20161081 Ver 1_Shoreline Stabilization_20161107

State of North Carolina
Department of Environment and Natural Resources
W,
Division of Water Resources
..
15A NCAC 02H .0500 —Water Quality Certification, Shoreline Stabilization
Division of Water Resources 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
20101081
1617 Mail Service Center
Raleigh, NC 27699-1617
I. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: i_yNiP_i p. l am;p pe? I l
Mailing Address:(%,
i •i
ryU V 0 7 2016
Telephone Number: Z0,-Z,-7-55CCFax Number:
E-mail Address: I l . cow
2. Agent/ Contact Person Informatio
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
htto://www.saw.usace.armv.miI/Portals/59/docs/reRulatory/re2docs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name:
Compal
Mailing Address
Telephone Number: 104.5?.�%,7A D Fax Number: `7('q-SZ,9-34nn
E-mail Address: Awm . In nrnr_,i;+Prdn,- k,,:: -)a nvwrr . I . rnm
Person to receive the Certification Approval:
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
5,1nc.

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: Cad-" Nearest Town: e rf P I I
Subdivision name or site address (include phase/lot number):
�nme�rSP� o►� Lc�>�e 1�c�r►�an , Phln6P I L )+ 7 -
Directions to site - please include road names and numbers, landmarks, etc.: 5rofn
1= T71�b ` 'CoLhe Eid .3(e . -ar r-, I Pa n nin Nr-- 15n* _ Fe I In W
I nAn 01 0 VA)a O n . --Iu r r -N 1p -c+ r) nth 51')e,rr'►1 15 Er -A A.
T.t r -►-1 I P -P-4- nJ )*) AY -0,01 fP _4 {kM Al I
Latitude (in decimal degrees) `), 585307 Longitude (decimal
5. Describe the existing land use or condition off thesiteat the time of this application
(residential, undeveloped, etc.):
6. Property size (acres): .750 A t
7. Lake/ river/ ocean adjacent to property: N Orli an
8. Describe proposed work (include discussionas to how hardening of shoreline has been
avoided, or why it is necessary): Df -e 8 *o /0 \ a+ -FPnnrl
9. Will work be conductJd from land? ❑ From water? 19
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:
.(A3 nGreer
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: 0
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):
Owner/Agent's Signature Printed Name
[15A NCAC 02H .0502(f)]
µAgent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013
1612- 46
Date
Page 2 of 3

�, , `� f'�I\ 12.0 Q c(,"�"�
Lake �
(At Full Pond/ Normal Water Level) '11 /Q t
' JN' o de eP
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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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 Initials
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 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 aonlication.
PART I. - APPLICANT INFORMATION (Please Print)
Name
Lake Address J ()l, LTr ,0 I ta()r'.
:T r re ISN L 7
T5�) C� (a>/I On
l. C /n m
L
Contractor Company ail /gab 1 r' !/ S�jM ,
Telephone
Mailing Address
(If different)
i
Contractor Contact Person Dov_11�n �_ R� _ Telephone [phone]
LAKE LOT INFORMATION --�'
Lake&AdA County City /P_YI''e %� State Tax Map No.�i(017d453
SubdivisionSUMer<jp-r n� �. Lot/ Section No.
Acres
1�otr 1'%10. Lot Size
Are there any Co -Applicants*? (check one) ❑Yes ANo (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 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.
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.
ayn A /1
Date of on-site inspection ` Initials (Duke Energy) (applicant/contractor)ZE5.
Duke Energy Page I of I1 rev 9i19/14
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
PART II. - DESCRIPTION OF PROJECT
A. BASIC INFO
1. Type of excavation: (check one) X New excavation ❑ Maintenance excavation
2. Purpose of excavation: (check one) JkBoat Access Channel ❑ Water Intake Channel
❑ Wastewater Discharge Channel ❑ Other (specify):
3. Lake user category: (check one) XPrivate ❑Residential Marina ❑Commercial Marina
❑Public ❑Other (snecifv):
4. Max. Excavation Area Dimensions (ft): Length Width -5Z) 4' 15 Depth If)
(Note: include 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): ( 0 Cubic yards
6. Type of material removed (applicant determines by field sample if practical):Kl 46'A �) /
Q
7. Excavation Site area: ---(A 5 Acre (s) Disposal Site area: 45 Acre (s)
8. Total Disturbed Area (including equipment staging area): , c (j_ 4,3 Acre (s)
9. Does the project meet the requirements of the applicable General Pen -nit? (check one) XYes ❑No
10. Do you claim title to the disposal area? (check one) glYes ❑No
11. Do you claim title to the equipment staging area? (check one) J0,'Ves ❑No
12. Are there any water -treatment facilities within 50 feet of the proposed excavation area? (check one)
(If Yes, specify):
13. How will the excavated material be
:lisoosal area design): T)rpAr. o
Type(s) of excavation equipment to be used:
and the erosion controlled? (e.g. see attached
❑Yes (14No
control plan and
Ili -
15. Will waters o weda ds be crossed in transporting equipment tq or from the site? (ch ck one) es ❑No
(If yes, explain) CA
%h4i. 79, —Pymi�� Al-te Oh L-nA'P-A00—Wdr
16. Will return water re-enter the reservoir? (Check one) ❑Yes ❑No V/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? IR"Yes ❑No
(If Yes, specify the existing permit number. If No, include a scaled drawing of the proposed facility). Permit # 948 (V
18. Total planned duration of the work (Include first equipment mobiliza ion, excava ion through final mitigation measures
complete): START / —t. FINISH Z /
(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 M
Avoid (A) or Mitigate (M)
Field ID
Work Area DWI!. ID
Acreage
**
a. Marshland, swamp, ponds, beneficial
aquatic vegetation or other potential wetlands (circle all
that apply)
/
b. Buffer Zones (specify width &source of
requirement)
prpI n VV* 11 be o kw� lis
froyn e, W 1 +A) eXlCkV4
o�'IoQ e -Vu durn,p
w i l l e levet ted 0-F by
b4r e..
r
c. Environmental Areas as identified by Duke
Energy
� / / /t
/v
d. Natural Areas as identified by Duke Energy
�
��l IA -
e. Historic properties (specify)
v
L Rare or threatened species (specify)
/
V A -
Buried gas, water, sewer, communications
/V ZIA
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DUKE ENERGY EXCAVATION PERMIT APPLICATION FORM
Protection/Avoidance Areas
(check all that apply)
A rox.
Identification Method(*)
Field ID
Work Area Dwe. ID
Acreaee
or electric lines (circle)
h. Impact Minimization Zones as identified by
Duke Energy
/k
i. Other areas requiring specific avoidance,
protection or mitigation (specify)
NIA
Avoid (A) or Mitieate (M)
* For "Field 1D" 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)4411
ze/
Applicant Signature* .` .'" r. ,
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 #
Date
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 comer 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 form PARTS I & II, 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 1"= 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).
An accurate scaled drawing (1 "=25' for projects <1000 cubic yards of material removed or I "= 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.
F� 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� A list of names and addresses of adjoining property owners for both the excavation area and disposal area.
G. A copy of all pen -nits and/or letters of correspondence to/from local, state and federal agencies that require notification or
issue individual pen -nits.
X" Provide the existing permit 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).
I. 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://.izis.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.coin 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. Anny 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 Pen -nit (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 pen -nit 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 pen -nit 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 them. (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 III A. 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 IV.A. I 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 Form (including the information 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
Transvlvania 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
infonnation 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 Fonn (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
828-652-4360 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 Form
(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 Expect:
a) You will typically receive a letter from the resource agencies documenting the agency's concurrence with your
application, requiring additional information 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 them.
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 Information Form (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 them.
4. If the excavation meets the requirements of the applicable General Permit (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 Permit Application Form, including the information
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. I and 2, the following agencies must be provided with a copy of the
completed Duke Energy Excavation Permit 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 infonnation 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 Pen -nit Application Form, including the
information 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. Army 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. 1f 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

Excise Tax: $1,140.00
arcel Identifier No. 4617
Verified by
by
FILED Cairn" County
on Mar 04, 2096 at 02:22:00 prn
Effte Tax $1140.00 (AT)
mr. #03362
OMWA rucksSPEWIM,
Roodw at otteds
arc 03331 pg 0562-0564
Recording Time, Book and Page
County on the _ day of , 2016
Mail after recording to: GRFtNTEE Law Offices of W. Daniel Grist -4525 Park Rd, Suite 201B
Charlotte, NC 28209
This instrument was prepared by: Law Offices of W. Daniel Grist, PLLC, a
licensed NC Attorney. Delinquent taxes, if any, to be paid by the closing
Attorney to the county tax collector upon disbursement of closing proceeds
Description for the Index
Lot 7, Phase 1 of SOMERSET ON LAKE
NORMAN
NORTH CAROLINA GENERAL 1fARRANTY DEED
THIS DEED made this �ay of *arCL 2016 by and between:
GRANTOR
STEVE E. PERRY and wife,
DIANA D. PERRY
Forwarding Address:
309 Commodore Loop
Mooresville, NC 28115
GRANTEE
DANIEL D. CAMPBEL and wife,
BARBARA P. CAMPBELL
Property Address:
3902 Granite Street
Terrell, NC 28662
If checked or initialed, the property Mailing Address:
includes the primary residence of at least one of the 11341 Vale Road
Grantors. (NC GS§ 105-317.2) Oakton, VA 22124
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.
Page 1 of 3

M9
WITNESSETH, that the Grantor, for a valuable consideration paid by the
Grantee, the receipt of which is hereby acknowledged, has and by these
presents does grant, bargain, sell and convey unto the Grantee in fee simple,
all that certain lot or parcel of land situated in the City of
Terrell, Catawba County, North Carolina and more particularly described as
follows:
Being all and the full contents of Lot 7, Phase 1 of Somerset on Lake Norman
as shown on a plat recorded in Hook 47 at Page 155-157 of the Catawba County
Public Registry.
The property hereinabove described was acquired by Grantor by deed in Book
2167, Page 1802.
A map showing the above-described property is recorded in Map Hook 47, Page
155-157.
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 in subject to the following
exceptions:
Restrictions recorded in Book 2156, Page 1123; Book 2147, Page 1441;
Flood easement to Duke Snergy Corporation (formerly known as Duke Power
Company) to flood to the 770' contour line and all other reservations,
restrictions and conditions contained in that deed recorded in Deed Book 947,
Page 632;
All applicable zoning; any easements and right of ways for service lines,
roads and utilities as may border or cross the subject property, including
streets as shown on recorded plat; any easements reserved in the restrictive
covenants, including homeowners association provisions; applicable
restrictive covenants of record and street assessments; ad valorem real
property taxes for the current year; subject to matters that could be
revealed by an accurate and current physical survey and boundary survey of
the property.
Page 2 of 3

IN WITNESS WHEREOF, the Grantor has hereunto set his hand and seal, or if
corporate, has caused this instrument to be signed in its corporate name by
its duly authorized officers and its seal to be hereunto affixed by authority
of its Bo#TZrpf Direct the day and year first above written.
Y -f g rte— (SEAL)
STEVE Z. PERRY
/FJL/
f.Y�,�jJ 16 / IJUKa (SEAL)
DIANA D. PERRY
STATE OF N W k --LI 61VB B 11'Y'1
COUNTY O,FLL 1 v i tJ (� I tM ���
11 rncd to 3 -OoW ^ N a Notary Public of the County and State aforesaid, certify
that the following persons) appeared before me this day, each acknowledging to me that he or she voluntarily
signed the foregoing document for the purposes stated therein and in the capacity indicated:
STEVE E. PERRY AND DIANA D. PERRY
Witness my hand and official stamp or seal this _ day of Ma" 2016.
mAiR�1
MATTHEW B. DOWNS Notary Public
Nobly Puerto. Medaa*,o C-Unty
Stab e1 Nam cardYr Printed Name of No Public
W U nWOM Etght A0017, 2Mtart
My Commission Expires: 2 % 6
Page 3 of 3

/
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This 22th day of Snpta ber, 2016
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SCALE: 1' - 40'
um rav— u mer (.A etc ortaaa ou _ .mart (01
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fJcetue Nam bar C -,?M
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Boundary and Physical Survey
3902 Granite Street
SOMERSET ON LAKE NORMAN
fA`IARI- PHASE ONELOT 7
Mountain Creek Township, Catawba County, NC
" 4617-04-53-2831 — D.B. 3331-562 — P.B. 47-156
Property of. Daniel & Barbara Campbell
LEGEND
UNE TABLE
/ NUN BEARING INSTANCE
PROPERTY UNE (PA)
-----
RMWT OF WAY(R/W)
L2 S3T43 4J'W 33.21'
51456'31'W 39.89'
TIE LINE
—
— ADXWING PROPERTY UNE
FROM DEED OR PUT
______________FUU
POND
---------
FEMA FLOODUN£
— - — -
— BUILDING SETBACK LINE
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' --- 50' VEGETA RYE BUFTER
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reauiemrrtr oI IM Sfergab M HocOw h- LaM 9vwMq h NaM CardM
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This 22th day of Snpta ber, 2016
40 0 40 80
SCALE: 1' - 40'
um rav— u mer (.A etc ortaaa ou _ .mart (01
�illiems Lead Surveyia& Ina
fJcetue Nam bar C -,?M
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SEAL -
< L-4718
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Boundary and Physical Survey
3902 Granite Street
SOMERSET ON LAKE NORMAN
fA`IARI- PHASE ONELOT 7
Mountain Creek Township, Catawba County, NC
" 4617-04-53-2831 — D.B. 3331-562 — P.B. 47-156
Property of. Daniel & Barbara Campbell
NDIFS
UNE TABLE
/ NUN BEARING INSTANCE
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- Eff-U- Oote 3^8/2006,
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Bast JJJ6 Pew .To2 n
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This 22th day of Snpta ber, 2016
40 0 40 80
SCALE: 1' - 40'
um rav— u mer (.A etc ortaaa ou _ .mart (01
�illiems Lead Surveyia& Ina
fJcetue Nam bar C -,?M
274 B ymoemt Drfsa Steteffl lo, NO 26625
Ph". OW070-SM -• amsD run L.9 -f i"bell .thndt
tae' IB1SJItElL4Ti
o. FESS%p••.2':
:4Q0 Ny� y
SEAL -
< L-4718
� i9�, JO•i,(�
�' :� SURdF; : • \per,
Boundary and Physical Survey
3902 Granite Street
SOMERSET ON LAKE NORMAN
fA`IARI- PHASE ONELOT 7
Mountain Creek Township, Catawba County, NC
" 4617-04-53-2831 — D.B. 3331-562 — P.B. 47-156
Property of. Daniel & Barbara Campbell

A I . � A
A
40
50X20 dredge cut
10 -ft deep with required slopes
15x120 access channel
10 -ft deep with required slopes

Ic'eerth

DUKE ENERGY DIRECTIONS BY ROAD FORM
Lake Use Permit Applicants and Contractors: Ease of locating the proposed project
site can have a big impact on permitting processing time. Please complete this form and
return it along with your completed application to:
DUKE ENERGY
CIO LAKE SERVICES — EC 12 Q
526 SOUTH CHURCH STREET
CHARLOTTE, NC 28202
Applicant's Name: I a Irl I P G ya ;1 hezI
Street Address (at lake): 3LI Q ,r
Lake Name: i
Subdivision Name: )hv'YlPr SPT oyn Lave &0r nQC1y-)
Property Section: Lot #:
City: y- rim I I County:
State: b V-+Vl Car
Zip:
Telephone: —Z ()/ - %117 -
Directions
7
Directions (from major road or highway)A` tt
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us r) Ie�� 0►-1tp 5V)err, Its rc)r12ci. -y�kfv% itp+0n-fu
G r c- ►+ e s- ree+. I -Ln m e i s o h +VA e r 1qq h�- .
�J
Descriptive Structure(s) on Property (i.e. brick garage, white fence, mobile
home, etc.) P r i CV) �p ►ry e \N I C Cly'3 y 0.x0. .
*Note: Please use the back of this form if desired to draw us a map to the site.

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List of Names of Adjoining Property Owners
3902 Granite Street
Terrell, NC 28682
Excavation Neighbors
Russell Edward and Rita Rae Caperoon
3894 Granite St.
Terrell, NC 28682
Bruce K and Kathlyn E Edwards
3906 Granite Street
Terrell, NC 28682
Disposal Neighbors
Harold Edwin and Cherie C. Stutts
8585 E NC 150 Hwy
Terrell, NC 28682

DUKE
' ENERGY
EXCAVATION PROJECT USER'S AGREEMENT LETTER
(Please fill in the blanks. Please Print)
Date I t -? D
TO: Duke Energy
c/o Lake Services - EC12Q
P. O. Box 1006
Charlotte, NC 28201-1006
RE: Excavation For
Name)_y_
(Lake/County/C
(Duke File No.)
and Lot Ws or Other Project
Lake Services
Duke Energy
X26 South Chup h Street
hadotte, M, 28202
Mailing AddfeSs
cC 120 r PO Box 1006
;hanotte. NC 28201-1006
(Applicant's full name)D &-ij e V V CL bP hereby agrees to comply
with all recommendations, requirements and/or conditions of Duke Energy Lake
Services, General Permit(s)
(if applicable) and other federal, state
and local
agency
requirements pertaining to
OAff
the application to excavate for the
purpose
of a
In addition, I/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 I/we obtain approval for a single,
time extension (maximum of one year) in writing from Duke Energy Lake Services. 1/we
understand that if the SMG or other applicable 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 fling of a new application within the then -current SMG and
that the new application must include any applicable fees and security deposits.
Nwwduke n��rgy.curn

1/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.
Uwe attest to be the owner(s) or lease holder(s) of the land that will be used for
equipment staging and disposal of excavated material or if not the owner or lease holder,
I/we have included proof of title to the property and written authorization from the
owner(s) or lease holder(s) to carry out the work on their land.
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 I/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, I/we 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. Uwe
understand that written authorization and/or other permits may be required by some of
these agencies and such required authorizations must be obtained before Uwe submit the
final application to Duke Energy 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.
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.
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 Page 2
EXCAVATION APPLICATION g Rev: 9/15/06
GpaVLAKEMCMT/Package InfortnaEffective Date: 11/15/98
tionrNC C-W Dredge/Excagre9.15.06.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.
1/we recognize that it is my/our responsibility to clearly locate in the field and label on
my/our work area drawings any areas that require specific protection or avoidance during
this excavation work. Examples of these protection/avoidance areas include but are not
limited to, any Environmental Areas, Natural Areas or Impact Minimization Zones as
identified by Duke; jurisdictional wetlands; historic properties; rare or threatened species;
and buried gas, water, sewer, electric or communications lines. l/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 Lake Services and the State Historic Preservation Office to
Duke Energy Page 3
EXCAVATION APPLICATION g Rev: 9/15/06
Effective Date: 11/15,98
GpaVLAKEMGMT,Package [nformatioNNC C -W Dredge/Ezcagre9.15.06.doc

determine what measures, if any, I/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 I/we understand that this
responsibility is considered to transfer automatically along with ownership and leases of
the adjoining tract.
I/we 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.
I/we 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.
I/we agree to develop any required mitigation plans and to complete any required
mitigation activities at my/our own expense within the specified time frames. 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.
I/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 job site
and visible from the water's edge.
I/we 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.
I/we have included a check for the applicable filing fee and security deposit, and copies
of all other necessary permits. I/we 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 e 4
EXCAVATION APPLICATION Rev: 9;15/06
Gpal/LAKEMGMT/Package InformatiowNC C -W Dredge/ Excagre9.15.06.doc Effective Date: 11/15/93

I/we understand that this user's agreement does not, in any way, constitute the transfer of
any rights in real property and that my/our use and enjoyment of FERC project lands and
waters shall not hinder the general public's lawful use and enjoyment of the same.
Sincerely,
Applicant's Name (Print) Lot # Applicant's Signatu e
*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
EXCAVATION APPLICATION Rev: 9/15/06
GpaVLAKEMGMT/Package Information/NC C -W Dredge/Excagre9. 15.06.doc Effective Date: 11/15/98