20230731 Ver 1_Sketch_20230525

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�5 q3 Z ials W44��"-- �
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 Emmett Ross III Telephone [phone]
Email address: cross0sumterpackaging.com
Lake Address Mailing Address (f different)
132 Brookridge Lane same as lake address
Mooresville, NC 28117
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 Mooresville State AQ_ Tax Map No.
Subdivision Brookridge Shores Lot/Section No. 6 Lot Size 0.482 Acres
Duke Energy Page 4 of 13 rev 11/22/21
Excavation Program

Duke Enemy 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: Tax ID:
Mailing Address:
Are there any Co-Applicants*? (check one) ❑Yes Oio (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 5 ` $ Z
Initials (Duke Energy) (applicant/contractor)
0
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) ❑New excavation la Maintenance excavation
2. Purpose of excavation: (check one) ®Boat Access Channel
❑ Water Intake Channel ❑ Wastewater Discharge Channel
❑ Other(spec):
3. Lake user category: (check one) ®Private ❑Residential Marina
❑Commercial Marina ❑Public
❑Other(spec):
4. Max. Excavation Area Dimensions (ft): Length 50' Width 50' Depth 3, =277.77 cy
(Note: include additional area dimensions if necessary so response to #5 below equals max. area
dimensions in #4) 44.75'x 25'x 3'"v"channel = 124.30 cy
5. Volume of Excavated Material (TOTAL for the project): 402.07 Cubic yards
6. Type of material removed (ap
plicant determines b aeld sample i Tactical):
Dirt/Silt
7. Excavation Site area: 0.249 Acre (s) Disposal Site area: 3.34 Acre
(s)
8. Total Disturbed Area(including equipment staging area): 0.249 Acre (s)
9. Does the project meet the requirements of the applicable General Permit? (check one)
0Yes ❑No
10. Do you claim title to the disposal area? (check one) ❑Yes 0No
11. Do you claim title to the equipment staging area? (check one) ❑Yes ONO
12. Are there any water-treatment facilities within 50 feet of the proposed excavation area?
(check one) ❑Yes IZNo
(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 out by land at access property with permission from owner also having dredge done.Take by
dump truck to disposal site located at 241 McKendree Rd. Mooresville, NC 28117 with permission from owner.
Silt fence to be installed at disposal area to prevent any run off from occurring.
Duke Energy Page 6 of 13 rev t 1/22/21
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) OYes ❑No
(If yes, explain)
By barge
16. Will return water re-enter the reservoir? (Check one) ❑Yes ONo ❑N/A
(If Yes, specify oint(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? Oyes ❑No
(If Yes,provide the existing permit number. If No, include a scaled drawing of the proposed
facility). Permit# 10142
18. Total planned duration of the work(Include first equipment mobilization, excavation
through final mitigation measures complete):
START 8 / 23 FINISH 8 / 23
(Month) (Year) (Month) (Year)
Duke Energy Page 7 of 13 rev 11/22/21
Excavation Program

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Duke Enemy Excavation Permit Avolication Form
C. Applicant's Signatures
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Applicant Name(print) �i►9w1 �b.'�'�.�_
rAR&cafir-Signa-tvi-q-v �l /� �, ' � -- 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 hest of my
knowledge.
Duke Energy Page 10 of 13 rev 1 1122/2 02 1
Excavation Program

Excavation Project User's Agreement Letter
(Please fill in the blanks. Please Print)
Date 5/8/23
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)
Lot 6 Brookridge Shores
(Lake/County/City) Norman / Iredell / Mooresville
(Applicant's full name) Emmett Ross III 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, 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 1/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, I/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,1/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 I Rev:4/6/2020

I/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.
1/we understand that for proposed excavations,11we 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 Uwe submit the final application to Duke
Energy.
At FERC-licensed reservoirs,Vwe 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.
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.
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.
1/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.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. 1/we 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

Ave agree to develop any required mitigation plans and to complete any required mitigation
activities at my/our own expense within the specified time frames. Ave 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.
L`we agree to notify Duke Energ bby phone when the excavation is initiated and to ensure that
during the excavation period Uwe will post Duke Energy's approval letter in a clear watemroof
bag at the job site and visible from the water's edge
Uwe 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.
Ifwe recognize security deposits will not be refunded if any violations of the SNP,other
applicable guidelines,or this user's agreement occur.
Uwe understand there will be no change in hydro project operations as a result of the excavation
and/or utilization of the excavated area.
Uwe 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.
Uwe 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 ofFERC project and Duke Energy
lands and waters shall not hinder the general public's lawful use and enjoyment of the same.
Sincerely,
App icant's Name(Print) _Applicant's.Signature
Co-Applicant's Name(Print) Co-Applicant's Signature
Co-Applicant's Name(Print) Co-Applicant's Signature
Co-Applicant's Name(Print) Co-Applicant's Signature
Co-Applicant's Name(Print) Co-Applicant's Signature
Duke EMW Page 4

i����i��iiii���i���1�i��ii�iiit�►�un��ii��ii��iu��1�� -���i IIIIII! �
Doe ID: 010133540002 Tvoe: CRP
Recorded: 07/25/2006 at 03:57:35 PM
Fee Amt; $867,00 Page i of 2
Excise Tax: $850.00
Iredell County. NC
Brenda D. Bell RReoisterQQofQQDeeds
8K 176$ PG986-98 7
Purchase Price: $425,000.00 Revenue Stamps: $850,00
Tax Lot No.: Parcel Identifier No.4626 67 8010
Verified by County on the day of _ ,200_
Mail after recording to: GRANTEE
This instrument was prepared by:THOMAS&GODLEY,PLLC,514 Williamson Road,Ste.421,Mooresville,NC 28117
File#2006062262
Title Insurance Company:Investors Title Insurance
Brief description for the Index: Lot 6,Phase 2 Brookridge Shores
NORTH CAROLINA GENERAL WARRANTYDEED
THIS DEED made this 07/25/06,by and between
GRANTOR GRANTEE
Andrew Sipperiy and spouse, Emmett E.Ross III
Lesa Sipperly 132 Broakridge Lane
Mooresville,NC 28117
The designation Grantor and Grantee as used herein shall include aid 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
Township,Iredell County,North Carolina and more particularly described as follows:
BEING all of Lot 6, Phase Two,BROOKRIDGE Subdivision as shown on Map Book 17, at Page 59 in the Iredell County
Public Registay.

The property hereinabove described was acquired by Grantor by instrument recorded in Deed Book 1665,Page 517 in the Iredell County
Public Registry. A map showing the above-described property is recorded in Map Plat Book 17,Page 59.
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 warrant 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:
1. Any and all easements,rights of way and restrictions of record.
2. Any and all zoning and planning ordinances.
3. Any discrepancies as an accurate survey of the premises might reveal.
4. Any and all other matters of record.
IN WITNESS V4WREOF,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 officers duly authorized by its Board of Directors.,the day and year first above written.
(ssAt,}
(SEAL)
Andrew Sipperly �Lesa Si perly
{SEAL} - (SEAL)
(SEAL) (SEAL)
SEAL-ST NORTH CAROLINA,Iredell County.
to 1,a Notary Public of the County and State aforesaid,certify that Andrew Sipperly and spouse,Lesa Sipperly,
3 m Grantor,personally appeared before the this day and.acknowledged the executi of the foregoing instrument.
amok _
iWitness my hand and official stamp or seal this day of 200 7
Pic SrA
My z siWa expires:
N
b Notary Public
SEAL-ST NORTH CAROLINA,Iredell County.
1, a Notary Public of the County and State aforesaid, certify that
Grantor,personally appeared before me this day and acknowledged the execution of the foregoing instrument.
Witness my hand and official stamp or seal this day of 200_
My commission expires:
Notary Public
The foregoing Certificate(s)of is/are certified to he correct This instrument and this
certificate are duly registered at the date and time and in the Book and.Page sho on the first page hereof.
RE TER OF DEEDS FOR COUNTY
By Deputy/Assistant-Register of Deeds