20231278 Ver 1_Adukeform_20230918

Duke Energy Excavation Permit Application Form
FOR DUKE ENERGY USE ONLY
Duke File No.
Application Fee $ Security Deposit $ Check # Date Recv'd
Initials -
Date Date of Duke Energy Lake Services, applicant and/or contractor on -site inspections Date � I ..S Z linitials .2 Lit tt
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 ONO (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 annlieatinn_
Part I. Applicant Information (Please Print)
Name Robert L. & Kelly C. Aylward Telephone [phone]
Email address: Bob.aylward(a)-gmail. com
Lake Address Mailing Address (if different
14521 NC Highway 73 X 3 o-7 cow, lr_I :�)?,
Huntersville NC
Contractor Company
Contractor Contact Person �, , L : 11 e Telephone ? `ZIK q j� - ? 1.7 S'
Contractor Email Address: :tea (; ."le (/ 0 P_ -21 M AA . e-Dn1
LAKE LOT INFORMATION
Lake LVo,eo►t County IN e v City liwa. 1411, l[e State -&, Tax Map No.
Subdivision
Duke Energy
Excavation Program
Lot / Section No. Lot Size qAAcres
Page 4 of 13 rev 11/22/21

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 ONo (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 a 13 ZS
Initials (Duke Energy) e-Ull
(applicant/contractor) -7-2 l e-#
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 ❑ Maintenance excavation
2. Purpose of excavation: (check one) ❑ Boat Access Channel
❑ Water Intake Channel ❑ Wastewater Discharge Channel
® Other (spec): New Dock Construction
3
Lake user category: (check one)
❑Commercial Marina
❑Other (specify):
®Private ❑Residential Marina
❑Public
4. Max. Excavation Area Dimensions (ft): Length 67' Width 50' Depth 5'
(Note: include additional area dimensions if necessary so response to #S below equals max. area
dimensions in #4) Channel 30' x 20' x 1.5'
5. Volume of Excavated Material (TOTAL for the project): 653.70
6. Type of material removed (applicant determines b field sample ifpractical)•
Red Clay/ silt
Cubic yards
7. Excavation Site area: 0.09 Acre (s) Disposal Site area: 3.0 Acre
(s)
8. Total Disturbed Area (including equipment staging area): 0.09
Acre (s)
9. Does the project meet the requirements of the applicable General Permit? (check one)
[]Yes ❑No
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) ❑Yes ❑No
12. Are there any water -treatment facilities within 50 feet of the proposed excavation area?
(check one) []Yes ❑No
(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): v
Dredge by barge, haul off by owners land and take to disposal site
3776 Amity Hill rd, Statesville NC 28677
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 and dump Truck
15. Will waters or wetlands be crossed in transporting equipment to or from the site?
(check one) ®Yes ONo
(If yes, explain)
By Barge
16. Will return water re-enter the reservoir? (Check one) ❑Yes ®No rIN/A
(If Yes, specify 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? ❑Yes ®No
(If Yes, provide the existing permit number. If No, include a scaled drawing of the proposed
facility). Permit #
18. Total planned duration of the work (Include first equipment mobilization, excavation
through final mitigation measures complete):
START Jan / 2024 FINISH Jan. / 2024
(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
Comments: 19 e. ,I � Z2, %
j O1 N.C. 73 14
lq J 35 3 I"+ i
Applicant Name (print)
Applicant Signature* Date r 6 Q
Co -Applicant Name (print) �2� u <<,JO"J
Co -Applicant Signature* Date q Rfl-5
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

For Registration
Fredrick Smith
Register of Greeds
Mecklenburg County, NC
Electronically Recorded
2022 Apr 2211:43 AM RE Excise Tax: $ 11000.00
Book: 37274 Page: 807 - 809 Fee: $ 26.00
Instrument Number: 2022062019
NORTH CAROLINA GENERAL WARRANTY DEED
No tltlp. RPnrf h wac narfe%v .p a — • 0 7 _— .i_ _
I'1XCISe Tax:
a�y�acoucu 111 1,1w p lep araidon oI this cleen
it, ,00
Parcel ID:
MailiBlox to:
Grantee
Prepared by:
Laura Snider Baker, a duly licensed attorney in the sta te of North Carolina
Brief
description
for the Index:
4.69 acres, more or less; Highway 73
THIS GENERAL WARRANTY DEED ('Deed") is made on the 20thday of Apr" 20 22 by and between:
GRANTOR
GRANTEE
John Charles Blythe, Jr. (unmarried)
Robert L. Aylward and wife, Kelly C. Aylward
14521 NC 73 Hwy.
16001 Beatties Ford Rd
Huntersville, NC 28078
Huntersville, NC 28078
Enter in the appropriate block for each Grantor and Grantee their name, mailing address, and, if appropriate, state of
organization and character of entity, e.g. North Carolina or other corporation, LLC, or partnership. Grantor and apantee
includes the above parties and their respective heirs, successors, and assigns, whether singultar, plural, masculine, feminine or
neuter, as required by context.
FOR VALUABLE CONSIDERATION paid by Grantee, the receipt and legal sufficiency of which is acknowledged,
Grantor by this Deed does hereby g it, bargain, sell and convey Grantee, in fee simple, all th ee aI lot, parcel of land or
condominium unit in the City of untersville Lemley Township, ec�Z elNuorg
Nortlx Carolina and mole partieularly described as Foliows (the "ProperCy"): County,
See attached Exhibit A which is incorporated by reference herein.
Property Address: 14521 Hitrhwav 73: Huntommillp, NO 29079
All or a portion of the Property was acquired by Grantor by instrument recorded in Book 36667 page 985
All or a portion of the Property © includes or Cf does not include the primary residence of a Grantor.
Page I of 2
NC liar Association Rcal Property Section Form No. 3 C7 Rcvised 02/2021
Printed by Agreement with the NC Bar Association
Submitted electronically by "Samantha H. Terres, FLLC"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Mecklenburg county Register of Deeds.

A map showing the Property is recorded in Plat Book page
TO HAVE AND TO HOLD the Property and all privileges and appurtenances thereto beloeaging to Grantee in fee
simple. Grantor covenants with Grantee that Grantor is seized of the Property in fee simple, Grantor has the right to convey
the Property in fee simple, title to the Property is marketable and free and clear of all encumbrances, and Grantor shall warrant
and defend the title against the lawful claims of all persons whomsoever, other than the following exceptions:
1. All easements, restrictions, covenants and rights of way of record.
2. 2022 Ad valorem property taxes
3. Those matters which would be revealed by an accurate survey of
the property
IN WITNESS WHEREOF, Grantor has duly executed this North Carolina General Warranty Deed, if an entity by its
duly authorized .representative.
Na John Charles Blyth , Jr. Entity Name
Name:
By:
Name:
Title:
Name:
Name: By'
Name:
Title:
YNA
STATE or �'i��� couNTY ors e-c.La" —U
9Z . L—
""v ec efj
, a Notary of the above state and county, certify that the following
person(s) Personally appeared before me on th day of ° f` 20_M each acknowledging to me
that lie or she signed the foregoing docu nt, in the capacity represented and identified therein (if any):
Affix Notary SoallStamp
Notary Public (Official Signature)
MY commission expires: 1 f - (p
Notary Public
Iredell County, NC
My Commission Expires: J
Page 2 of 2
NC Bar Association Real Properly Section Form No. 3 40 Revised 02t2021
Printed by Agreemeni with the NC Bar Association

I
EXHIBIT A
Property Address: 14521 Highway 73; Huntersville, North Carolina 28079
Parcel Number: 00102101
BEGINNING at a point lying in the centerline of North Carolina Highway 73, a public
right-of-way and being a common point with Lot 1, and running North 1547-20 West 460.17 feet
to an iron in the contour line located at 760 feet above mean sea level; thence with said contour
line in six courses, as follows: (1) South 87-43 East 117.6 feet to a point; (2) North 60-14 East
116.7 feet to a point; (3) North 41-04 East 80 feet to a point; (4) North 78-31 East 100,4 feet to a
Point; (5) South 51-56 East 183.1 feet to an iron; and (6) South 54-00 East 1.37 feet to a point;
thence South 17-47-55 West 559.66 feet to a point in the centerline of North Carolina Highway 73
thence with the centerline of said highway North 72-12-05 West 229.70 feet to the point and place
of BEGINNING. Containing 4.69 acres and being all of Lot 2 as shown on that certain boundary
survey of John C. Blythe Estate Divided, Lemley Township, Mecklenburg County, North Carolina,
by Richard B. Brooks, R.S., dated September 12, 1984.
Being a portion of the property conveyed to John C. Blythe and wife, Helen Johnson Blythe, by
deed dated June 22, 1985, and recorded in Deed Book 5042, at Page 0984, in the records of the
Mecklenburg County Register of Deeds, being described as "First Parcel" less and except , that
portion of "First Parcel" known as "Lot I as shown on that certain boundary survey of John C.
Blythe Estate Divided, Lernley Township, Mecklenburg County, North Carolina, by Richard B.
Brooks, R.S., dated September 12, 1984, reference to which is hereby made for a more complete
description, and conveyed by the Helen Johnson Blythe Revocable Trust, dated March. 7, 2001 by
John Charles Blythe, Jr., Trustee and John C. Blythe, Jr., by deed dated February 4, 2016 to Sandra
Blythe Edens, recorded in Book 30579 at Page 14, in the records of Mecklenburg County Register
of Deeds.
Being the same property acquired by the Grantor herein as Tract One on that certain General
Warranty Deed recorded in Deed Book 36667 at Page 995 in the Mecklenburg County Register of
Deeds.

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Duke Enera Excavation Permit Application Form
Part III. Additional Information
A. Deed and Survey Plat: A copy of the deed and registered survey plat or other instrument
under which each applicant and co -applicant claims title to the affected property (the
shoreline adjoining the excavation area, equipment staging area, area crossed by any spoil
and return water lines, and the disposal area). If the applicant(s) is(are) not the owner(s) of
said property, then forward a copy of the deed and registered survey plat or other instrument
under which the owner(s) claim title plus written authorization from the owner(s) to carry
out the project on their land.
B. Excavation Area Drawing: An accurate drawing of the area to be excavated. The drawing
must show at a minimum, a North arrow; the boundaries and acreage of the proposed
excavation area and equipment staging areas; lake, county, city, cove, tributary, road and
subdivision names and lot numbers (as applicable); property corners for project front lots;
the full pond elevation contour and lines dividing the cove width into equal thirds (as
applicable); approximate volume in cubic yards of the material to be excavated; point(s) of
return water re-entry; the boundaries of any adjoining areas that are to be specifically
avoided or protected during the work and the location (address) of the disposal area for the
excavated material. [NOTE: A copy of this drawing must also be provided to the
excavation contractor to ensure restricted areas are not impacted.]
C. Disposal Area Drawing: An accurate drawing of the proposed design for the disposal area.
The drawing must show at a minimum, a North arrow; the boundaries and acreage of the
proposed disposal area; lake, county, city, cove, tributary, road and subdivision names and
lot numbers (as applicable); the full pond elevation contour (unless disposal is well away
from the lake); the boundaries of any adjoining areas that are to be specifically avoided or
protected during the work; the location (address) of the excavation area from which the
material came and a statement of the disposal area's capacity with all dimensions labeled
that were used in the volume calculation. [NOTE: A copy of this drawing must also be
provided to the excavation contractor to ensure restricted areas are not impacted.]
Also note for projects larger than one (1) acre in North Carolina, including excavated,
equipment staging, and disposal areas, you must submit an erosion control plan. For
projects larger than two (2) acres in South Carolina, including excavated, equipment staging
and disposal areas, you must submit an erosion control plan. For projects < two (2) acres in
South Carolina, you must submit a completed standard reporting form for construction sites
disturbing two (2) acres or less to the South Carolina Dept_ of Health and Environmental
Control (SCDHEC) - Stormwater Management
D. Vicinity Map and Driving Directions: A vicinity map and directions by road showing
directions to both the excavation area and disposal area. Include the latitude and longitude of
both the excavation area and the disposal area.
Part IV. Agency Reviews and Approvals
Begin this section with a summary table of all agencies consulted and applicant response to
agency comments as shown in the example table below. Agencies should be listed in the order
Duke Energy Page 11 of 13 rev 1 v22/2021
Excavation Program

Duke Energy Excavation Permit Application Form
shown in the Agency/Organization List. Consultation letters must be dated within the two years
preceding Duke Energy's receipt of the application.
Table IV-1. Sample Agency Comment and RPcnnnep Tahla
Agency Comment vly Applicant Response
Agency 1
The activity is approved as proposed.
NA
Agency 2
The on -site well provides drinking water to the
Contacted Mr. Smith on 1/1/20xx. No
public. Please contact W. Smith to discuss the
further action needed.
proposed changes and potential issues
associated with your pr2posal.
You must contact us immediately if
Applicant will contact Agency 2 if
endangered species are located during the
endangered species are located during
course of construction.
construction
_.Agency 3
Requested agency comments on 1/l/20xx and
NA
again on 2/l/20xx. No response as of
2/16/20xx.
Agency 4
Section 401 Water Quality Certification
Applicant will comply with the conditions of
the 401 Water Quality Certification
Following the table of agency comments and applicant responses, include a table of permits and
certifications issued by the reviewing agencies. As with the table of agency comments and
applicant responses, agencies should be listed in the same order as they are listed in the
Agency/Organization List.
Table IV-2. Sample Agency Permits and Cert fieafinne T.hlo
Agency
Permit/Certification Name
Date of
Issuance
Date of
Expiration
Agency 1
Surface Water Withdrawal Permit
Agency 2
Section 401 Water Quality Certification
Following the two summary tables, include a copy of all correspondence to and from any local,
regional, state and federal agencies or other organizations with which you are required to consult,
including any required permits (e.g., Section 401 water quality certifications, Section 404
dredge/fill permits, building permits, etc.) or other approvals or comments which have been
obtained from these organizations regarding this activity. Include a copy of any local, regional,
state or federal regulations or guidelines that will be followed. All permitting issues must be
resolved and clearly documented. Correspondence should be organized in the order the agencies
are listed on the Agency/Organization list with the applicant's request for comments followed by
additional correspondence in chronological order. All permits must be valid at time of
Duke Energy Page 12 of 13 rev 11/22/2021
Excavation Program

Duke Ener2y Excavation Permit Application Form
application and have a term longer than the projected schedule for completing the permitted
project.
Part V. Additional Information
Provide relevant additional information. Reference previous parts as applicable. Include the
FERC-required Environmental Assessment if you were directed to do so during the initial site
visit. If there are co -applicants, this is where their information would be provided (see Part I).
Duke Energy Page 13 of 13 rev 11/22/2021
Excavation Program

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