20181093 Ver 1_Shoreline Stabilization_20180821

Sullivan, Shelton
From: Andrea <[e-mail]>
Sent: Tuesday, August 21, 2018 9:43 AM
To: Johnson, Alan
Cc: Sullivan, Shelton
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Good Morning Mr. Johnson,
I left you a voice mail this morning feel free to email instead of calling I know you are busy.
Please see attached in this email all the paperwork filled out to the best of my ability and the payment has been
received for the permit to with the exception of adding the entire area with mulch which I met with Timbercreek this
weekend to do from the lake shore to cover the entire area where the trees have been planted, he and his workers will
be performing that this week. If you remember I did cover around the trees and a thin layer on the ground when I
planted the first 25 back in 2017. But they are going to put another layer on the ground this week to ensure coverage.
At this time the money has been paid for the permits and I sent the money and completed application to Duke Energy
(7-8-2018) however they would not process my payment until I have the approval letter from DWR so I have at this time
tried to obtain that permit also.
Please let me know what steps I need to take now.
I suppose I will send my paperwork back to Duke Energy as soon as I have the letter of approval from DWR.
I look forward to hearing back from you.
Thanks
Andrea B. Witherspoon
336-607-4787
-----Original Message -----
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State of North Carolina
Department of Environment and Natural Resources
ELfir DWAILNL
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
1617 Mail Service Center
Raleigh, NC 27699-1617
Applicant Information [15A NCAC 02H .0502(a)]
1. Owner I
Name:
Mailing
Telephone Number: SS4 -667-1-17g7 Fax Number:
E-mail Address: 04Cl/t� m. i2G%Pa ew p%dDe/ trlsnC zom-,
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http://www.saw.usace.army.miI/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name:
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Person to receive the Certification Approval:
Fax Number:
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)
CalCounty: i' Nearest Town: T"f
Subdivision name or site address (include phase/lot number): A(14
Directions to site - please include road names and numbers, landmarks, etc.:
Latitude (in decimal degrees) Longitude (decimal degrees)
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.):
6. Property size (acres): LD - 3,5
7. Lake/ river/ ocean adjacent to property: ��k2
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
9. Will work be conducted from land? [✓7 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:
106(6
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal poollake level/ Normal Water Level and 50 feet land -ward in
� M
square feet or acres: , Zm &a Qe�_e
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):
o idwt, bAA66pon
Owner/Agent's Signature* [15A NCAC 02H .0502(f)]
Date
Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

Duke Energy Lake Services Fee Schedule
Effective Date: January 1, 2018
Please note: For combined activities, the highest fee and/or deposit is required
Program
Activity
Application Filing Fee'
Security
Deposit
Private
FacilitiesCommon-Use
Individual Private Facility (new
& maintenance
$350 ✓
NA
Facility
$350 pera licant
Transfer of Existing Facility
$350
Excavation
$1,500 or $2,500 per
applicant
$1,000 per
applicant
Shoreline
Stabilization
Landscape plantings &
bioen ineerin
No Charge
NA
Rip -Rap
$100 ✓
Seawall
$350
Miscellaneous
Reservoir Uses
Fish Attractors
No Charge
NA
Heat exchange coils for heat
pumps
$100
Irrigation pumps for minor
withdrawals
$100
Ski Ramps / Slalom course
$250
Special Use Facilities
$350
Temporary Sales Pier (<2 yrs)
$350
Commercial Marina
$2,500 or $3,000
$2,000
Residential Marina
$2,500 or $3,000 b
$2,000
Marina
Facilities
Rebuilds
$1,500
$1,000
Time Extensions `
$1,500
NA
Transfer of Permit/ Lease
$750
NA
All
$2,500 or $3,000
$2,000
Time Extensions`
$1,500
NA
Conveyance
Staging Area
$2,500 or $3,000 b
$2,000
Transfer of Permit/Easement
$750
NA
Notes:
a Studies necessary for application review or studies required pursuant to application approval
must be paid for by the applicant and those costs are not included in the filing fees shown
above. For multiple activities in the same application, the largest of the fees apply.
Larger fee required for applications that must be approved by the FERC.
Fee for the first 12 -month extension. Applicants can request a second and final extension, but
must pay a second application filing fee and security deposit, and forfeit the original deposit.

DUKE ENERGY PRIVATE FACILITIES
"APPLICANT'S USER AGREEMENT"
(Fill in blanks with required information.P lease Print)
TO: Duke Energy
c/o Lake Services - EC 12Q
526 S. Church Street
Charlotte, NC 28202
RE: (Lake Name) r&v - pfmwda.)
(Lake Address) 40,0,5 Kj� Rood
\J I'lv, �c
(Applicant's fitll name)rJA 20hereby
agrees to comply with all requirements and conditions set "forth by uke Energy's Lake Services
(Duke Energy) office, and any federal, state or local agencies pertaining to our application to
construct a d/or maintain a
-4 ►1 ae 9mmi-t- on Lake In addition,
1/tive have read and agree to comply with Duke Energy's Shoreline Management Guidelines
(SMG) and understand that written authorization must be obtained from Duke Energy prior to
beginning any activity/construction within the Federal Energy Regulatory Commission (FERC)
Project boundary. The construction will be completed as described in the approved application
and within twelve (12) months following the date of approval by Duke Energy. An extension
will be considered for legitimate extenuating circumstances (as determined by the sole discretion
of Duke Energy) provided a specific timefi•ame in which to complete the construction, not to
exceed an additional 12 months, is provided in writing to Duke Energy by the applicant. Failure
to complete construction within the 12 -month build -out period or any Duke Energy approved
extension will require the applicant to file a new application that complies with the then -current
SMG. The new application filing will include any applicable fees and security deposits.
11we attest to be the owner or lease holder of the tract of land immediately adjoining the Project
boundary where the proposed private facility is to be constructed.
Ilwe agree to comply with all FERC orders (as modified or interpreted by FERC), with all other
applicable FERC Rules and Regulations implemented by Duke Energy, and with all rules or
regulations imposed on Duke Energy by any governmental agency.
Pagel of 5
Rev 11/9/2016

I/we understand the physical location of nay/our lot in relation to the common property line with
Duke Energy, if any, the FERC Project boundary, and any deeded flood easements or required
building setbacks.
Five understand that this lake was constructed as a working hydropower reservoir for the primary
purpose of producing cost-effective electric energy and that this remains as the lake's primary
purpose. I/we understand the lake and its associated hydroelectric facilities are operated by Duke
Energy under the terms of a license issued by the FERC and there will be no change in hydro
project operations as a result of the construction and/or use of any facilities that 1/tive may be
allowed to place within the FERC Project boundary or on any Duke Energy -owned property.
Ilive understand during drought conditions Duke Energy may request reduced usage or
discontinued usage of any water withdrawal or related systems, until such drought conditions
improve. Failure to do so may cause possible removal of the system and/or any other permitted
facilities that I/tive may have, and any costs associated with removal of the facilities will be
assessed to the lot owner.
Five understand lake levels will rise and fall over time in response to weather events and hydro
project operations and Duke Energy does not guarantee an approved facility will always have
sufficient water depth to be accessible by boat or for other water depth related recreation
activities.
I/we acknowledge Duke Energy provides no guarantee of any specific quantities (except those
identified in the FERC license) or quality of water in the lake.
Ave understand the facilities to be installed and/or maintained are my/our property and Ave
therefore agree to be fully responsible for the permitted reservoir use including maintaining
facilities in good repair. If the private facility is deemed unsafe by Duke Energy, Five agree to
repair or remove the private facility at my/our own expense and within the specified timeframe
set by Duke Energy.
1/we understand Duke Energy approval of the requested reservoir use in no way constitutes
assignment of any interest in real property Duke Energy may have (i.e. land rights). The approval
is granted and maintained solely at Duke Energy's discretion. Five also understand the permitted
use may be revoked at any time by Duke Energy or its successors for any reason whatsoever. If
the approval is revoked, I/we agree to remove the facility at my/our own expense within the
specified timeframe set by Duke Energy.
I/we understand ownership/interest in a Common Use Facility or residential marina eliminates
the option of having a separate private facility on any other owned or leased lot within the
affected subdivision.
Ave understand this lake is open for use by the general public and that maintaining safe and
lawful public use is one of the primary lake management objectives of Duke Energy.
Page 2 of 5
Rev 11/9/2016

I/we understand the use for which we are applying is a private use and it should not interfere with
the general public's safe and lawful use of the lake.
Ihve understand lake use permit holders have the authority to prevent others from trespassing on
the facilities I/tive have built. Ave also understand Ave, however, do not have any authority to
impede anyone from pursuit of the lawful public recreation enjoyment of FERC Project lands
and waters. Except as specified otherwise in the SMG, other Duke Energy documents (e.g.
Public Safety Plans), or a separate lease agreement, anyone may fish around/under facilities built
by others, may walk/wade/fish within the FERC Project boundary, boat in the lake's waters, etc.
without having to get anyone's permission to do so.
Five agree to fully disclose all information regarding the approved private facility to any
prospective buyer/leaseholder of the property and any new owner/leaseholder. Ave agree to
notify Duke Energy immediately of any sale/transfer of the property, including the name and
address of the new owner and to transfer the permit and/or Duke Energy lease to the new owner.
Ihve agree the adjacent Duke Energy Project property, if any, shall be used exclusively for non-
commercial recreational purposes and that Ave shall not rent or otherwise allow third parties
(except for temporary use by guests, family members, and leaseholders of the residential
property) to use any facilities permitted to me/us by Duke Energy.
Ave agree not to allow any use of the adjacent property, and will exercise due care and diligence
to prevent all other persons that are affiliated with i y/our property (including invitees, family
members, guests, etc.),to violate an applicable federal, state or local law or regulation. Examples
include, but are not limited to nudity, illegal discharge of firearms or fireworks, controlled
substance abuse, public drunkenness, public urination or defecation, or other activities
detennined to be a nuisance by law enforcement officials.
Ave agree to exercise all care and due diligence to preserve and maintain the character of the
Duke Energy's adjacent property, if any. I ve agree to comply with the Duke Energy vegetation
management requirements as stated in the SMG. IAve agree further to not allow sewage,
including discharge from septic tanks (or similar facilities) or boat holding tanks, garbage, trash,
or other waste material to be discharged or dumped into the reservoir, tributaries or adjacent
property.
A-ve understand that as an adjoining property owner Ave can make no change in land form of
land within the FERC Project boundary or land owned by Duke Energy, if any, such as grading,
excavation or filling without prior written approval by Duke Energy.
Uwe agree for myself/ourselves, members of my/our family, guests and invitees that Ave assume
all risks of personal injury or property damage incident to mylow, occupancy and use of the
FERC Project boundary or land owned by Duke Energy, if any; including,but not limited to,a ny
personal injury or property damage which may be sustained as a result of flood waters or in
connection with the rise and fall of water in the reservoir as a result of floods or of the operation
of Duke Energy's hydroelectric facilities. Ave as the adjoining property owner(s) further agree
Ave will indemnify, protect, defend, and save harmless Duke Energy from any and all loss, cost,
Page 3 of
Rev II/9/2016

claims damages, expenses, judgments and causes of action for all injuries and damages sustained
by the members of my/our• family, guests, and invitees arising or claimed to have arisen in
connection with their occupancy or use of the Duke Energy permitted facility(s).
Ihve agree if any action is taken by Duke Energy to enforce any provision, covenant or
agreement contained in this user agreement or Duke Energy SMG or if Duke Energy is required
to retain an attorney to enforce any provision, covenant or agreement contained in this user
agreement or SMG (including, without limitation, the payment of fees due hereunder or the
removal of an encroachment constructed in violation of this user agreement or SMG), then Duke
Energy shall be entitled to recover all of its reasonable costs associated with such an action,
including but not limited to, attorneys' fees and court costs incurred in such action and/or
enforcement.
I/1ve understand certain activities specified in the SMG are prohibited because of environmental
concerns, boating capacity limitations, safety considerations and other reasons.
Ave specifically waive any claim against Duke Energy for consequential damages arising out of
or relating to this application, Duke Energy's approval or denial of it, or subsequent revocation
of approval, and Ave specifically understand and acknowledge that, because Duke Energy can
revoke the permitted use at any time, I/we am/are not entitled to reliance damages.
Ave understand the proposed facility will be used only for the purposes described in the
information submitted to Duke Energy and other appropriate governing bodies for approval.
Ave understand every reasonable effort must be made to minimize adverse impacts on fish,
wildlife, and other natural resources.
Ave understand trees and vegetation growing within the Project boundary play an important role
in the overall environmental condition of the lake. The ecological benefit the vegetation has on
the fish and wildlife habitat supports a sound and healthy lake environment. I/tive also understand
unauthorized removal of shoreline vegetation and/or disturbance of the shoreline buffer may
result in suspension or denial of lake use permitting requests and require n7e/us to re-establish the
vegetation, if the disturbance is found to be in violation of the state or county watershed buffer
regulations or Duke Energy's vegetation management requirements as stated in the SMG.
Ihve agree to maintain any prescribed mitigation activities that are required in order to gain
approval for facility construction, as long as the facility exists.
Five recognize I/ive have the continuing responsibility to ensure that the constructed facilities are
maintained in good repair, including, but not limited to maintenance of the facilities, and proper
erosion control within the permit area and along the shoreline, and agree to take all reasonable
steps necessary to meet this responsibility. I/we agree to maintain all facilities within the Project
boundary and on Duke Energy -owned property, if any, in a sound condition and in a neat
appearance and pay all costs for said maintenance.
Page 4 of S
Rev I U9R016

Ave understand Duke Energy representatives may issue Stop Work Directives for any
violation(s) of the SMG or engagement in prohibited acts or activities on Duke Energy property,
if any, as specifically identified in the SMG. I/we understand persons found to be in violation
will be subject to Duke Energy sanctions which can include, but are not necessarily limited to: 1)
restoration of the impacted area at the person's expense; 2) loss of consideration of any future
lake use permitting activities for up to five years for improper vegetation removal or until
vegetation is satisfactorily re-established (even if there is a change in property ownership); 3)
revocation of a previously issued permit and loss of consideration of any fiiture lake use
permitting activities and/or reinstatement of the revoked permit; 4) increase in fees; 5)
modification or removal of non -complying facilities; and/or 6) further legal action being taken
by Duke Energy.
Ywe agree that if any historic or archaeological resources are discovered during construction of
an approved activity the applicant must stop work immediately and contact Duke Energy. Ave
understand that in the event that anyone discovers a potential site of archaeological or historic
significance including any gravesite within the Project, the individual must immediately notify
Duke Energy.
Five acknowledge Duke Energy has the right to charge reasonable user's fees for private use of
its property, if any, and the Project and failure to pay any applicable user's fees in a timely
manner can result in the suspension or cancellation of any previously approved lake use permit.
Ave agree to notify Duke Energy when construction is completed and during the construction
period, I/tive will post the Duke Energy approval (to be provided by Duke Energy) at the job site
visible from the water's edge.
Pfo -&S
A plic nt Name r�
Lake Street Address
City/State/Zip Code
636-&67-'{79-1
Preferred contact Phone Number
a.ndnya. yordpe-r#esx6.ewu
Email Address
Page 5 of 5
Appli ant Signature
.a -&66g
Home Mailing Address
City/Sta -r71336,-F71-aa/9
Home Phone Number
61a7/ V4e
Date
Rev 11/9/2016

DUKE ENERGY INTERNAL USE ONLY Construction DUKE
Date Received F App Fee Amt LYS Application ENERGY
ersion 1a
Check # Check Date v
Duke 8Energy Lake Services
Mail Code EC12Q
526 S. Church St.
Site ID — HEP Fee Charlotte, NC 28202
I. APPLICANT INFORMATION (applicant mailing address and contact information)
Name* J & �-05 5
Primary Phone*
33G (vDZ �}�l8'1
Address* O Qa)O
Secondary Phone
3 Z�i�4' 23o
City* W x�n State* A f 1�
V V IV
Zip Code
Email
II. PROPERTY INFORMATION (location of permit)
Is there an existing dock or other facilities El Yes (If yes, include Dock Tag #)*
along the shoreline property or over the Lake? u 0
Address* � �
County*
City* TP.xre-lt State* © Z.ip•Code*2
OlQ c?/ O p /1 Lake*
ID�rnUJL�
Subdivision Nf A
Lots)
To enter the Latitude and Longitude of the property, please use
a service/software to acquire the location information. Values
Latitude (e.g. 35.12345)*
should be provided in Decimal Degrees format (35.1245).
Example service: http:Hitouchmap.com/latlong.html
Longitude (e.g. -80.12345)*
III. PROPOSED ACTIVITY (check all that apply)
JNew/Modification of Existing Structure IIMaintenance of Existing Structure
7New/Modification of Existing Shoreline Stabilization ❑ Maintenance of Existing Shoreline Stabilization
Transfer of Ownership ❑ Other (please describe below)
Structure size (square Is dock covered? 1-1 Yes Number of slips
feet) 3zoa
No Number of jetports
Shoreline Stabilization (feet) Length ofa�''�� Distance from Shoreline
Stabilization �J
Brief Description of
the Activity
Describe Briefly the Existing
Structures Over Land and
Water (include sq ft)
Materials R* I �Wll
No 5`h vo- re' 6n +he- pd

IV. Checklist of Required Documents (to include with application submission)
Survey (stamped/signed by a professional licensed Applicable local, state, and federal permits
surveyor showing the location of the existing or F1Signed Applicant's User Agreement Letter
proposed structure and/or survey of the existing or
proposed stabilization) Plan and profile drawing showing all measurements
Photos along property shoreline and photos of any
existing structures and/or stabilization in or near the
water
Application fee (check only, payable to Duke Energy)
and elevations
Habitat Enhancement Program payment (if
applicable)
Please limit documents sizes to 11"X 17" or smaller.
V. Approval Process
• Application is reviewed and determined if complete. Fields with an asterisk are required,
• If application is not complete or does not include all items and information listed in the checklist, the application
will be returned as incomplete.
A Duke Energy representative will visit the site to conduct a visual inspection.
Applicant will be notified of approval or denial.
Applicant is to have the notice, to be supplied by Duke Energy upon application approval, posted and must be
viewable from water. The notice must remain posted until a representative inspects the project and
determines the project is complete and within the approval specifications.
VI. Directions by Road
Directions by Road*
1!3D -�D tv'-W �(afd P&ncl
�-ewl l
qu� te�
qo loo--Ii'r �Ijlack. �a.il
VII. Application Submission
Please complete, print and sign this application. Then enclose all items from the checklist above and submit all the
information to the address below.
Duke Energy Lake Services
Mail Code EC12Q
526 S. Church St.
Charlotte, NC 28202
I agree the information contained within is accu

La ke
(At Full Pond/ Normal Water Level)
Full Pond/
Normal Water Level
Shoreline
I n1 cc e, A rt. '110
p65+5 �)r a
dock or)
�fi, '% rrvp&'�
bt
2-75-14
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
t, ' Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
✓� 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.
WIA 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

L _
I
PS 67-192
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_____.._..___._
P867-192
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- MARVIN WILLIAM
\^+\ I
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6 554 AC +-
DB 3024-1827
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PB 42-105 1
I � My,�, r•k� _ r' i
u I PS 42-105
PB 42-105
r PB 42.105
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PB 42-105
;•%::. r �n,(. cs?:an -aeo+� °'�' Oa 0 6o Iza leo .r/ P842-105
'fit b -
,�'" GRAPHIC SCALE - M,,, ri
DEDMON SURVEYS AucusT 16. zol7 6B: 3024 lezT PG
PHYSICAL. SURVEY
SCALE: I' PG FOR
`� K• ��- CHUCK POOVEY, PLS #3762
ROBERT DEDMON, PLS #3899 MOUHLVN CREEK TOWr15HiF ANDREA WITHERSPOON
'g .� - - - 3704 NC HIGHWAY #16 NORTH CATAWBA COInOY. NC
P.O. BOX 494 - DENVER, NC !8037
PHONE: [phone]
FAX: [phone] 4005 KISER IWI10 RD - TERRELL NC
aSEa muuC.0 Da SURV er JR DRAWN: RD 000,4 —.005 PIN 4617-0452-0969
VANY.0mhI0N5URVEYS.COhI

Applicability
These fees and deposits apply as noted to all allowable, non -exempted lake use requests on the
following reservoirs managed by Duke Energy:
Bear Creek Lake
Belews Lake
Blewett Falls Lake
Cedar Cliff Lake
Cedar Creek Lake
Fishing Creek Lake
Gaston Shoals Lake
Great Falls Lake
Lake Glenville
Lake Hickory
Lake James
Lake Jocassee
Lake Keowee
Lake Norman V/
Lake Rhodhiss
Lake Robinson
Lake Summit
Lake Tillery
Lake Wateree
Lake Wylie
Lookout Shoals Lake
Mountain Island Lake
Nantahala Lake
Ninety -Nine Islands
Lake
Rocky Creek Lake
Wolf Creek Lake
Habitat Enhancement Fee
For requests on Catawba-Wateree and Keowee-Toxaway reservoirs, a separate Habitat
Enhancement Program (HEP) fee may also be required. See the website (Catq",ba-Wateree
1 -IEP; Keowee-Toxaway. HLP) or contact Lake Services for additional information.
Refunds
• Application filing fees will only be refunded if the applicant withdraws the application prior
to its approval by Lake Services or if the application is denied by Lake Services.
• Security deposits will be refunded provided no violations of the Shoreline Management
Guidelines occur.
Enforcement Fee Schedule
Refusal to remove an unapproved, dilapidated, or unsafe structure: In the event an
adjoining property owner refuses to remove unapproved, dilapidated or unsafe structures,
Duke Energy may remove it. Additional consequences may include loss of consideration for
lake use permitting activities until the cost of removal, which includes all removal costs
including Duke Energy or contractor expenses, landfill fees, and a set management fee of
$1,000, is paid.
Unauthorized structure built within the Project Boundaries: After -the -fact applications
may be accepted if the unauthorized structure conforms to specific requirements. The fee
will be twice the current permit fee to cover additional processing costs. Non -complying
structures will be subject to modification or removal and restoration of disturbed areas at the
owner's expense.
Revisions
• Duke Energy may revise this fee schedule without notice.

DUKE ENERGY PRIVATE FACILITIES
"APPLICANT'S USER AGREEMENT"
(Fill in blanks with required information.P lease Print)
W
TO: Duke Energy
c/o Lake Services - EC 12Q
526 S. Church Street
Charlotte, NC 28202
RE: (Lake Name)
(Lake Address) Kj� 4AIand
NJ SA), k
(Applicant's full name) hereby
agrees to comply with all requirements and conditions set forth by buke Energy's Lake Services
(Duke Energy) office, and any federal, state or local agencies pertaining to our application to
constructas }d/or maintain a
a. C1_E11 4 on LakeAlmu)In addition,
I/we have read and agree to comply with Duke Energy's Shoreline Management Guidelines
(SMG) and understand that written authorization must be obtained from Duke Energy prior to
beginning any activity/construction within the Federal Energy Regulatory Commission (FERC)
Project boundary. The construction will be completed as described in the approved application
and within twelve (12) months following the date of approval by Duke Energy. An extension
will be considered for legitimate extenuating circumstances (as determined by the sole discretion
of Duke Energy) provided a specific timeframe in which to complete the construction, not to
exceed an additional 12 months, is provided in writing to Duke Energy by the applicant. Failure
to complete construction within the 12 -month build -out period or any Duke Energy approved
extension will require the applicant to file a new application that complies with the then -current
SMG. The new application filing will include any applicable fees and security deposits.
I/we attest to be the owner or lease holder of the tract of land immediately adjoining the Project
boundary where the proposed private facility is to be constructed.
I/we agree to comply with all FERC orders (as modified or interpreted by FERC), with all other
applicable FERC Rules and Regulations implemented by Duke Energy, and with all rules or
regulations imposed on Duke Energy by any governmental agency.
Page 1 of 5
Rev 11/9/2016

I/we understand the physical location of my/our lot in relation to the common property line with
Duke Energy, if any, the FERC Project boundary, and any deeded flood easements or required
building setbacks.
I/we understand that this lake was constructed as a working hydropower reservoir for the primary
purpose of producing cost-effective electric energy and that this remains as the lake's primary
purpose. 1/we understand the lake and its associated hydroelectric facilities are operated by Duke
Energy under the terms of a license issued by the FERC and there will be no change in hydro
project operations as a result of the construction and/or use of any facilities that Uwe may be
allowed to place within the FERC Project boundary or on any Duke Energy -owned property.
Uwe understand during drought conditions Duke Energy may request reduced usage or
discontinued usage of any water withdrawal or related systems, until such drought conditions
improve. Failure to do so may cause possible removal of the system and/or any other permitted
facilities that I/we may have, and any costs associated with removal of the facilities will be
assessed to the lot owner.
I/we understand lake levels will rise and fall over time in response to weather events and hydro
project operations and Duke Energy does not guarantee an approved facility will always have
sufficient water depth to be accessible by boat or for other water depth related recreation
activities.
Uwe acknowledge Duke Energy provides no guarantee of any specific quantities (except those
identified in the FERC license) or quality of water in the lake.
I/we understand the facilities to be installed and/or maintained are my/our property and Uwe
therefore agree to be fully responsible for the permitted reservoir use including maintaining
facilities in good repair. If the private facility is deemed unsafe by Duke Energy, I/we agree to
repair or remove the private facility at my/our own expense and within the specified timeframe
set by Duke Energy.
I/we understand Duke Energy approval of the requested reservoir use in no way constitutes
assignment of any interest in real property Duke Energy may have (i.e. land rights). The approval
is granted and maintained solely at Duke Energy's discretion. I/we also understand the permitted
use may be revoked at any time by Duke Energy or its successors for any reason whatsoever. If
the approval is revoked, I/we agree to remove the facility at my/our own expense within the
specified timeframe set by Duke Energy.
I/we understand ownership/interest in a Common Use Facility or residential marina eliminates
the option of having a separate private facility on any other owned or leased lot within the
affected subdivision.
I/we understand this lake is open for use by the general public and that maintaining safe and
lawful public use is one of the primary lake management objectives of Duke Energy.
Page 2 of 5
Rev 11/9/2016

I/we understand the use for which we are applying is a private use and it should not interfere with
the general public's safe and lawful use of the lake.
I/we understand lake use permit holders have the authority to prevent others from trespassing on
the facilities I/we have built. I/we also understand I/we, however, do not have any authority to
impede anyone from pursuit of the lawful public recreation enjoyment of FERC Project lands
and waters. Except as specified otherwise in the SMG, other Duke Energy documents (e.g.
Public Safety Plans), or a separate lease agreement, anyone may fish around/under facilities built
by others, may walk/wade/fish within the FERC Project boundary, boat in the lake's waters, etc.
without having to get anyone's permission to do so.
Uwe agree to fully disclose all information regarding the approved private facility to any
prospective buyer/leaseholder of the property and any new owner/leaseholder. I/we agree to
notify Duke Energy immediately of any sale/transfer of the property, including the name and
address of the new owner and to transfer the permit and/or Duke Energy lease to the new owner.
Uwe agree the adjacent Duke Energy Project property, if any, shall be used exclusively for non-
commercial recreational purposes and that I/we shall not rent or otherwise allow third parties
(except for temporary use by guests, family members, and leaseholders of the residential
property) to use any facilities permitted to me/us by Duke Energy.
I/we agree not to allow any use of the adjacent property, and will exercise due care and diligence
to prevent all other persons that are affiliated with my/our property (including invitees, family
members, guests, etc.),to violate an applicable federal, state or local law or regulation. Examples
include, but are not limited to nudity, illegal discharge of firearms or fireworks, controlled
substance abuse, public drunkenness, public urination or defecation, or other activities
determined to be a nuisance by law enforcement officials.
I/we agree to exercise all care and due diligence to preserve and maintain the character of the
Duke Energy's adjacent property, if any. I/we agree to comply with the Duke Energy vegetation
management requirements as stated in the SMG. I/we agree further to not allow sewage,
including discharge from septic tanks (or similar facilities) or boat holding tanks, garbage, trash,
or other waste material to be discharged or dumped into the reservoir, tributaries or adjacent
property.
I/we understand that as an adjoining property owner I/we can make no change in land form of
land within the FERC Project boundary or land owned by Duke Energy, if any, such as grading,
excavation or filling without prior written approval by Duke Energy.
I/we agree for myself/ourselves, members of my/our family, guests and invitees that 1/we assume
all risks of personal injury or property damage incident to my/our occupancy and use of the
FERC Project boundary or land owned by Duke Energy, if any; including,but not limited to,a ny
personal injury or property damage which may be sustained as a result of flood waters or in
connection with the rise and fall of water in the reservoir as a result of floods or of the operation
of Duke Energy's hydroelectric facilities. Uwe as the adjoining property owner(s) further agree
1/we will indemnify, protect, defend, and save harmless Duke Energy from any and all loss, cost,
Page 3 of 5
Rev 11/9/2016

claims damages, expenses, judgments and causes of action for all injuries and damages sustained
by the members of my/our family, guests, and invitees arising or claimed to have arisen in
connection with their occupancy or use of the Duke Energy permitted facility(s).
I/we agree if any action is taken by Duke Energy to enforce any provision, covenant or
agreement contained in this user agreement or Duke Energy SMG or if Duke Energy is required
to retain an attorney to enforce any provision, covenant or agreement contained in this user
agreement or SMG (including, without limitation, the payment of fees due hereunder or the
removal of an encroachment constructed in violation of this user agreement or SMG), then Duke
Energy shall be entitled to recover all of its reasonable costs associated with such an action,
including but not limited to, attorneys' fees and court costs incurred in such action and/or
enforcement.
1/we understand certain activities specified in the SMG are prohibited because of environmental
concerns, boating capacity limitations, safety considerations and other reasons.
I/we specifically waive any claim against Duke Energy for consequential damages arising out of
or relating to this application, Duke Energy's approval or denial of it, or subsequent revocation
of approval, and I/we specifically understand and acknowledge that, because Duke Energy can
revoke the permitted use at any time, I/we am/are not entitled to reliance damages.
I/we understand the proposed facility will be used only for the purposes described in the
information submitted to Duke Energy and other appropriate governing bodies for approval.
I/we understand every reasonable effort must be made to minimize adverse impacts on fish,
wildlife, and other natural resources.
1/we understand trees and vegetation growing within the Project boundary play an important role
in the overall environmental condition of the lake. The ecological benefit the vegetation has on
the fish and wildlife habitat supports a sound and healthy lake environment. I/we also understand
unauthorized removal of shoreline vegetation and/or disturbance of the shoreline buffer may
result in suspension or denial of lake use permitting requests and require me/us to re-establish the
vegetation, if the disturbance is found to be in violation of the state or county watershed buffer
regulations or Duke Energy's vegetation management requirements as stated in the SMG.
I/we agree to maintain any prescribed mitigation activities that are required in order to gain
approval for facility construction, as long as the facility exists.
I/we recognize I/we have the continuing responsibility to ensure that the constructed facilities are
maintained in good repair, including, but not limited to maintenance of the facilities, and proper
erosion control within the permit area and along the shoreline, and agree to take all reasonable
steps necessary to meet this responsibility. I/we agree to maintain all facilities within the Project
boundary and on Duke Energy -owned property, if any, in a sound condition and in a neat
appearance and pay all costs for said maintenance.
Page 4 of 5
Rev 11/9/2016

I/we understand Duke Energy representatives may issue Stop Work Directives for any
violation(s) of the SMG or engagement in prohibited acts or activities on Duke Energy property,
if any, as specifically identified in the SMG. I/we understand persons found to be in violation
will be subject to Duke Energy sanctions which can include, but are not necessarily limited to: 1)
restoration of the impacted area at the person's expense; 2) loss of consideration of any future
lake use permitting activities for up to five years for improper vegetation removal or until
vegetation is satisfactorily re-established (even if there is a change in property ownership); 3)
revocation of a previously issued permit and loss of consideration of any future lake use
permitting activities and/or reinstatement of the revoked permit; 4) increase in fees; 5)
modification or removal of non -complying facilities; and/or 6) further legal action being taken
by Duke Energy.
1/we agree that if any historic or archaeological resources are discovered during construction of
an approved activity the applicant must stop work immediately and contact Duke Energy. I/we
understand that in the event that anyone discovers a potential site of archaeological or historic
significance including any gravesite within the Project, the individual must immediately notify
Duke Energy.
I/we acknowledge Duke Energy has the right to charge reasonable user's fees for private use of
its property, if any, and the Project and failure to pay any applicable user's fees in a timely
manner can result in the suspension or cancellation of any previously approved lake use permit.
1/we agree to notify Duke Energy when construction is completed and during the construction
period, I/we will post the Duke Energy approval (to be provided by Duke Energy) at the job site
visible from the water's edge.
A plic nt Name r�
Lake Street Address
�ztieza, / .6 . m4(0
City/State/Zip Code
,&36 -& D 7- X87
Preferred contact Phone Number
a ndrea. 61�,��ncypropu l�s�1�.
Email Address
Page 5 of 5
Appli ant Signature
_ .6 - f&6o
Home Mailing Address
City/Sta e
7-aa�8
Home Phone Number
Date
�Z7 /off) /CJ
Rev 11/9/2016

CATAWBA THIS IS NOT A PERMIT
COUNTY CATAWBA COUNTY HEALTH DEPARTMENT
North Cor-- Application for Environmental Services
Application is for: New Construction ❑ Existing Facility
❑ Improvement Permit ❑ Authorization to Construct
[j New Septic ❑ Septic Repair/Malfunction ❑ Septic Relocation ❑ Septic Expansion
❑ Existing System Inspection or Reconnection
['New Well ❑ Replacement Well ❑ Well Abandonment ❑ Well Repair
Property Address 7465 /`USP.YLlan� �CGL1L7
%P, & a. ffe, SGB
Subdivision 0
Lot # Acres
Applicant Contact Information
Name n�Wn Wkf 94 )K -C4` r I
Address Telp-r---6n C Z�
Phone 336 . 1 Cell Phone 331 •gyp?. 4197
Owner Contact Information
Name
Address QCj �,ph C
Phone . 23p 77 Cell Phone 3 7- L� �
Lontractor luontact tntormation
Name fG 9 T -License #
Addresse-
�C
Phone jD6- 52/,f / Cell Phone
Name to Appear on Permit? [Owner ❑ Applicant ❑ Contractor
Who will be the Primary Contact? Owner ❑ Applicant ❑ Contractor
Existing Structures on Site?
❑ Yes [oNo If yes, describe
# of Bedrooms * # of Occupants Stricture Dimensions
Basement ElYes No Basement Plumbing ❑ Yes ❑ No
Existing Water Supply?
❑ Individual Well ❑ Community Well ❑ County/City/Township Water Line
Is a public water supply available? ** ❑ Yes [ I�Io
Well Construction/Abandonment/Repair
Proposed Well Type dividual Well ❑ Semi -Public Well ❑ Community Well
Abandonment Type LV Drilled ❑ Bored ❑ Dug ❑ Unknown
Well Repair Requested ❑ Yes ❑ No Describe
Will Certified Well Contractor Install Water Line or Electrical Line from Well Head to Pressure Tank? es ❑ No

CATAWBA
COUNTY
North Carolina
THIS IS NOT A PERMIT
CATAWBA COUNTY HEALTH DEPARTMENT
Application for Environmental Services
Proposed New Construction - Residential
Primary Residence [i7 New Residence ❑ Addition to Residence # of New Bedrooms *t4
Project Description Horne,
Structure Dimensions (sol X 20 # of Occupants ,
Basement ❑ Yes [VNo Basement Plumbing ❑ Yes ❑ No
Accessory Structure(s) Describe
Plumbing ❑ Yes ❑ No
Accessory Dwelling ❑ Yes
Structure Dimensions
Describe Plumbing Needed
❑ No # of New Bedrooms *t # of Occupants
Proposed New Construction - Commercial
Food Service Specify Type
# Seats
# Employees per Shift
Business/Other Specify Type
Floor Space -Entire Food Service Facility (Sq. Ft.)
# of Shifts Dining Area (Sq. Ft.)
Structure Dimensions
Retail Floor Space # of Employees per Shift # of Shifts
If Church # of Seats Commercial Kitchen r_1Yes ❑ No
If Daycare, # of Children
If Multi -Family Residence, # of Apartments #Bedrooms per Apartment*t
Other Information
Calculated Design Flow, Commercial t
Total # Bedrooms *t
(This value will be determined by EH staff)
The Applicant shall notify the local health department upon submittal of this application if any of the following apply to
the property in question. If the answer to any question is "yes", applicant must attach supporting documentation.
❑ Yes 3'-N- o Does the site contain any jurisdictional wetlands?
❑ Yes 3'1lo Does the site contain any existing wastewater systems?
❑ Yes allo Is any wastewater going to be generated on the site other than domestic sewage?
❑ Yes Cd'No Is the site subject to approval by any other public agency? nn
21 es ❑ No Are there any easements or right of ways on this property? Describe �CQQ J CI
If applying for an Improvement Permit or Authorization to Construct, Please Indicate Desired System Type(s):
(systems can be ranked in order of your reference)
ElAccepted ❑ Alternative L onventional ❑ Innovative ❑ Other ❑ Any
*Any room that will be intended for sleeping at the time of construction or for future consideration should be noted as a bedroom and counted
on all applications. The number of bedrooms will be confirmed by rooms identified on floor plans as a bedroom at the time of building permit
issuance. This may prevent the need for septic system expansion in the future.
t If structure is plumbed but has no bedrooms, calculated design flow will be determined by EH Staff.
** If No, a well permit must be issued with the Authorization to Construct.
RETRIP TO THE PROPERTY AND/OR SYSTEM REDESIGN WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE)
Completed applications are valid for a period of 2 years. Improvement Permits are valid: with complete site plan = 60 months (5 years);
with complete plat = without expiration. An Authorization to Construct will remain valid as long as the Improvement Permit is valid.
Permits may be revoked if the information on this application/site plan changes or if the intended use for the proposed facility changes.
Permits may be revoked if site conditions are altered such that they effect permit conditions or installation requirements.
I have read this application and certify that the information provided herein is true, complete and correct. Authorized county and state
officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and riles. I
understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site
accessible so that a complete site evaluation can be performed.
The undersigned is the owner of the rop I or legal ,t�e owner.
Signature of Owner or Legal Age t ��y=F� GJ Date .?O
Printed Name of Owner or Legal Agen

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SOIL/SITE EVALUATION
for ON-SITE WASTEWATER SYSTEM
OWNER: William Jenrette
ADDRESS:_6208 Splitrock Tr., Apex, NC 27
PROPOSED FACILITY: 4 bdrm
LOCATION OF SITE: 4005 Kiser Island Rd
WATER SUPPLY: u Private Public
PROPOSED DESIGN FLOW (.1949):480 GPD
E Well Spring Other
Sheet _I _ of _2
PROPERTY ID #: 461704620969
COUNTY: Catawba
APPLICATION DATE
DATE EVALUATED: _
PROPERTY SIZE: _6.5 AC
PROPERTY RECORDED:
EVALUATION METHOD: E Auger Boring E Pit Cut TYPE OF WASTEWATER: —7 Sewage Industrial Process Mixed
P
R
F
I
L
E
#
.1940
LANDSCAPE
POSITION/
SLOPE %
HORIZON
DEPTH
(IN.)
SOIL MORPHOLOGY
(.1941)
OTHER
PROFILE FACTORS
PROFILE
CLASS
& LTAR
.1941
STRUCTURE/
TEXTURE
.1941
CONSISTENCE/
MINERALOGY
1942
SOIL
WETNESS/
COLOR
.1943
SOIL
DEPTH
.1956
SAPRO
CLASS
.1944
RESTR
HORIZ
PIT
1
LS 6%
0-14
RBr SCL WSBK
FR SS SP SEXP
Few YB @ 40"
50"
N/A
N/A
PS 0.3 TO
40"
14-50
R C SBK
FR SS SP SEXP
PIT
2
LS 6%
0-7
RBr SCL WSBK
FR SS SP SEXP
N/A
52"
F -C SAP
PS
N/A
PS 0.3
7-39
R C SBK
FR SS SP SEXP
39-52
R CL WSBK
FR SS SP SEXP
52-61
VER SL SAP M
VFR SS SP SEXP
PIT
3
LS 6%
0-9 1
RBr SCL WSBK
FR SS SP SEXP
YB
CHR 2 @ 38"
3805
Few SAP
N/A
PS 0.3 TO
36"
9-36
R C SBK
FR SS SP SEXP
36-56
R CL WSBK
FR SS SP SEXP
PIT
4
LS 6%
0-24
R CL WSBK
FR SS SP SEXP
N/A
24"
F -C SAP
PS
N/A
PS 0.3-0.4
24-60
VER L SAP M
VFR SS SP SEXP
DESCRIPTION
INITIAL SYSTEM
REPAIR SYSTEM
OTHER FACTORS (.1946):
SITE CLASSIFICATION (.1948): PS
Available Space (.1945)
1200 FT2
810 FT2
EVALUATED BY: MA&A
System Type(s)
25% Reduction
PPBPS
OTHER(S) PRESENT:
Site LTAR
0.3
0.3
COMMENI

SOIL/SITE EVALUATION Sheet _z_ of_2_
(C077 till tlatiO17 Sheet)
PROPERTY ID #: 461704620969
DATE OF EVALUATION:
COUNTY: Catawba
P
R
F
1
E
#
1940
LANDSCAPE
POSITION/
SLOPE %
HORIZ
ON
DEPTH
D
(IN)
SOIL MORPHOLOGY
(.1941)
OTHER
PROFILE FACTORS
PROFILE
CLASS
& LTAR
.1941
STRUCTURE/
TEXTURE
.1941
CONSISTENCE/
MINERALOGY
.1942
SOIL
WETNESS/
COLOR
.1943
SOIL
DEPTH
.1956
SAPRO
CLASS
.1944
RESTR
HORIZ
PIT
5
LS 6%
0-5
Br SCL WSBK
FR SS SP SEXP
N/A
48"
F -C SAP
PS
N/A
PS 0.3
I
I
5-18
R C SBK
FR SS SP SEXP
18-48
R CL WSBK
FR SS SP SEXP
48-60
VER SL SAP M
VFR SS SP SEXP
AB
1
LS 6%
0-26
RC SBK
FR SS SP SEXP
N/A
36"
F -C SAP
N/A
PS 0.3
26-36
R CL WSBK
FR SS SP SEXP
36-48
VER SL SAP M
VFR SS SP SEXP
AB
2
LS 6%
0-16
R CL WSBK
FR SS SP SEXP
N/A
16"
F -C SAP
N/A
PS 0.4 -
0.6
16-48
VER L SAP M
FR SS SP SEXP
AB
3
LS 6%
0-18
R C SBK
FR SS SP SEXP
N/A
32"
F -C SAP
N/A
PS 0.3
18-32
R CL WSBK
FR SS SP SEXP
32-48
VER L SAP M
VFR SS SP SEXP
[KIJ010v100411611

MICHAEL ATHANAS & ASSOCIATES
LICENSED SOIL SCIENTIST
561 Ennis Rd.
Weddington, NC 28173
[phone]
Reference: Data Sheet for 4005 Kiser Island Rd.
House Footprint: See attached plan
Building Setbacks: 30' front/rear, 15' side, 30' lake
Water Source: Private well
Number of Bedrooms: 4/480 GPD
Proposed LTAR: 0.3 GPD/FT2
Proposed System Type: 25% Reduction
Proposed Repair System Type: PPBPS
Distribution: End cap/Drop box
Septic Tank Size: 1000 gallons
Proposed Trench Bottom: 20" (initial), 36" (repair)
Line Design Length Actual Length
White 1 110' 160'
Pink 2 110' 140'
Blue 3 100' 105'
Orange 4 80' 80'
Initial System: 400'
comments!
This property is 6.5 AC. MA&A have laid out the initial system and we have shown a PPBPS
area for repair because we did not evaluate the entire property.

I
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MARVIN WILLIAMS
DB 3305-1698
6.554 AC +-
DB 3024-1827
j
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90 120 180
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Il IiT.�.`�.. i I
fGRAPHIC SCALE - FEET ,
mINITY YAP AUGUST 16, 2017 De: 3024 PG: 1827 PHYSICAL SURVEY
„o o,n, raw. �.x DEDMON SURVEYS SCALE: I' = 60' P� FOR
rhe _ CHUCK POOVEY, PLS #3762
s - ROBERT DEDMON PLS #3899 MOUNTAIN CREEK TOWNSHIP ANDREA WITHERSPOON
.u.,rowesxeR .� - 3704 NC HIGHWAY NORTH CATAWBA COUNTY, NO
P.O. BOX 494 -DENVER, NC 28037
srre ��o,w «ow >ux. ""`0f'°"- PHONE: [phone]
FAX: [phone] KISERISLAND RD - TERRELL, NO
W VJVJ.OEDMONSURVEYS.COM
gsEe cauuoHS GR SURV. BY: JR DRAWN: RO JOB# WK14005 PIN 4617-0462-0969

Carolina Pump and Well
Business Number: 3987 well drillers license
363 Taylor Springs Rd
Union Grove, NC
28689
P: 704-902-3027
[e-mail]
Bill To
Andrea Witherspoon
[e-mail]
Estimate EST0010
Date 02/15/2018
DIESCRIF'TION QTY
RATE
AMOUNT
Well Job
$5,500.00
$5,500.00
6" air drilled well up to 200' deep, PVC well casing up to
80' deep, grouted to state and county code 20' deep.
1/2HP 10gpm pump in well, 12/2 pump cable, 1" black
roll pipe down well, galvanized fittings on pump and thru
well seal, sanitary ABS well seal, 20 gallon bladder tank,
small rock well cover, up to 100' ditch with 1" sch40 PVC
to home with 12/2 OF cable in ditch.
Upcharges
$0.00
$0.00
Upcharges would be additional footage, larger pump,
Galvanized casing, deeper set on pump, larger tank,
larger cover, longer ditch, etc.
Any of these upcharges would be determined after the
depth and yield is established on the well.
Other Notes
$0.00
$0.00
1 supply the electrical line from the well to the house, but
I do not make those connections. I do not go through
the wall on the home or plumb to the waterline in home.
Both of these are required per NC State codes to be
done by licensed electricians and plumbers, which I'm
not. I am a licensed well driller, License #3987.
Additional footage 1
$11.00
$11.00
Anything over 200' will be 11.00 per ft
Total $5,511.00