NCC233392_FRO Submitted_20231115

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 N/A in the blank.)
Part A.
1. Project Name UNIT 5 INACTIVE ASH BASIN IMPOUNDMENT CLOSURE-PHASE 6 EROSION CONTROL PLAN
2. Location of land-disturbing activity: County RUTHERFORD City or Township CLIFFSIDE/MOORESBORO
MCCRAW ROAD 35.2146136 -81.7652858
Highway/Street Latitude(decimal degrees) Longitude(decimal degrees)
3. Approximate date land-disturbing activity will commence:
Q1 2024
4. Purpose of development(residential, commercial, industrial, institutional, etc.): INDUSTRIAL
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 7.87 acres
$2,800($800+$2,000)
6. Amount of fee enclosed 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 0 No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Duke Energy- Preston McCloud E-mail Address [e-mail]
Phone: Office# Mobile# [phone]
9. Landowner(s)of Record (attach accompanied page to list additional owners):
DUKE ENERGY 704-382-3853
Name Phone: Office# Mobile#
526 SOUTH CHURCH ST. 526 SOUTH CHURCH ST.
Current Mailing Address Current Street Address
CHARLOTTE NC 28202 CHARLOTTE NC 28202
City State Zip City State Zip
10. Deed Book No.2149 Page No. 0006 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(ies).
DUKE ENERGY CAROLINAS, LLC
Company Name E-mail Address
526 SOUTH CHURCH ST. 526 SOUTH CHURCH ST.
Current Mailing Address Current Street Address
CHARLOTTE NC 28202 CHARLOTTE NC 28202
City State Zip City State Zip
Phone: Office# 704-382-3853 Mobile#
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 SYSTEM
Name of Registered Agent E-mail Address
160 MINE LAKE CT, STE 200 160 MINE LAKE CT, STE 200
Current Mailing Address Current Street Address
RALEIGH NC 27615 RALEIGH NC 27615
City State Zip City State Zip
Phone: Office# Mobile#
Name of Individual to Contact(if Registered Agent is a company)
(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:
NA NA
Name of Registered Agent E-mail Address
NA NA
Current Mailing Address Current Street Address
NA NA
City State Zip City State Zip
Phone: Office# NA Mobile# NA
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.
NA
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:
WSP USA [e-mail]
Engineering firm or other consultant E-mail Address
Ken Daly [phone] [phone]
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 inform ion provid d h rein.
/4.4 Atec b f.11°
Type or print n me Title or Authority v.(
L° - 10 -
Signature Date
I, \LtLI . �QQ f` , a Notary Public of the County of KZ.C4tilbu,
1 -kt,k(11 1 State of North Carolina, hereby certify that Hai be t I appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/her.
Witness my hand and notarial seal, this I Q'y day of CYf G6Q1-\ , 20
Notary MURIEL R. SPEAR My commission expires ad,. 3.0 �U�3
NOTARY PUBLIC
Mecklenburg County
North Carolina
My Commission Expires /d I

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 3 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 4 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 5 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.

Continued from Item 1 in Part B of the Financial Responsibility/Ownership Form for multiple parties.
Attach copies of this page as needed to list all financially responsible parties.
Company 2 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 3 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 4 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 5 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#

Doc ID: 002998800005 Type: CRP
Recorded: 08/10/2007 at 08:38:15 Art
Foe Amt: 928.00 Page I of 5
Excise Tex: 80.00
Instr#200700002143
Rutherford County, NC
Faye H. Hughey Register of Deeds
at940 PD93-97
Excise Tax .00 Recording.Time,Book and Page
Tax Lot No.: Parcel identifier Nos.916311,913489,913490,906650,915588,915589,1621577,1620186
1637972,1638148,1G37974,911071,1642600,1642601;portions of 916312 and 905249;and Rutherford County
portion of Cleveland County Tax Parcel No.312.
Verified by County on the_day of August,2007 by
Mail alter recording to: A.Grant Whitney.Jr..Parker Poe Adams&Bcxstein,L,L.P.,Three Warlwvia Center,
Suite 3000.Charlotte.NC 28202
This instrument was prepared by: Parker,Poe,Adams BernsteinL.L.P,fA.Grant Whitney.Jr.)
Brief Description For The Index:
182,47 acres,Plat Book Page Rutherford County Public Registry
NORTH CAROLINA NON-WARRANTY DEED
TEAS DEED made this 10 day of August,2007,by and between
GRANTOR GRANTEE
DUKE ENERGY CAROLINAS, LLC DUKE ENERGY CAROLINAS, LW
a North Carolina limited liability company a North Carolina limited liability company
Address:
400 South Tryon Street
ST30C
Charlotte,North Carolina 28201
Enter, appropriate block for each party: name.address,and,if appropriate character of entity,e.g.cn oratbn or partnership.
CLT 1006660v3
�y�

The designation Grantor and Grantee as used herein shall include said parties,then heirs,successors and assigns,
and shall include singular.plural,masculine,feminine or neuter as required by context
WITNESSETH, that Grantor, for a 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 that
certain lot or parcel of land situated in High Shoals Township,Rutherford County,North Carolina and more
particularly described as follows:
See EXHIBIT 4,attached hereto and incorporated herein by this reference(the"Property'),
The sole purpose of this deed is to recombine into one tract the Property described on EXHIBIT A which contains
182.47 acres.
The property hereinabove described was acquired by Grantor by instrument recorded in
A map showing the above described property is recorded in Plat Book .R ,Page4. ,4 3`Rutherford County
Public Registry.
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.
The Grantor makes no warranty,express or Implied,as to title to the property hereinabove described.
IN WITNESS WHEREOF,the Grantor has caused this instrument to be duly executed under seal,the day and year
first above written.
(SEE SIGNATURE AND NOTARY ACKNOWLEDGMENT ON FOLLOWING PAGE]
CLT 10066600

EXHIBIT A
LEGAL DESCRIPTION
ALL of that certain 182.47 acres shown plat entitled "DUKE ENERGY CAROLINAS, LLC
RECOMBINATION PLAT"recorded in Plat Book Q Page.238 3ci,Rutherford County Public Registry.
CLT t00666Ov3

GRANTOR;
DUKE ENERGY CAROLINAS,LLC
a North Carolina limited liability company
By:
Title: s,� 444
d
STATE OF NIorJAN.ear 01ir•+r+.
COUNTY OF ilkee.in e,n(mu:)
1.Edward T.Cr,,,.,®,() a Notary Public of S4anla County,State of tU nn kte,l . ,certify that
yo to ct,.,.1,,.,,,5.. (the"Signatory"),r44,ao1,. Mull..t 1,._of DUKE ENERGY CAROLINAS,
LLC,a North Carolina limited liability company,personalry came before me this day and by authority duly given
acknowledged the due execution of the foregoing instrument on behalf of the limited liability company.
I certify that the Signatory personally appeared before me this day,and
(check one of the following)
✓(I have personal knowledge of the identity of the Signatory);or
(I have seen satisfactory evidence of the Signatory's identity,by a current state or federal
identification with the Signatory's photograph in the form of
(check one of the following)
_a driver's license or
in the form of );or
_(a credible witness has sworn to the identity of the Signatory).
The Signatory acknowledged to use that he voluntarily signed the foregoing document for the purpose
stated therein and in the capacity indicated.
Witness my hand and official stamp or seal this_i__day of August,2007,
Notary Public
:et , Note:Notary musts exactly as on notary seal]
of Stardy
7, Notary,Public,Math Caroline I rJ sign y"`. . Count MyCommission Tres: tz—2 00
! ., EDWARD T.CONNELL
I, My Commtaaton Iles Fa .12,2099
"®[NOTARY SEAL) (MUST BE FULLY LEGIBLE)
The foregoing Certificates)of
Isiare certified to be correct. This instrument and certificate are duly registered at the date and time and in the Book
and page shown on the first page hereof. Register of Deeds for Rutherford County.
By: Deputy/Assistant—Register of Deeds
II
UT It106660v3

DUKE ENERGY CORPORATION
ASSISTANT CORPORATE SECRETARY CERTIFICATE
I,Sue C.Harrington,Assistant Corporate Secretary of Duke Energy Corporation,
do hereby certify that the Board of Directors of Duke Energy Corporation on April 4,
2008,approved and adopted the Approval of Business Transactions Policy Statement,
which provides in relevant part that any direct report to the President and Chief
Executive Officer of Duke Energy Corporation may approve,or delegate the authority to
approve,business transactions(including acquisitions and divestitures)involving
amounts of$50 million or less.
I further certify that Christopher C.Rolfe,Group Executive and Chief
Administrative Officer,Duke Energy Corporation,is a direct report to the President and
Chief Executive Officer of Duke Energy Corporation,who,pursuant to the authority
granted by the Approval of Business Transactions Policy Statement,has delegated to
Angeline M.Clinton,Vice President,Enterprise Operations Services,Duke Energy
Corporation,the authority to approve amounts up to$10,000,000 for capital projects,
commitments to buy products or services,equity investments(including acquisitions,
partnerships,joint ventures,etc),divestitures,operating leases,and termination of
commodities contracts;and subsequently,Angeline M.Clinton,in accordance with the
Delegation of Authority for Enterprise Business Services,has delegated to Dennis F.
Wood,Ill,General Manager for Real Estate Services,Duke Energy Business Services,
LLC,the authority to approve up to$5,000,000 for land acquisitions and divestitures and
building rent,and subsequently,Dennis F.Wood,III,in accordance with the Delegation
of Authority for Enterprise Business Services:Enterprise Operations,has delegated fo
R.Steven Bodenheimer,Director of Transaction Management,and GeorgeE.loft,
Director of Land Services,the authority to approve$1,500,000 to execute deeds,leases,
and similar real estate documents on behalf of Duke Energy Corporation and its affiliates
for land and facility acquisitions and divestitures,which authority includes the
authorization to execute any contract,lease,deed,easements,rights of way or other
instruments related to the authorized transaction;and to George W.Christian,Jr.,
Manager,Real Estate Acquisitions and Valuations,Harold L.Glorius,Jr.,Supervisor,
Engineering Support and Christopher E.Arbuckle,Supervisor,Engineering Support,the
authority to approve up to$750,000 to execute deeds,leases and similar real estate
documents on behalf of Duke Energy Corporation and its affiliates for land and facility
acquisitions and divestitures,which authority includes the authorization to execute any
contract,lease,deed,easements,rights of way or other instruments related to the
authorized transaction.
IN WITNESS WHEREOF,I have hereunto set my hand and affixed the
Corporate Seal of said Duke Energy Corporation this 20th day of July,2007.
.9,6 f Ct & � terry
rs Ass€stant Carper -ecretary
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