20161080 Ver 1_Shoreline Stabilization_20161107

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State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center 2 0 1 6 1 0 8 0 D
Raleigh, NC 27699-1617 V"0 7 2016
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
K
Name:
Mailing
Telephone Number: %03-102A - IgOP) Fax Number:
E-mail Address: h 0 r V In r1 (COG M 0 1 1, C 0VY)
Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
htto://www.saw.usace.armv.mil/Portals/59/docs/reRulatory/reedocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: I Jr YNf%r1 -P HrKn
Compar
Mailing
Telephone Number: TA- 5M)-74bn Fax Number
E-mail Address: A _ I Gnf'r1'4Pr-dnr l
Person to receive the Certification Approval:
A =_ �
107 Al.I
II. Project Information [15A NCAC 02H .0502(a) & (b)]
1. Attach a vicinity map (i.e. street map) clearly showing the location of the property with
respect to local landmarks such as towns, rivers, and roads.
2. Provide a detailed site plan showing property boundaries and proposed locations of
vegetation clearing, structures (buildings, retaining walls, docks, impervious surfaces,
FORM: SSGP 10-2013 Page 1 of 3

etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
and construction access corridors. You may use the diagram provided at the end of this
application form.
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale
of some sort- a yard stick, shovel handle, etc.)
4. Location of the property (where work is to be conducted))
County: I r e -J e- l< Nearest Town: Mot) re5 V i e.,
Subdivision name or site address (include phase/lot number): CrP_ 60flo-i 1 ar7d
4 %; rnber 6e nY) 7 e2 -71A04
Directions to site - please include road names and numbers, landmarks, etc.: Fi-Drn /-77
Latitude (in decimal degrees) �� �� CJCJU Longitude (decimal degrees) — C} _ , 95 :376n
5. Describe the existing land use or condition of thesiteat the time of this application
(residential, undeveloped, etc.):ieslde�T7Q�
6. Property size (acres): .7&
7. Lake/ river/ ocean adjacent to property: No ri na o
8. Describe proposed work (include discussion as to how hardening of shoreline) has been I
avoided, or why it is necessary): T*')re&p_ GLY ecL3� 0 I�� � ll L7bYl�l
r,% —
9. Will work be conducteYfrom land? ❑ From water?
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool lake level/ Normal Water Level in square feet or acres:
.qla k.re,,,�
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres:
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 feet landward to be impacted (number of trees, for instance): Allk
. C.
Owner/Agent'siS'gTtr aturel Printed Name Date
[15A NCAC 02H .0502(f)]
Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

f
r'
(. 4
Lake'
(At Full Pond/ Normal IVer L
l' V
Full Pond/ OIx5.5,
Normal titer Level
. � � � --I — — d.-490-4
Shoreline
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ft x 100 ft)*:
1. All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
3. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
4. Location of any proposed structures such as buildings, retaining walls, docks, etc.
5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
FORM: SSGP 10-2013
Page 3 of 3

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12x30 boatslip with cable lift
NOT TO SCALE!
finger with Lancaster
down
3 -ft main
3 -ft stairs
3x55 fixed pier
11
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/400
2x14 Jet Ski Finger
j#W,uMiER
Klock & U
110C.
cable boatlift for bass boat
23x33 Sundeck
Mr. and Mrs. Ryland
403 Barber Loop
Mooresville NC 28117

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 I o Z% lu Initials drat
Date Final Protection/Avoidance Area Markings Field - Verified
Approved to Start Work By * :
Date Completion Required
Date Passed Closeout Inspection*
(Print)
Date of Any Approved Extension
Initials
Initials
Date_
(Sign)
Initials
Any Stop Work Orders or SMG Violations*? (check one) ❑Yes ❑No (If Yes, explain in PART V)
Date Deposit Refunded Initials Date Pen -nit 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 aaolication.
PART I. - APPLICANT INFORMATION (Please Print)
Name__K��U � � d Telephone 70 ) &Zt9 - 140tQ)—
Lake Address 40--5 Bar her np
M onre.6y l I I e,OC,228117
KC r\J Ia n f� QMQ'l I r�
V
Contractor Company
Mailing Address
(If different)
1 �
Contractor Contact Person �a ArY Q Telephone (�)5Zf j—' 460
b`'1e)cL. ��Cv1C +erdoC�S�O,vuat�.Cp✓Yi
LAKEw� LOT INFORMATION J
Lake 1 �1(7fYY1[lY1 County I re A p I I City tAObYESV 1 1112 State 1�G Tax Map No. 4!d5- 6 Jq
Subdivision �t t--,�y_� Lay/ 4 Ti MhP Lot / Section No. I Q4 eCJQy% P7 Lot Size( _Acres
Are there any Co -Applicants*? (check one) ❑Yes KNo (If Yes, include names, addresses, phone nos., lot nos., lot
sizes in PART V — ADDITIONAL INFORMATION) * Co -Applicants exist when the proposed work is being done under a
single application, will be perfonned 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. The check for the application filing fee and security deposit
should be from the party shown as Applicant and not several checks from the Applicant and Co -Applicants.
Do not continue the application until an on-site inspection has been conducted between a Duke Energy Lake Services
Representative (DELSR) and the applicant and/or the excavation contractor. NOTE: Initializing this portion of the
application by a DELSR in no way constitutes approval or eminent approval of the excavation or any other lake use
permitting activity.
Date of on-site inspection ID Z 1 1 U Initials (Duke Energy) 1 I2F�:
(applicant/contractor)
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
PART II. - DESCRIPTION OF PROJECT
A. BASIC INFO
1. Type of excavation: (check one) ® New excavation ❑ Maintenance excavation
2. Purpose of excavation: (check one) DdBoat Access Channel ❑ Water Intake Channel
❑ Wastewater Discharge Channel ❑ Other (specify):
3. Lake user category: (check one) X rivate ❑Residential Marina ❑Commercial Marina
❑Public ❑Other (specify):
4. Max. Excavation Area Dimensions (ft): Length Width Depth 10'
(Note: inchide additional area dimensions if necessary so response to #S below equals max. area dimensions in #4)
5. Volume of Excavated Material (TOTAL for the project): 6Q SO Cubic yards
6. Type of material removed (applicant determines by field sample if practical): G nl 6 1j� I C'k
7. Excavation Site area: g Acre (s) Disposal Site area: . q 1 "1 Acre (s)
8. Total Disturbed Area (inchtding equipment staging area): . q l q Acre (s)
9. Does the project meet the requirements of the applicable General Permit? (check one) IRYes ❑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) RYes ❑No
12. Are there any water -treatment facilities within 50 feet of the proposed excavation area? (check one)
(If Yes, specify):
[]Yes ZNo
13. How will the excavated material be entrapped and the erosion controlled? (e.g. see attached erosion control plan and
disposal area design)_Dfe� �/ ��-�1 \ona irme %1 L'XCi'i 4d r �1CQ�({ O I"1 ioci
14. Type(s) of excavation equipment to be used:
15. Will waters o w tl—a1nds be crossed in transporting equiipsigen-t too from the site? (check one) MY ❑No
(If yes, explain) A ,i vl(5 P � f j I t��L!)eL/L� � �'� V 1 Cl �1�t�7 ✓I
I - - - �--I . _r . M
16. Will return water re-enter the reservoir? (Check one) ❑Yes ❑No DIN/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, specify the existing permit number. If No, include a scaled drawing of the proposed facility). Permit # /I q 7 6
18. Total planned duration of the work (Include first equipment mobilization, excavation through final mitigation measures
complete): START 123 / _L(C_ FINISH Z /_L7
(Month) (Year) (Month) (Year)
Note: Notify Duke Energy Lake Services at 1-800-443-5193 prior to commencing any excavation work within
the project boundary.
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
PART II. (Continued)
B. PROTECTION / AVOIDANCE AREA DESCRIPTION
Complete the following table including all land areas within and immediately adjoining the disturbed area:
Protection/Avoidance Areas
(check all that apply)
Approx.
Identification Method (*)
Avoid (A) or Mitigate (M)
Field ID
Work Area DWg. ID
Acreage
a. Marshland, swamp, ponds, beneficial
aquatic vegetation or other potential wetlands (circle all
that apply)
A I /�
,
b. Buffer Zones (specify width & source of
requirement)
W 'l I 1 be accoVI;5 heJ
{ro m e w4h eXaida-ID
0f'Igade --b ciuynpiruc.�S
a+ Ad)#q Mar; no- aerial
-.v-1 ll be I-eveled of joq
P-
c. Environmental Areas as identified by Duke
Energy
//_L[,
d. Natural Areas as identified by Duke Energy
/16/4
e. Historic properties (specify)
A//4
L Rare or threatened species (specify)
Buried gas, water, sewer, communications
IV Z 14
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
Protection/Avoidance Areas
(check all that apply)
Approx.
Identification Method (*)
Avoid (A) or Mitigate (M)
Field ID
Work Area Dwg. ID
Acreage
**
or electric lines (circle)
l
h. Impact Minimization Zones as identified by
Duke Energy
. /
/V
i. Other areas requiring specific avoidance,
protection or mitigation (specify)
A 14
* For "Field ID" column, specify entity or person that performed the identification and how it was physically marked (e.g. Duke Energy (John Doe)/Pink and purple -dotted tape,
Corps of Eng. (John Smith)/ yellow flagging). For "Work Area Dwg ID" column, show the symbol that is used on the drawings to identify the protection/avoidance area.
** List and attach mitigation plans
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
C. APPLICANT'S SIGNATURES
Comments:
Applicant Name (print)
Applicant Signature* - .
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Lot # Ids'
Date 10 - Z7- I lP
Lot #
Date
Lot #
Date
Lot #
Date
Lot #
Date
Lot #
Date
*Per my signature, the information provided in this application is correct to the best of my knowledge.
BEFORE YOU MAIL THE APPLICATION TO DUKE ENERGY LAKE SERVICES ENSURE YOU HAVE:
• CHECKED THE INFO THOROUGHLY
• MET ALL REQUIREMENTS FOR A COMPLETE APPLICATION (see cover letter of application package)
• INCLUDED A SINGLE CHECK TO DUKE ENERGY FOR THE APPLICATION FILING FEE AND SECURITY
DEPOSIT
• INCLUDED ALL AGENCY PERMITS OR COMMENT LETTERS AND RESOLVED ALL ISSUES RAISED
• INCLUDED ALL REQUIRED DRAWINGS (INCLUDING PROPOSED FACILITIES), PERMIT # FOR EXISTING
FACILITIES, SURVEYS AND PLANS
• INCLUDED COPIES OF DEEDS AND AUTHORIZATION LETTERS
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
PART III - INFORMATIONAL REQUIREMENTS FOR ALL APPLICANTS (NC & SC)
In addition to the completed application fonn PARTS I & 11, the following items must be provided to Duke Energy Lake Services
for all applicants in North and South Carolina:
A copy of the deed and registered survey plat or other instrument under which the applicant claims title to the affected
property (the shoreline adjoining the excavation area, equipment staging area and the disposal area), OR if the applicant is
not claiming to be 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.
An accurate scaled drawing (1"=25' for projects <1000 cubic yards of material removed or I"= 100' for larger projects) of
the area to be excavated, including all the information required under Application Process - ITEM 5 of the Application
Package cover letter (Attachment 1).
XAn accurate scaled drawing (1 "=25' for projects <1000 cubic yards of material removed or l "= 100' for larger projects) of
the proposed design for the disposal area, including all the information required under Application Process - ITEM 6 of the
Application Package cover letter (Attachment 1). Also include any erosion control plan or standard reporting form
requirements as noted under ITEM 6 of the Application Package cover letter.
A map or Duke Energy Directions by Road form showing directions to the excavation area and disposal area.
A USGS topographic map with a directional arrow indicating the exact location of the excavation project and Latitudinal
and Longitudinal coordinates for the project site.*
A list of narmes and addresses of adjoining property owners for both the excavation area and disposal area.
G. A copy of all permits and/or letters of correspondence to/from local, state and federal agencies that require notification or
issue individual pen -nits.
�I! Provide the existing pen -nit number if excavation is being conducted to maintain access to an existing facility (e.g. pier) or
provide an accurate scaled drawing of any proposed facility if a facility does not currently exist. Note: A separate
application and approval is required for proposed Private Facilities (e.g. pier).
A check for the application filing fee and security deposit and the signed Excavation Project User's Agreement letter.
*USGS maps may be accessed via the Internet at http://ilis.enr.state.nc.us/ utilizing the following pathway: Data
catalogue/Digital Raster Graphics/specific county. Longitudinal and latitudinal information is available via the Internet at
www.mapblast.com, www.mapsonus.com or www.maptech.com.
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
PART IV — AGENCY REVIEWS/APPROVALS REQUIRED
A. NORTH CAROLINA APPLICANTS ONLY
1. The following agencies and the Catawba Indian Nation Tribal Historic Preservation Office require at least 30 days prior
notification for all excavations in North Carolina reservoirs. Notify them by forwarding a completed copy of this
application, including the information required under PART III A -F to:
U.S. Army Corps of Engineers N.C. State Historic Preservation Office
Regulatory Field Office N.C. Dept. of Cultural Resources
151 Patton Avenue Division of Archives & History
Room 208 c/o Ms. Renee Gledhill -Earley
Asheville, North Carolina 28801 4617 Mail Service Center
[phone] Raleigh, NC 27699-4617
[phone]
Catawba Indian Nation Tribal Historic Preservation Office
Dr. Wenonah Haire
1536 Tom Steven Road
Rock Hill, SC 29731
[phone]
What to Expect:
a) If the excavation can be done under the requirements of the General Permit (GP) or a Nationwide Permit (NWP),
you will typically receive a copy of the Corps' tear sheet documenting authorization and providing any additional
instructions. If the excavation isn't covered under the GP or a NWP, you'll be required to obtain an individual
404 Dredge and Fill permit from the Corps.
b) You will typically receive a letter from the NC SHPO documenting their concurrence with your application,
requiring additional information or recommending modifications. You must address each comment in your final
application.
c) You must receive written documentation from the Corps that your application either meets the requirements of the
GP or a NWP or that the proper 404 Dredge and Fill permit has been received before Duke Energy can process
your application.
d) If you do not receive any documentation from the NCWRC within 30 days of their receipt of your application, you
may proceed with the application process, recognizing however that if their comments come in later in the
application process, you will also be required to address thein. (See exception for Commercial/Conveyance/FERC
review applications below).
e) If you do not receive any documentation from the NC SHPO within 30 days of their receipt of your application, you
must provide that agency with a follow-up letter requesting the agency comment on your proposal within 15 days
from the date of the letter. If you do not receive any response as a result of this second letter, you may proceed
with the application process, recognizing however that if their comments come in later in the application process,
you will also be required to address them. Note: This second 15 -day letter requirement also applies to the
agency reviews in PART IIIA. 1-4 when the application is for a Commercial Facility, Conveyance or other
application requiring FERC review.
2. In addition to the three entities in PART W.A.1 above; if the proposed excavation is located in the counties listed below, the
applicant must also provide at least 30 days prior notification to the following agency by forwarding a copy of the completed
Excavation Pen -nit Application Fonn (including the infonnation required under PART III A -F) to:
(For Alexander, Catawba, Cleveland, Gaston,
Iredell, Lincoln or Mecklenburg Counties)
N.C. Dept. of Environment & Natural Resources
Division of Water Resources
610 East Center Avenue; Suite 301
Mooresville, North Carolina 28115
[phone]
[phone] (fax)
(For Burke, Caldwell, McDowell or
Transylvania Counties)
N.C. Dept. of Environment & Natural Resources
Interchange Building
59 Woodson Place
Asheville, North Carolina 28801
[phone]
What to Expect:
a) You will typically receive a letter providing Division of Water Resources concurrence, which may require additional
information or recommend modifications. You must address each comment in your final application to Duke.
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
b) You must receive written documentation from the NCDENR that 401 Water Quality requirements are met before
Duke Energy can process your application.
3. In addition to the above requirements, if the proposed excavation is located in Mecklenburg County, the following agency
must be provided with a copy of the completed Excavation Permit Application Form (including the information required
under PART III A -F):
Mecklenburg County Land Use and Environmental Services Agency
700 North Tryon Street
Charlotte, North Carolina 28202
[phone]
What to Expect:
a) You will typically receive a letter from the county documenting their concurrence with your application, requiring
additional information or recommending modifications. You must address each comment in your final application.
b) If you do not receive any documentation from the county within 30 days of their receipt of your application, you may
proceed with the application process, recognizing however that if their comments come in later in the application
process, you will also be required to address them. (See exception for Commercial/Conveyance/FERC review
applications below).
4. In addition to the above requirements, if the proposed excavation is part of a Commercial Facilities Application,
Conveyance Application, or will require FERC review, the applicant must provide at least 30 days prior written
notification to the following additional agencies by forwarding the completed Excavation Permit Application Form,
including the information required under PART III A -F:
N.C. Wildlife Resources Commission
U.S. Fish & Wildlife Service
c/o Mr. Chris Goudreau
c/o Mr. Mark Cantrell
645 Fish Hatchery Rd.
160 Zillicoa Street
Marion, NC 28752
Asheville, NC 28801
828-6524360 Ext. 223
[phone] Ext. 227
(For lakes Wylie, Mtn. Island, Norman, Lookout, Hickory)
(For lakes Rhodhiss and James)
N.C. Dept. of Environment & Natural Resources
N.C. Dept. of Environment & Natural Resources
Division of Environmental Health
Division of Environmental Health
Public Water Supply Section
Public Water Supply Section
c/o Mr. Britt Setzer
c/o Mr. Harold Saylor
610 East Center Street; Suite 301
59 Woodfin Place
Mooresville, NC 28115
Asheville, NC 28801
N.C. Dept. of Environment & Natural Resources
Division of Parks and Recreation
12700 Rayleaf Church Road
Raleigh, NC 27614
[phone]
What to Expect:
a) You will typically receive a letter from each agency documenting their concurrence with your application, requiring
additional information or recommending modifications. You must address each agency comment in your final
application.
b) If you do not receive any documentation from an agency within 30 days of their receipt of your application, you
must provide that agency with a follow-up letter requesting the agency comment on your proposal within 15 days
from the date of the letter. If you do not receive any response as a result of this second letter, you may proceed
with the application process, recognizing however that if their comments come in later in the application process,
you will also be required to address them. Note: This second 15 -day letter requirement also applies to the
agency reviews in PART IV.A. 1-4 when the application is for a Commercial Facility, Conveyance or other
application requiring FERC review.
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
PART IV — AGENCY REVIEWS/APPROVALS REQUIRED
B. SOUTH CAROLINA APPLICANTS ONLY
1. Consultation or review is required by the S.C. State Historic Preservation Office (SC SHPO) and the S.C. Institute of
Archaeology and Anthropology (SCIAA) for all excavations in South Carolina. The applicant must submit a copy of the
completed South Carolina Department of Archives and History State Historic Preservation Office Project Review Fonn
(attached) to:
S.C. State Historic Preservation Office
S.C. Institute of Archaeology & Anthropology
Department of Archives and History
c/o Mr. Jim Spirek
c/o Ms. Caroline Wilson
1321 Pendleton Street
8301 Park Lane Road
Columbia, SC 29208
Columbia, SC 29223-4905
What to Erect:
a) You will typically receive a letter from the resource agencies documenting the agency's concurrence with your
application, requiring additional infonnation or recommending modifications. You must address each agency's
comment in your final application.
b) If you do not receive any documentation from the resource agencies within 30 days of their receipt of your
application, you must provide that agency with a follow-up letter requesting the agency comment on your proposal
within 15 days from the date of the letter. If you do not receive any response as a result of this second letter, you
may proceed with the application process, recognizing however that if their comments come in later in the
application review process, you will also be required to address them.
c) For the SCIAA agency the applicant must wait 30 days after receiving the signed postal returned receipt. If a
response from SCIAA has not been received by this time you may proceed with the application process,
recognizing however that if their comments come in later in the application review process, you will also be
required to address thein.
2. (For Lake Keowee only) Consultation or review is required by the Eastern Band of Cherokee Indians (EBCI) for all
excavations on Lake Keowee. The applicant must submit a copy of the completed Tribal Historic Preservation Officer
(THPO) Consultation Infonnation Fonn (attached) to:
Eastern Band of Cherokee Indians
c/o Tyler Howe
PO Box 455
Cherokee, NC 28719
What to Expect:
a) You will typically receive a letter from the EBCI documenting the tribe's concurrence with your application,
requiring additional infonnation or recommending modifications. You must address each comment from the tribe
in your final application.
b) If you do not receive any documentation from the EBCI within 30 days upon their receipt of your application, you
must provide the tribe with a follow-up letter requesting the tribe's comment on your proposal within 15 days
from the date of the letter. If you do not receive any response as a result of this second letter, you may proceed
with the application process, recognizing however that if their comments come in later in the application review
process, you will also be required to address them.
3. (For Catawba - Wateree lakes only) Consultation or review is required by the Catawba Indian Nation Tribal Historic
Preservation Office for all excavations on the Catawba —Wateree Lakes in South Carolina. The applicant must submit a
request for comments to the Catawba Indian Nation Tribal Historic Preservation Office at:
Catawba Indian Nation Tribal Historic Preservation Office
Dr. Wenonah Haire
1536 Tom Stevens Road
Rock Hill, SC 29731
[phone]
What to Expect:
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
a) You will typically receive a letter from the Catawba Indian Nation Tribal Historic Preservation Office documenting
the tribe's concurrence with your application, requiring additional information or recommending modifications.
You must address each comment from the tribe in your final application.
b) If you do not receive any documentation from the Catawba Indian Nation tribal Preservation Office within 30 days
upon their receipt of your application, you must provide a follow-up letter requesting comments on your proposal
within 15 days from the date of the letter. If you do not receive any response as a result of this second letter, you
may proceed with the application process, recognizing however that if their comments come in later in the
application review process, you will also be required to address thein.
4. If the excavation meets the requirements of the applicable General Pen -nit (GP 87-14-001) and will remove from 50 to 150
cubic yards, in addition to the entities listed above in PART IV.B.I and 2, the S.C. Department of Natural Resources
(SCDNR) must be provided with a copy of the completed Excavation Pen -nit Application Forn, including the infonnation
required under PART III A -H for at least 30 days consultation:
S.C. Dept. of Natural Resources
c/o Mr. Mark Hall
206 Laurel Valley Road
Sunset, SC 29685
[phone]
What to Expect:
a) You will typically receive a letter from the SCDNR documenting the agency's concurrence with your application,
requiring additional information or recommending modifications. You must address each agency comment in
your final application.
b) If you do not receive any documentation from the SCDNR within 30 days of their receipt of your application, you
may proceed with the application process, recognizing however that if their comments come in later in the
application process, you will also be required to address them.
5. In addition to the entities listed above in PART IV.B.1 and 2, the following agencies must be provided with a copy of the
completed Duke Energy Excavation Pen -nit Application Form, including the information required under PART III A -H, for
all excavations not covered under the applicable General Permits on South Carolina reservoirs:
(For Lake Keowee)
S.C. Dept. of Natural Resources
c/o Mr. Mark Hall
206 Laurel Valley Road
Sunset, SC 29685
[phone]
S.C. Dept of Health &Environmental Control
Water Quality Standards & Wetland Section
c/o Mr. Chuck Hightower
2600 Bull Street
Columbia, SC 29201
[phone]
(For Catawba-Wateree lakes)
S.C. Dept. of Natural Resources
c/o Greg Mixon
Rembert C. Dennis Building
2600 Bull Street
PO Box 167
Columbia, SC 29602
[phone]
What to Expect:
a) You will typically receive a letter from each entity documenting concurrence with your application, requiring
additional information or recommending modifications. You must address each comment in your final
application.
b) If you do not receive any documentation from an entity within 30 days of their receipt of your application, you must
provide that entity with a follow-up letter requesting comment on your proposal within 15 days from the date of
the letter. If you do not receive any response as a result of this second letter, you may proceed with the application
process, recognizing however that if their comments come in later in the application process, you will also be
required to address them.
Duke Energy Page 10 of 11 rev 9/19/14
Excavation Program
e:\#daren\@duke permit\c-w excavation application 11.3.10.docx

DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
6. In addition to the consultation requirements specified for the agencies listed in Part IV. B.1 and 2, the following agencies
must be provided with a copy of the completed Duke Energy Excavation Permit Application Form, including the
infonnation required under PART III A -H, for any excavation that is part of a Commercial Facilities Application,
Conveyance Application or will require FERC review on South Carolina reservoirs:
U.S. Anny Corps of Engineers
Regulatory Functions Branch
c/o Mr. Colton Bowles
1835 Assembly Street
Room 86513-1
Columbia, SC 29201
[phone]
US Fish and Wildlife Service
c/o Ms.Amanda Hill
176 Croghan Spur Road, Suite 200
Charleston, SC 29407
[phone] ext. 12
S.C. Dept. of Parks, Recreation & Tourism
c/o Mr. Tony Bebber
Edgar A. Brown Bldg.
1205 Pendleton Street
Suite 110
Columbia, SC 29201
[phone]
S.C. Dept. of Health & Environmental Control
Water Quality Standards & Wetlands Section
c/o Mr. Chuck Hightower
2600 Bull Street
Columbia, SC 29201
[phone]
S.C. Dept. of Natural Resources
c/o Greg Mixon
Rembert C. Dennis Building
PO Box 167
Columbia, SC 29202
[phone]
What to Expect:
a) You will typically receive a letter from each entity documenting concurrence with your application, requiring
additional information or recommending modifications. You must address each comment in your final
application.
b) If you do not receive any documentation from an entity within 30 days of their receipt of your application, you must
provide a follow-up letter requesting comments on your proposal within 15 days from the date of the letter. If you
do not receive any response as a result of this second letter, you may proceed with the application process,
recognizing however that if their comments come in later in the application process, you will also be required to
address them.
PART V - ADDITIONAL INFORMATION
(Reference previous parts as applicable. !f more pages are needed, add a suffix to last page (e.g. 12a, 12b, 12c, etc)
Duke Energy Page 11 of 11 rev 9/19/14
Excavation Program
e:\#daren\@duke permit\c-w excavation application 11.3.10.docx

Type: CONSOLIDATED REAL PROPERTY
Recorded: 1/9/2013 12:04:47 PM
Fee Amt $26.00 Page 1 of 2
Revenue Tax: $0.00
Iredell County, NC
Matthew J. McCall Register of Deeds
BK 2217 PG 1044 - 1045
NORTH CAROLINA GENERAL WARRANTY DEED
Excise Tax: $0.00 Purchase Price: $0.00
No dile opinion rendered
No closing held by preparing attorney
Parcel Identifier No. 4615899019 Verified by County on the _ day of 20
Mail/Box to: Grantee
This instrument was prepared by: Ben S. Thomas of THOMAS & GODLEY, PLLC, 514 Williamson Road, Ste. 421, Mooresville,
NC 28117
File# 2012111266
Title Insurance Company: Statewide Title, Inc.
Brief description for the Index: Recreation Lot 104, Section 7
I MIN iJCtt)
GRANTOR GRANTEE
Michael J. Dobbins and spouse Joann M. Dobbins Keith C. Ryland and spouse,
Trustees of the Dobbins Family Trust dated Juliette S. Ryland
January 31, 2000
10611 Riverbank Terrace 11521 Seneca Woods Court
Brandenton, FL 34212-5251 Great Falls, VA 22066
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
Iredell County, North Carolina and more particularly described as follows:
BEING all of Lot 104 in Section 7 of the Crescent Land and Timber Corp. Recreation Lots, as shown on a map thereof recorded
in Map Book 14 at Page 76 in the Iredell County Public Registry, reference to which map is hereby nude for a more particular
description of the property.
The purpose of this Deed is to correct the Grantee in that certain Deed recorded In Book 2215, Page 836,
Iredell County Registry.
raw

Delinquent property taxes, if any, are to be paid by the closing attorney to the county Tax Administrator upon
disbursement of the closing proceeds.
The property hereinabove described was acquired by Grantor by instrument recorded in Book 2077, Page 105.
All or a portion of the property herein conveyed , includes or --) does not include the primary residence of a Grantor.
A map showing the above described property is recorded in Book 14, Page 70.
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, other than 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 WHEY& , the Grantor has duly executed the foregoing as of the day and year first above written..
SEA(SEAL)
(L)
Michaej J. bb , Trustee �—M.�bbfi��Trustee
(SEAL) (SEAL)
(SEAL) (SEAL)
State of N u - County or City of J;UaL L
, the undersigned Notary Public of unty and State aforesaid, certify that Michael J. Dobbins and spouse Joann M.
Dobbins rally appeared before me this day and acknowledged the due execution of the foregoing instrument for the purposes
therein exp W'tness my hand d No stamp or seal this day of 20 f.
elf TrU les o the jobb ns cpm fid TYvS� elidedif F
Janv4vA al, a0C0 • ,, ani.. , ab N, 'a1,a0i5 '``'
My Commission Expires: v ' F, t45 (� �e , ' ;. No Public
(Affix Seal) Notary's ��� Cit Notary's Printed or Typed Nam
State of North Carolina - County or City of Iredeil�4•r. r"
I, the undersigned Notary Public of the (� * and NPafor&&A certify that
Witness my hand and Notarial stamp or seal, this 20.
My Commission Expires:
(Affix Seal)
Notary's Printed or Typed Name
Notary Public

D DON ALLEN & ASSOCIATES, P. A.
"Since 1971"
Commercial * Residential * Mortgage Surveys * Multi -Family
Construction Staking * Subdivision Design * Topographical
111-D Raceway Drive * Mooresville * NC * 28117
[phone] [phone] Fax
I, certify that this map was drawn under my supervision from an actual
survey made under my supervision recorded in deed book2077___, page_ 105 and/or
plat book 14 page_is __ that the ratio of precision is 1':10,000, that this map
was prepared in accordance with the General Statutes of North Carolina Chapter 89C.
my hand and seal on the --1--3, day of _DECEMBER A.D. ,2
760 CONTOUR LINE PER
ACTUAL FIELD SURVEY
,RPR
n
EV E,
14
u
Q4
NEIGHBORS FRAME
BUILDING ENCROACHES
1.5'
LOT 103
LOUIS B. BALDWIN
FAMILY TRUST
1461/1281
LEGEND
cD, - P.P. - POWER POLE
C] - DUKE POWER TRANS.
EJP..- EXISTING IRON FOUND
LP.S. - +4 REBAR SET
R/W - RIGHT -GF -war
® - WELL.
PDE - PUBLIC DRAINAGE EASEMENT
_. ___ — — I. _._ _
__
OYERNEAD VOWM .. _ _
NOTES
BARBER LOOP 1) THIS PROPERTY MAY BE SUBJECT TO
ANY EASEMENT AND/OR RIGHTS-OF-WAY
60' PUBLIC R/W OF RECORD.
2) AREA COMPUTED BY THE COORDINATE
METHOD.
^,... s 3) E70SMG 760' & 761' CONTOUR ELEV-
�"~ ARON BASED ON LAKE NORMAN LAKE
T' H Y S I C A L SURVEY /112/12) ELEVA° FORD 75, (READING
4) NO GRID MONUMENT FOUND WITHIN
OF 2000 FEET.
403 BARBER LOOP
LOT 104 CRESCENT LAND & TIMBER CORP. SECT. 7
SCALE_
DAVIDSON TWSP., IREDELL CO., N.C. FILES ELDBCRESCENTLOT 104
ACQUIRED BY: KEITH C. & JULIETTE S. RYLAND OTAx LE'MAP No 4615e99018

Vow

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2015 Goode _I1_� �
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DUKE ENERGY DIRECTIONS BY ROAD FORM
Lake Use Permit Applicants and Contractors: Ease of locating the proposed project
site canhavea big impact on permitting processing time. Please complete this form and
return it along with your completed application to:
DUKE ENERGY
C/O LAKE SERVICES — EC 12 Q
526 SOUTH CHURCH STREET
CHARLOTTE, NC 28202
Applicant's Name: I"l e- if h C. RV favid
Street Address (at lake): 403 hof her Loo
Lake Name: _ .1 V orf' yY)O'n
Subdivision Name: Cre g p e n t Lail A 0.n -T; b P r
Property Section: '7 Lot #: 104
City: tAoores\ 11 I e- County: lreAed
State: SIDY-1V) l rifo h n(1 Zip: 2,2 1 7
Telephone: 70-3 - UW- IgOF)
Directions (from major road or highway): From 1'77 N13. 7-0,V1e EX1+ 35, IC-�fcn+p
'Bro-* ley School "Rd. , -R i c�h+ on+u DwcAwood , 1 e f + 0"+0
Sar ber- Loo p. 1-�om e 1 S o n -the I e �+
Descriptive Structure(s) on Property (i.e. brick garage, white fence, mobile
home, etc.)
*Note: Please use the back of this form if desired to draw us a map to the site.

usgUS. DEPARTMENT OF THE INTERIOR �p LAKE NORNAN NORTH QUADRANGLE
U.S. OEOLOOIUL SURVEY �� mom i�;USTop 1.SLrR►�ESE

List of Names of Adjoining Property Owners
403 Barber Loop
Mooresville, NC 28117
Excavation Neighbors
Margaret S. Payne
399 Barber Loop
Mooresville, NC 28117
Louis B Baldwin, Jr.
407 Barber Loop
Mooresville, NC 28117
Mailing Address
Louis B Baldwin, Jr.
2217 Westover Drive
Winston-Salem, NC 27103
Disposal Neighbors
Harold Edwin and Cherie C. Stuffs
8585 E NC 150 Hwy
Terrell, NC 28682

/r' DUKE
NERGY
EXCAVATION PROJECT USER'S AGREEMENT LETTER
(Please fill in the blanks. Please Print)
Date _I O - 27 - I Cp
TO: Duke Energy
c/o Lake Services - EC 12Q
P. O. Box 1006
Charlotte, NC 28201-1006
RE: Excavation For (Subdivision and Lot #'s or Other Project
Name)
(Lake/Coa nebty)
(Drake File No.)
/ Ir
Lake Services
Duke Energy
5?�i SuU'h l;hudrh stleot
;t ,0otte NC 28'02
I1illOtte,iyl: ?t�1O�-!Ut1C
(Applicant's full name) i�e1�- �y `Qytd hereby agrees to comply
with all recommendations, requirements and/or 'conditions son of Duke Energy Lake
Services, General Permit(s)
(if applicable) and
other federal, state
and local
agency
requirements pertaining to
__boa+ sV►�c) riereaz,
the application to
excavate for the
purpose
of a
In addition, 1/we have read and agree to comply with Duke's current Shoreline
Management Guidelines (SMG), much of which is repeated hearin, and understand that
written authorization must be obtained from Duke Energy Lake Services prior to
beginning any activity within the FERC project boundary or on Duke Energy land. The
excavation will be completed as described in the approved application and within
eighteen (18) months from the date of written approval by Lake Services, unless
specifically noted otherwise in the application or unless Uwe obtain approval for a single,
time extension (maximum of one year) in writing from Duke Energy Lake Services. I/we
understand that if the SMG or other applicable rules change during any extension period,
Uwe 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 SMG and
that the new application must include any applicable fees and security deposits.
wwwdWke �ntargy.�;�n

I/we attest to be the owner(s) or lease holder(s) of the land immediately adjoining the
project boundary or Duke -owned peripheral strip 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,
Uwe 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.
Uwe understand that all excavation work must be done directly in front of my/our
property and within the third of the cove nearest my/our property or within any middle
third of the cove that Duke Energy owns, or 1/we have written authorization from the
owner(s) or lease holder(s) to carry out the proposal within the project boundary adjacent
to/on their land. 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.
Uwe understand that for proposed excavations , Uwe must notify the appropriate local,
state and federal agencies in advance of the activity by sending them a completed copy of
Duke'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 I/we submit the
final application to Duke Energy Lake Services.
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 Federal Energy Regulatory Commission (FERC)
review does itself require specific review and approval by the FERC before Duke Energy
can issue any approvals.
Uwe agree that unless specifically approved otherwise in the application, explosives will
not be used as part of this excavation activity.
Uwe understand that every reasonable effort must be made to minimize any adverse
impact on fish, wildlife and other natural resources.
Uwe 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 Lake Services.
Duke Energy Pape 2
Page Rev: 9/19/06
EXCAVATION APPLICATION Effective Date: 11 15;95
Gpab'LAK EMGMT,Package info—ation'NC C -W Dredge, Escagre9.15.06.doc

I/we agree that excavation activities in North Carolina and South Carolina will not occur
during the months of March, April, May and June because of the potential impacts to fish
spawning areas.
I/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 that 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.
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.
I/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.
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; 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. 1/we will then
notify Duke Energy Lake Services and the State Historic Preservation Office to
Duke Energy Page 3 Rev: 9'15/06
EXCAVATION APPLICATION Effective Date: 11, 1593
GpaVLAKEMGMT-Package Information NC C -W Dredge: Excagre9.15.06.doc

determine what measures, if any, Uwe must pursue to protect or salvage the
archaeological resources.
Uwe 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 I/we understand that this
responsibility is considered to transfer automatically along with ownership and leases of
the adjoining tract.
Uwe understand that Lake Services representatives may issue Stop Work Directives for
any violations of the SMG and that 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 Lake Services and other agencies as necessary and to perform the necessary
remedial actions within the specified time frame.
Uwe agree to develop any required mitigation plans and to complete any required
mitigation activities at my/our own expense within the specified time frames. I/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 Lake Services by phone when the excavation is initiated and to
ensure that during the excavation period the weather-proof "Duke Energy Approved
Lake Use Activity" sign (to be provided by Duke Energy) remains posted at the iob site
and visible from the water's edge.
Uwe agree to notify Lake Services 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.
Uwe have included a check for the applicable filing fee and security deposit, and copies
of all other necessary permits. Uwe recognize that security deposits will not be refunded
if any violations of the SMG or this user's agreement occur.
I/we understand that 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.
Duke Energy Page 4 Rev: 915506
EXCAVATION APPLICATION Effective Date: 11;15'93
GpaLLAKEMGMTPackage Information;NC C-W Dredge,E.ecagre9.15.06.doc

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 of FERC project lands and
waters shall not hinder the general public's lawful use and enjoyment of the same.
Sincerely,
Y� el- I + � I C. -R-4 I 0-n d 104- Y- V— - C - 0_VLJ
Applicant's Name (Print) Lot # Applic gn ure
*Co -Applicant's Name (Print) Lot # *Co -Applicant's Signature
*Co -Applicant's Name (Print) Lot # *Co -Applicant's Signature
*Co -Applicant's Name (Print) Lot # *Co -Applicant's Signature
*Co -Applicant's Name (Print) Lot # *Co -Applicant's Signature
* 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. The check for the application filing fee and security
deposit should be from the party shown as Applicant and not several checks from the Applicant and Co -
Applicants. By signing this agreement, Co -Applicants are in fact recognizing and agreeing to the same
conditions as is the party signing as Applicant.
Duke Energy Page 5
Rev: 915/06
EXCAVATION APPLICATION Effective Date: 11 15,98
Gpai'LAKEMGMT'Package Information NC C -W Dredge,Excagre9.15,06.doc