ver 1_Sketch_20230323

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 Date " 15 ials h.
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 ❑No (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
Orders with application.
Part I. Applicant Information (Please Print)
Name Todd Williams Telephone [phone]
Email address: [e-mail]
Lake Address Mailing Address (f different)
238 Clark Cove Rd. same as lake address
Statesville, NC 28677
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 City Statesville State Ar Tax Map No.
Subdivision Old Homestead 1 Lot / Section No. 4 Lot Size o.61 Acres
Duke Energy Page 4 of 13 rev 11/22/21
Excavation Program

Duke Energy Excavation Permit Application Form
Security Deposit Refund Information
The security deposit will be refunded after the excavation permit has expired if no violations of
the approval occurred. The applicant will receive the security depost refund at the mailing
address in Part I unless an alternative recipient is identified.
Send the security deposit to an alternative recipient? (check one) ❑Yes ONo (If Yes,
include name and mailing address below.
Name:
Mailing Address:
Tax ID:
Are there any Co -Applicants*? (check one) ❑Yes OTo (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 can be 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 3 15
Initials (Duke Energy)
(applicant/contractor)
0 'IT, -
Duke Energy Page 5 of 13 rev 11/22/21
Excavation Program

Duke Energy Excavation Permit Application Form
Part II. Description of Project
A. Basic Information
1. Type of excavation: (check one)
2. Purpose of excavation: (check one)
❑ Water Intake Channel
❑ Other (spec):
3. Lake user category: (check one)
❑Commercial Marina
❑Other (spec):
❑ New excavation 0 Maintenance excavation
® Boat Access Channel
❑ Wastewater Discharge Channel
OPrivate ❑Residential Marina
❑Public
4. Max. Excavation Area Dimensions (ft): Length 30' Width 40' Depth 3'
(Note: include additional area dimensions if necessary so response to 95 below equals max. area
dimensions in #4)
5. Volume of Excavated Material (TOTAL for the project): 133.33 Cubic yards
6. Type of material removed (applicant determines by field sample if practical):
Dirt/Silt
7. Excavation Site area: 0.082 Acre (s) Disposal Site area: 2.29 Acre
(s)
8. Total Disturbed Area (including equipment staging area): 0.082 Acre (s)
9. Does the project meet the requirements of the applicable General Permit? (check one)
OYes ONo
10. Do you claim title to the disposal area? (check one) ❑Yes ONo
11. Do you claim title to the equipment staging area? (check one) ❑Yes 13No
12. Are there any water -treatment facilities within 50 feet of the proposed excavation area?
(check one) ❑Yes ONo
(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 of by land through neighbor's property with permission and take
by dump truck to disposal site located at 638 Oakridge Farm Hwy, Mooresville, NC 28115
Neighbor is also having dredging done.
Duke Energy Page 6 of 13 rev 11/22/21
Excavation Program

Duke Energy Excavation Permit Application Form
14. Type(s) of excavation equipment to be used:
Long Reach Excavator, Dump Truck
15. Will waters or wetlands be crossed in transporting equipment to or from the site?
(check one) FdYes ONO
(If yes, explain)
By barge
16. Will return water re-enter the reservoir? (Check one) ❑Yes ONO ❑N/A
(If Yes, speck point(s) 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? 1ZYes ONo
(If Yes, provide the existing permit number. If No, include a scaled drawing of the proposed
facility). Permit # 11272
18. Total planned duration of the work (Include first equipment mobilization, excavation
through final mitigation measures complete):
START 7 / 23 FINISH 7 / 23
(Month) (Year) (Month) (Year)
Duke Energy Page 7 of 13 rev 11/22/21
Excavation Program

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Duke Energy Excavation Permit Application Form
C. Applicant's Signatures
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Applicant Name (print)
Applicant Signature*
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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
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 rev 11 /22/2021
Excavation Program

Excavation Project User's Agreement Letter
(Please fill in the blanks. Please Print)
Date 1/20/23
TO: Duke Energy
c/o Lake Services - EC 12Q
526 S. Church Street
Charlotte, NC 28202
RE: Excavation For (Subdivision and Lot 4's or Other Project Name)
Lot 4 Old Homestead 1
(Lake/County/City) Norman / Iredell / Statesville
(Applicant's full name) Todd Williams 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 boat access for dock
In addition, 1/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 1/we obtain approval for a single, time extension (maximum of one year)
in writing from Duke Energy. 1/we understand that if the SNIP 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.
I/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.
I/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, 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 work on their land.
Duke Energy Page 1 Rev: 4/6/2020

Uwe 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. Uwe understand that
written authorization and/or other permits may be required by some of these agencies and such
required authorizations must be obtained before Uwe submit the final application to Duke
Energy.
At FERC-licensed reservoirs, Uwe 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.
I/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.
I/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.
1/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

I/we agree to adequately stabilize all excavated material and all disturbed shoreline to prevent
erosion and runoff into the lake.
I/we 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.
1/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. I/we agree to provide my/our contractor with a
copy of these work area drawings showing these areas to stress the necessary protection
measures.
I/we agree that if any archaeological resources (e.g. pottery shards, Indian artifacts, etc.) are
discovered during the excavation, work shall be halted immediately. I/we will then notify Duke
Energy and the State Historic Preservation Office to determine what measures, if any, 1/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.
I/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 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. 1/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.
1/we agree to notify Duke Energy by phone when the excavation is initiated and to ensure that
during the excavation period, Five will post Duke Energy's approval letter in a clear waterproof
bagat t the iob 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.
I/we recognize security deposits will not be refunded if any violations of the SMP, 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.
I/we 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.
I/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,
` -o
Applicant's Name (Print) Spplicant'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 Ene bl Page 4 Rev 416/2020

Excise Tax $ A e�' bb
Type: CONSOLIDATED REAL PROPERTY
Recorded: 6/4/2013 11:17:32 AM
Fee Amt: $310.00 Page 1 of 2
Revenue Tax: $284.00
Iredell County, NC
Matthew J. McCall Register of Deeds
BK 2246 PG 857 - 858
Recording Time, Book and Page
Tax Lot No. Parcel Identifier No. 460703335333
Verified by County on the _ day of ,
2013
Mail alter recording to: Grantee at Address Below
This instrument was prepared by Lutzel, Broadway & Associates, PC, 3430 Toringdon Way,
Suite 105, Charlotte, NC 28277
Brief I Lot 4 OLD HOMESTEAD #1; Map
Description for Book 25 Page 125; Iredell County
the index
NORTH CAROLINA GENERAL WARRANTY DEED
THIS DEED made this 30TH day of MAY, 2013, by and between:
GRANTOR
JACQUELINE FAYE LYNN
POWER
AND SPOUSE
TIMOTHY ALAN BROOME
Sellers FoMardin Address:
a38 C Ir -cove 1'd.
kte/ WC
GRANTEE
TODD P. WILLIAMS
AND SPOUSE
VICKIE L. WILLIAMS
Property Address:
238 CLARK COVE ROAD
STATESVILLE, NC 28677
MAILING ADDRESS:
8530'Salem Rd.
Lewisburg, OH 45338
The designation Grantor and Grantee as used herein shall include said parties, their heirs,
successors, and assigns, and shall include singular, plural, masculine, feminine or neuter as
required by context.
WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of
which is hereby acknowledged, has and by these presents does grant, bargain, sell and convey
unto the Grantee in fee simple, all that certain lot or parcel of land situated in the County of
IREDELL, State of North Carolina and more particularly described as follows:
Being all of Lot 4 of OLD HOMESTEAD #1, as shown on map thereof
recorded in Map Book 25 Page 125 in the Office of the Register of Dees for
Iredell County, which recorded in map in-corporated herein by reference and
made a part of this description.
Being the same property acquired by Grantor by instrument recorded in Book 1725 Page 163,
IREDELL County Register of Deeds.
R.O.T.C. page Count, v
Book: 2246 Page: 857 Page 1 of 2 ❑.MS ppQ pst

All or a portion of this property herein conveyed includes or does not include the
primary residence of a Grantor.
A map showing the above described property is recorded in Plat Cabinet/Map 25 at
File/Cabinet/Page 125.
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.
And the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee simple,
has the right to convey the same in fee simple, that title is marketable and free and clear of all
encumbrances, and that Grantor will wan -ant and defend the title against the lawful claims of all
persons whomsoever, except for the exceptions hereinafter stated.
Title to the property hereinabove described is subject to the following exceptions:
Enforceable easements, restrictions and rights of way of record.
Current Year Ad Valorem Taxes
All matters revealed by an accurate survey of the property
IN WITNESS WHEREOF, the Grantor has hereunto set his hand and seal, or if corporate, has
caused this instrument to be signed in its corporate name by its duly authorized officers and its
seal to be hereunto affixed by authority of its Board of Directors, the day and year first above
written.
STATE OF NORTH CAROLINAI
SEAL- COUNTY OF L ,P L
STAMP I, &,� -C( C 1 O�-—/ , a Notary Public of the State of NORTH
CAROLINA, County of er/— ( certify that JACQUELINE FAYE LYNN
POWER AND TIMOTHY ALAN BROOME who is known to me or proved to me on the basis
of satisfactory evidence to be the person described, personally appeared before me this day and
acknowledging tome that she/he/they voluntarily signed t foregoing instrument for the purposes
stated therein, and in the capacity indicated.. Witnes y hand and official stamp or seal, this
30TH Day of MAY, 2013.
My commission expires:
Notary Public
Printed Name ofNotaly:
a "N S. rHOMAS
NOTARY PUBLIC
IREDELL COUNTY
1 STATE OF NORTH CAHOLINA
n t COMMISSION EXPIRES 03-01-2017
Book: 2246 Page: 857 Page 2 of 2