20181262 Ver 1_Shoreline Stabilization_20180912

State of North Carolina
Department of Environment and Natural Resources
DWR 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 2 0 1 8' 2 6401 & Buffer Permitting Unit DN(L
O 2
1617 Mail Service Center
Raleigh, NC 27699-1617 a h
I
I. Applicant Information [15A NCAC 02H .0502(a)] VA1
1. Owner Information
Name:LLE Zasov)
Mailing Address:
1 Amresy, l le', N(, ZFi 117
Telephone Number: ID4- 3( -Ci Fax Number:
E-mail Address: "4) 1)*dlcurn0M )Mcy, < <G . C0 Im
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.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: T)on o ct _P 14r {)O T
Company Affiliation: Layl 5-'er5 (I�S�DVYI ►mac �'ri �i �.1� } �iu5%erYl s 1 ✓!c.
Mailing Address: per-wl
\ m +Yv ru,!i L 281 WD
Telephone Number: `-5D4 -6909 Fax Number: -704- rJZJB'cJ�C�
E-mail Address: Anvir-Aoc_111:5 I , Co
Person to receive the Certification Approval: Vi r
II. Project Information [15A NCAC 02H .0502(a) & (b)]
1. Attach a vicinity map (i.e. street map) clearly showing the location of the property with
respect to local landmarks such as towns, rivers, and roads.
2. Provide a detailed site plan showing property boundaries and proposed locations of
vegetation clearing, structures (buildings, retaining walls, docks, impervious surfaces,
FORM: SSGP 10-2013 Page 1 of 3

etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
and construction access corridors. You may use the diagram provided at the end of this
application form.
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale
of some sort- a yard stick, shovel handle, etc.)
4. Location of the property (where work is to be conducted}) � �
County: I r e.c', e I I Nearest Town: 1 1 p) / e5 V l
Subdivision name or site address (include phase/lot number): Y'CcC.+ I
Directions to site - please include road names and numbers, landmarks, etc.: V'rn VYL`
1-17 NL) +r.L )e Cx►133, leis- on4n W I l icymss Imo.. 1 -�-
Latitude (in decimal degrees)
D r,
Longitude (decimal degrees) —ED. 080303
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.):��Slden l L -o+
6. Property size (acres): 6Q , 0 � ) C3 QclreS
7. Lake/ river/ ocean adjacent to property: N o ✓ ma'n
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): ,rc-dQe QYrr, fir• bock- b 1; D Ci`Cress.
9. Will work be conducted from land? ['� From water?
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool lake level/ Normal Water Level in square feet or acres:
, D(o 3A nr)rrs
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres: (/)
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 feet landward to be impacted (number of trees, for instance): (U
C -v8-30-8
Owner A nt's Signature [15A NCAC 02H .0502(f)) Date
Age signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

La ke
(At Full Pond/ No r�zal Water Level)
� 1
NCV
IV
Full Pond/
Normal Water Level
� _'''
Shoreline
5x3
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

p-
----------
IPF
zt
0PT9
1 -A-il F
DISCLAIMERo
C11H Hf-Aklt�k-1
SURVEY PROVIDE BY CLIENT, ALL PROJECTION LINES ARE
ml9p7
ESTIMATED AND WOULD REQUIRE A LICENSED SURVEYOR
11).15 53, -.6,14 L
TO ACCURATELY LOCATE PIER 13N PROPERTY TO ENSURE
N13'23'93"F
THAT IT MEETS ALL DUKE LAKE SHORE MANAGEvENT AND
172
COUNTY REGULATIONS
JAY SHOTT
�K
7S,75'
AP_ WT�7S � DE
139 TPJCT I TRAVIS POW OR
R/V- I — 10"N ARFA Nc.rx)T Riw
REDELL COWN, NC
R21p1l
CA
KA( : 1 212,948.10 I.Q. 41, 9,A1jj4 q. f,,, v-:.
226.03
6.)66 acres 0.213 acre
160.3
-RAC- 2 J.
6,,tIF
j 3
p-
----------
IPF
zt
0PT9
1 -A-il F
CURW
C11H Hf-Aklt�k-1
C,t
4qI1
cl
11).15 53, -.6,14 L
39,24
CURVL IABL.-;
CURW
IFN(ifi, RADIJ1.5
C,t
cl
31,63
39,24
N13'23'93"F
172
7()142
176.03
7424056'50'6V
7S,75'
C.3
83,43
19R,14
N25°56'56'V
R21p1l
CA
101,21
226.03
-1;2S*03'16"F
160.3
C5
6,,tIF
148.14
61.6,"
"'1011715W,
64.67'

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Sh CA kla � s, L_ LC_
Project Name/address: ✓yl ✓l� ( V County: Yede�
-2-811,7
,
Owner:
Pri
Contractor/agent:
The approval is for the purpose and design described in your application. Impacts not indicated in the
application is a violation of the Buffer Rule. Site specific work should be provided in the application. [15A
NCAC 02H .0506 and 15A NCAC 02B .0243(8)]
Trees are not allowed to be removed from Zone 1 of the Buffer (within 30 ft of the full pond elevation), unless
approved. Exception, those trees that are severely undermined along the immediate shoreline can be
removed. Minimal shaping and sloping along the immediate shoreline is allowed. [15A NCAC 02B.0243(6)]
Benching, grading in the buffer is not allowed. Excessive disturbance of ground cover. [15A NCAC 02B .0243
(6)]
Beaches, impervious patios, impervious walkways, etc. are not allowed in the buffer unless specifically
approved by the Division. There are limitation on size for decks. [15A NCAC 02B.0243(4) and (6)]
Work to be conducted from land must indicate an access and indicate any trees that are to be removed. The
work corridor should be described. The approved access corridor shall be restored. Staging, spoil, construction
material must be outside the buffer. [15A NCAC 02H.0502 and 15A NCAC 0213.0243 (4), (6), (8)]
Stormwater cannot be piped or channeled for direct discharge to the lake. All constructed stormwater
discharges must be at the natural elevation and discharged prior to entering the buffer directed as diffuse or
sheet flow at non-erosive velocities to the lake. [15A NCAC 02B.0243(5), (6)]
Acknowledgement of Notification
I, _�V1 C. er o hereby state that I have been informed of the Catawba
Riparian Buffer Rule. Any work conducted in the buffer, not specifically stated in the application and approved
by the Division of Water Resources (DWR), is a violation and subject to enforcement. Due diligence will be
taken such that the construction will be built within substantial compliance and intent of the 401 Water
Quality Certification and Buffer Rules, the approved plan(s) and specification(s), and other supporting
materials.
(
Signature owner . Date: �+
g

Duke Energy Lake Services
Guidance for Completing an Excavation Permit Application
Step 1: Contact Duke Energy Lake Services
Complete "Part I" of the application and contact Duke Energy Lake Services to schedule a site
visit. Lake Services will conduct a site visit to determine if Duke Energy will accept an
excavation permit application for the proposed work. If the Lake Services representative
determines the application process may proceed, he/she will initial Part I of the application.
Step 2: Draft Application Development
Complete Parts II-III.A-G and Part V of the Excavation Permit Application.
Note: If you are proposing excavation in association with the permitting of a facility under the
Marina or Conveyance Programs, you do not need to complete this application. Instead, you
should incorporate the excavation request into the permit application for the marina/conveyance
using the appropriate application forms.
Step 3: Agency Consultation
Send the draft application developed during Step 2 to the agencies for review and comment on
the proposed activity. Refer to the Agency / Organization List available from Duke Energy to
determine which federal, state, regional, and local agencies and organizations require
consultation or review.
Note: Duke Energy reserves the right to require consultation with additional organizations
beyond those included in the Agency / Organization List.
Each agency / organization must be provided at least 30 days prior notification. Evidence must
be provided (e.g., response letter or Certified Mail receipt) in the complete application to show
each agency / organization was given the opportunity to review the proposal.
Consultation letters must be dated within the two years preceding Duke Energy's receipt of the
application. All permits must be valid at time of application and have a term longer than the
projected schedule for completing the permitted project.
What to Expect During Agency Review and Comment:
• You will typically receive a letter from each agency / organization either documenting its
concurrence with your proposal, requiring additional information, recommending
modifications, or offering no comment. You must address each agency's / organization's
comments with a follow-up letter and in your final application as described in part IV.
If you do not receive any documentation from an agency / organization within 30 days of its
receipt of your proposal, you must provide the agency / organization with a follow-up letter
requesting comment on your proposal within 15 days from the date of the follow-up letter. If
you still do not receive any response as a result of the second letter, type "NO RESPONSE"
at the top of the follow-up letter and include it in the application along with proof of the
agency's / organization's receipt of the letter (e.g., Certified Mail receipt). You may proceed
Duke Energy Page 1 of 14 rev 6/20/17
Excavation Program.

with the application process recognizing, however, that if its comments come later in the
application process, you will be required to address them.
From the United States Army Corps of Engineers (Corps): (* * Note — The Corps may have
additional forms to submit for your proposal and an additional fee.) If the excavation can be
done under the requirements of the General Permit (GP) or a Nationwide Permit (NWP), you
will typically receive a copy of the Corps' tear sheet documenting authorization and
providing any additional instructions. If the excavation isn't covered under the GP or a
NWP, you'll be required to obtain an individual 404 Dredge and Fill permit from the Corps.
You must receive written documentation from the Corps that your application either (1)
meets the requirements of the GP or a NWP or (2) the proper 404 Dredge and Fill permit has
been received before Duke Energy can process your application.
• From the North Carolina Department of Environmental Quality (NCDEQ), Division of
Water Resources: (Note NCDEQ may have additional forms to submit for your proposal
and an additional fee.) If the proposal meets the requirements of the Clean Water Act Sect.
401 Water Quality Certification, you will typically receive a letter from the NCDEQ Division
of Water Resources documenting Sect. 401 Certification and providing any additional
instructions. You may also receive a letter requiring additional information or
recommending modifications. You must receive written documentation from NCDEQ
noting any required Sect. 401 Certification has been received before Duke Energy can
process your application.
• From the North Carolina Wildlife Resources Commission (NCWRC): 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 without submitting a follow-up request,
recognizing however if comments come in later in the application process, you will be
required to address them.
• From the South Carolina Department of Health and Environmental Control (SCDHEC):
(Note — SCDHEC may have additional forms to submit for your proposal and an additional
fee.) The SCDHEC conducts a joint application process with the USACOE in S.C. If the
proposal meets any applicable requirements of the Clean Water Act Sect. 401 Water Quality
Certification, you will typically receive a letter from SCDHEC documenting Sect. 401
Certification and providing any additional instructions. You may also receive a letter from
USACOE requiring additional information for the agencies participating in the joint
application process. You must receive written documentation from SCDHEC noting Sect.
401 Certification has been received if required before Duke Energy can process your
application.
• From the South Carolina Institute of Archaeology and Anthropology (SCIAA): 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
without submitting a follow-up request, recognizing however if comments come in later in
the application review process, you will also be required to address them.
Duke Energy Page 2 of 14 rev 6/20/17
Excavation Program.

Duke Energy Excavation Permit Application Form
FOR DUKE ENERGY USE ONLY
Duke File No.
Application Fee S Security Deposit S Check # Date Recv'd Initials
Date of Duke Energy Lake Services, applicant and/or contractor on-site inspections Datc8f3 _ C- I ¢ Initials t
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 application.
Part I. Applicant Information (Please Print)
Name S51n0i+R0Idl or, S. LU
"3aSon C. C-2110* *—
Email address: i e,In r- % nG ttl
Lake Add ess
Telephone q RSO
Mailing Address (if different)
104 Oh s Int C_-
oDreb%Ai Ile. &'IIQ�_ MoorPSv, I le NG 22ja'5117
Contractor Company Uincwca r5 l LL51nm I)n Ai 4 U4 V54=rn 6_ In1C .
Contractor Contact Person Doli ne, Ni D Telephone (4 LS9 _60910
Contractor Email Address: (Any1 y) I CLyl C s r ancK s Q , MCU 1 Cn M
LAKE LOT INFORMATION
Lake County i+/'er4CI k City 900yebsVtI State&L Tax Map No.' &-433�p
Subdivision
Lot/ Section No.7irQLr_+ l Lot Size acres
Duke Energy Page 4 of 14 rev 6/20/17
Excavation Program.

Step 4: Final Application & Submittal to Duke Energy
Following the consultation process, finalize the application. The final application submitted to
Duke Energy should incorporate all comments and recommendations provided by agencies and
organizations during the agency consultation process as well as copies of all permits received. In
addition to the final application include the following:
• One check payable to Duke Energy for the application fee and security deposit
• If applicable, a separate check payable to the appropriate Habitat Enhancement Program fund
• Signed Excavation Program Applicant's Agreement
Note: Co -applicants must also submit the application fees and HEP fees, if applicable, with the
application.
Duke Energy Page 3 of 14 rev 6/20/17
Excavation Program.

Duke Energv Excavation Permit Application Form
Are there any Co -Applicants*? (check one) ❑Yes 2<o (If Yes, include names, street
addresses or lot numbers, pier numbers, phone numbers, and email addresses in Part V —
Additional Information)
* Co -Applicants exist when the proposed work is being done under a single application, will be
performed by a single contractor as one continuous project, and is done to benefit multiple
owners / lease holders of Project -front properties within a single development. There can be no
more than 4 co -applicants in addition to the lead applicant on any application.
Do not continue the application until an on-site inspection has been conducted between a
Duke Energy Lake Representative and the applicant and/or the excavation contractor.
NOTE. Initialling this portion of the application by a Lake Representative in no way
constitutes approval or eminent approval of the excavation or any other lake use permitting
activity.
Date of on=site inspection" O g>
Initials (Duke Energy) !
(applicant/contractor)
Duke Energy Page 5 of 14 rev 6/20/17
Excavation Program.

Duke Enemy Excavation Permit Application Form
Part II. Description of Project
A. Basic Info
1. Type of excavation: (check one)
2. Purpose of excavation: (check one)
❑ Water Intake Channel
❑ Other (specify):
3. Lake user category: (check one)
❑Commercial Marina
❑Other (specify):
a'1\1ew excavation ❑ Maintenance excavation
Coat Access Channel
❑ Wastewater Discharge Channel
05'rivate ❑Residential Marina
❑Public
4. Max. Exc yation Area Dimensions (ft): Length Width46-11-Z3 Gtr CU
Depth /V �(j Z4 Cha wel
(Note: include additional area dimensions if necessary so response to #5 below equals max. area
dimensions in 94)
5. Volume of Excavated Material (TOTAL for the project): /* SA Cubic yards
6. Type of material removed (applicant determines by field sample if practical):
7. Excavation Site area: .00P ?j Acre (s) Disposal Site area: 3Z Acre
(s)
8. Total Disturbed Area (including equipment staging area): %54'7-1 Acre (s)
9. Does the project meet the requirements of the applicable General Permit? (check one)
1J'7es ❑No
10. Do you claim title to the disposal area? (check one) LK'es ❑No
11. Do you claim title to the equipment staging area? (check one) C]'res ❑No
12. Are there any water -treatment facilities within 50 feet of the proposed excavation area?
(check one) ❑ Yes iK
(ff Yes, specify):
13. How will the excavated material be entrapped and the erosion controlled? (e.g. see attached
erosion control plan and disposal area design): ire W i}V1,!Q)tCQVQ Y �i'Dy1tr
L
Duke Energy Page 6 of 14 rev 6/20/17
Excavation Program.

Duke Enemy Excavation Permit Application Form
14. Type(s) of excavation equipment to be used:
15. Will waters or wetlands be crossed in transporting equipment to or from the site?
(check one) NYes ❑No
(If yes, explain) . redr � U t D menq± i s -gins Dorl ed v i
16. Will return water re-enter the reservoir? (Check one) ❑Yes ❑No
(If Yes, specify point(s) of re-entry and show on Excavation Area Drawing)
,K1/A
17. Is there an existin ility (e.g. pier) that access is being maintained to by conducting the
excavation? ❑ Yes)!�o
(If Yes, specify the existing permit number. If No, -include et scaled drawing of the proposed
facility). Permit 4
18. Total planned duration of the work (Includefirst equipme'nt;mobilization, excavation
through final mitigation measures complete);
START / _�) FINISH.:, <. 1'. /9
(Month) (Year) ; (Moh1h) : • (Year)
Duke Energy Page 7 of 14 rev 6/20/17
Excavation Program.

Duke Energy Excavation Permit Application Form
Part II. (Continued)
B. Protection / Avoidance Area Description
Complete the following table including all land areas within and immediately adjoining the disturbed area:
Protection/Avoidance Areas
(check all that apply)
Approx
Identification
Method (*)
Avoid (A) or Mitigate.(M)
Acre
Field ID
Work Area Dwg. IR
a. Marshland, swamp, ponds, beneficial
aquatic vegetation or other potential wetlands
(circle all that apply)
, //A
b. Buffer Zones (speck width & source
ofrequirement)
Ot`� r�;al Wittbe eJCCQ
D IOO�aed ` VAOPR%-
ICS bV1 St�G.
d KOS} S v l% it be off �oad�l
rc.Ks .Kidw
Iouri Ott. yY'4n � wi 11
Ll O5a. ti e.. ierta(s
_
_
c. Environmental Areas as identified by
Duke Energy
d. Natural Areas as identified by Duke
Energy
A
f
e. Historic properties (specify)
f. Rare or threatened species (spec)
1 Vlk
Duke Energy Page 8 of 14 rev 2/6/17
Excavation Program

Duke Energy Excavation Permit Application Form
Protection/Avoidance Areas
(check all that apply)
Approx
Identification
Method *
Avoid (A) or Mitigate (M)
Acre
Field ID
Work Area DWg. ID
411A,
g. Buried gas, water, sewer,
communications or electric lines (circle)
�/
,Y
h. Impact Minimization Zones as
identified by Duke Energy
i. Other areas requiring specific
avoidance, protection or mitigation (specify)
* For "Field ID" column, specify entity or person that performed the identification and how it was physically marked (e.g. Duke
Energy (John Doe)/Pink and purple -dotted tape, Corps of Eng. (John Smith)/ yellow flagging). For "Work Area Dwg ID" column,
show the symbol that is used on the drawings to identify the protection/avoidance area.
** List and attach mitigation plans
Duke Energy Page 9 of 14 rev 2/6/17
Excavation Program

Duke Eneryy Excavation Permit Application Form
C. Applicant's Signatures
Comments:
Applicant Name (pri
nt
Applicant Signature*
)
Date " 7J
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*
Date
Date
Date
Date
*Per my signature, the information provided in this application is correct to the best of my
knowledge.
Duke Energy Page 10 of 14 rev 2/6/17
Excavation Program

Duke Enerxv Excavation Permit Application Form
Part III. Information Requirements for All Applicants
In addition to the completed application form PARTS I & II, the following items must be
provided to Duke Energy by all applicants:
A. A copy of the deed and registered survey plat or other instrument under which each
applicant and co -applicant claims title to the affected property (the shoreline adjoining the
excavation area, equipment staging area and the disposal area), OR if the applicant(s) is(are)
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.
B. 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. The drawing must show at a
minimum, a North arrow; a vicinity map; the boundaries and acreage of the proposed
excavation area and equipment staging areas; lake, county, city, cove, tributary, road and
subdivision names and lot numbers (as applicable); property corners for project front lots;
the full pond elevation contour and lines dividing the cove width into equal thirds;
approximate volume in cubic yards of the material to be excavated; point(s) of return water
re-entry; the boundaries of any adjoining areas that are to be specifically avoided or
protected during the work and the location (address) of the disposal area for the excavated
material. [NOTE: A copy of this drawing must also be provided to the excavation
contractor to ensure restricted areas are not impacted.]
C. An accurate scaled drawing (1 "=25' for projects <1000 cubic yards of material removed or
1'= 100' for larger projects) of the proposed design for the disposal area. The drawing must
show at a minimum, a North arrow; a vicinity map; the boundaries and acreage of the
proposed disposal area; lake, county, city, cove, tributary, road and subdivision names and
lot numbers (as applicable); the full pond elevation contour (unless disposal is well away
from the lake); the boundaries of any adjoining areas that are to be specifically avoided or
protected during the work; the location (address) of the excavation area from which the
material came and a statement of the disposal area's capacity with all dimensions labeled
that were used in the volume calculation. [NOTE: A copy of this drawing must also be
provided to the excavation contractor to ensure restricted areas are not impacted.]
Also note for projects larger than one (1) acre in North Carolina, including excavated,
equipment staging, and disposal areas, you must submit an erosion control plan. For
projects larger than two (2) acres in South Carolina, including excavated, equipment staging
and disposal areas, you must submit an erosion control plan. For projects < two (2) acres in
South Carolina, you must submit a completed standard reportingform orm for construction sites
disturbing two (2) acres or less to the South Carolina Dept. of Health and Environmental
Control (SCDHEC) - Stormwater Management
D. A map or directions by road showing directions to both the excavation area and disposal
area.
Duke Energy Page 11 of 14 rev 2/6/17
Excavation Program

Duke Enemy Excavation Permit Application Form
E. 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.
F. A list of names and addresses of adjoining property owners for both the excavation area and
disposal area.
G. 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).
H. A copy of all permits and/or letters of correspondence to/from local, state and federal
agencies that require notification or issue individual permits.
Duke Energy Page 12 of 14 rev 2/6/17
Excavation Program

Duke Energy Excavation Permit Application Form
Part IV. Agency Reviews and Approvals
(Begin this section with a summary table of all agencies consulted, comments received, and
applicant response to agency comments (see example table below). Agencies should be listed in
the order shown in the Agency/Organization List. Consultation letters must be dated within the
two years preceding Duke Energy's receipt of the application.
Table IV -1. Sample Agency Comment and Response Table
Agency
Agency Comment
Applicant Response
Agency 1
The activity is approved as
NA
proposed.
Agency 2
Agency 2
The on-site well provides drinking
Contacted Mr. Smith on 1/l/20xx.
water to the public. Please contact
No further action needed.
Mr. Smith to discuss the proposed
changes and potential issues
associated with your proposal.
You must contact us immediately if
Applicant will contact Agency 2 if
endangered species are located
endangered species are located
during the course of construction.
during construction
Agency 3
Requested agency comments on
NA
1/l/20xx and again on 2/l/20xx. No
response as of 2/16/20xx.
Following the table of agency comments and applicant responses, include a table of permits and
certifications issued by the reviewing agencies. As with the table of agency comments and
applicant responses, agencies should be listed in the same order as they are listed in the
Agency/Organization List.
Table IV -2. Sample Agency Permits and Certifications Table
Agency
Permit/Certification Name
Date of
Issuance
Date of
Expiration
Agency 1
Surface Water Withdrawal Permit
Agency 2
Section 401 Water Quality Certification
Following the two summary tables, include a copy of all correspondence to and from any local,
regional, state and federal agencies or other organizations with which you are required to
consult, including any required permits (e.g., Section 401 water quality certifications, Section
404 dredge/fill permits, building permits, etc.) or other approvals or comments which have been
obtained from these organizations regarding this activity. Include a copy of any local, regional,
state or federal regulations or guidelines that will be followed. All permitting issues must be
resolved and clearly documented. Correspondence should be organized in the order the
agencies are listed on the Agency/Organization list with the applicant's request for comments
followed by additional correspondence in chronological order. All permits must be valid at time
Duke Energy Page 13 of 14 rev 2/6/17
Excavation Program

Duke Energy Excavation Permit Application Form
of application and have a term longer than the projected schedule for completing the permitted
project.
Part V. Additional Information
(Provide any relevant additional information. Reference previous parts as applicable. Include
the FERC -required Environmental Assessment if applicable. If there are co -applicants, this is
where their information would be provided.)
Duke Energy Page 14 of 14 rev 2/6/17
Excavation Program

Type: CONSOLIDATED REAL PROPERTY
Recorded: 9/26/2017 9:06:29 AM
Fee Amt $3,882.00 Pagel of 29
Revenue Tax: $3,800.00
Iredell County, NC
Ronald N. Wyatt Register of Deeds
BK 2514 PG 765 - 793
NORTH CAROLINA
GENERAL WARRANTY DEED
Excise Stamps: $3800.00
Parcel ID/Tax Lot Number: 4645064246
Mail after recording to: Grantee's Mailing Address
Prepared By: The Coley Law Firm, PLLC, 8320 Univ. Exec. Park Dr., Suite 109, Charlotte, NC 28262
Title Insurance with: Master Title Agency, LLC
Brief Description for the Index:
8.076 acres on Camino Real Road
THIS DEED made this 16' day of September, 2017 by and between:
GRANTOR
William Irwin Belk, married,
Christopher W. Belk, unmarried
Irwin Belk II, separated
Suzanne St. Clair Bowron Belk a/k/a Suzanne
St. Clair Bowman Belk, unmarried
Forwarding Address:
1131 Mockingbird Lane
Charlotte, NC 28209
GRANTEE
J Shott Holdings, LLC
Property Address:
Camino Real Road
Mooresville, NC 28117
Mail to:
104 Onslow Court
Mooresville, NC 28117
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and
assigns, and shall include singular, plural, masculine, feminine or neuter as required by context.
WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is
hereby acknowledged, has and by these presents does grant, bargain, sell and convey unto the Grantee in
fee simple, all that certain lot or parcel of land situated in the City of Mooresville, Iredell County, North
Carolina and more particularly described as follows:
See attached Exhibit A for legal description and Exhibit B for waiver of marital interest for
spouse of Irwin Belk II.
**See Free Trader Agreement recorded in Book 2513 Page 2157 for waiver of marital
interest for spouse of Wiliam Irwin Belk.
submitted electronically by "The Coley Law Firm, PLLC"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Iredell county Register of Deeds.

If initialed, the property includes the primary residence of at least one of the Grantors.
(NC GS § 105-317.2)
The property hereinabove described was acquired by Grantor by instrument recorded in Book 2190, Page
1209 and Book 2045, Page 681 and Book 2045, Page 678 and Book 1167, Page 547.
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 is subject to the following exceptions:
Enforceable easements, restrictions and rights of way of record.
Current Year Ad Valorem Taxes
IN WITNESS WHEREOF, the Grantor has hereunto set his hand and seal, the day and year first above written.
(SEAL)
Wi iam Irwin Belk
(SEAL)
Christopher W. Belk
(SEAL)
Irwin Belk II
(SEAL)
Suzanne St. Clair Bowron Belk a/k/a Suzanne St. Clair
Bowman Belk
SEAJrSTAMP
'°USLIC,
STATE OF NC, I COUNTY OF
0
I certify that the following person(s) personally appeared before me this day,
each acknowledging to me that he or she voluntarily signed the foregoing
document for the purpose stated herein and in the capacity indicated:
William Irwin Belk, Individually as Grantor
Date:
My Comm Exp: q. - \ q' DA
or Typed

If initialed, the property includes the primary residence of at least one of the Grantors.
(NC GS § 105-317.2)
The property hereinabove described was acquired by Grantor by instrument recorded in Book 2190, Page
1209 and Book 2045, Page 681 nod Book 2045, Page 678 and Book 1167, Page 547.
A map showing the above described property is recorded in Map Book, Page.
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
tatedTitle to the property hereinabove described is subject to the following exceptions:
Enforceable easements, restrictions and rights of way of record.
Current Year Ad Valorem Taxes
IN WITNESS WHEREOF, the Grantor has hereunto set his hand and seal, the day and year first above written.
William Irwin Belk
ew Z-
(SEAL)
Christopher W. Belk
(SEAL)
Irwin Belk II
(SEAL)
Suzanne St. Clair Bowron Belk a/k/a Suzanne St. Clair
Bowman Belk
(SEAL)
Georgia Belk
STATE OF CJte 04;, L COUNTY OF ���Cc ✓ %e
�,f.:•�==:;�/ �i I certify that the following person(s) personally appeared before me this day,
••'`SBach acknowledging to me that he or she voluntarily signed the foregoing
C10TA R.D i2 bQcumcnt for the purpose stated herein and in the capacity indicated:
SAV g0Go = �trist'pher W. Belk, Individually as r
'o `yo tx Gf
$gay • �.�ate�b r Z
'`'•-•• " �('�,� ucial Signature ofNotary
4Rcixes
My Comm Exp: IVjr,,�, � -�-Zo d//�,n:e1
Ut Notary's Printed or Typed Name

If initialed, the property includes the primary residence of at least one of the Grantors.
(NC GS § 10.5-317.2)
The property hereinabove described was acquired by Grantor by instrument recorded in Book 2190, Page
1209 and Book 2045, Page 681 and Book 2045, Page 678 and Book 1167, Page 547.
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 is subject to the following exceptions:
Enforceable easements, restrictions and rights of way of record.
Current Year Ad Valorem Taxes
IN WITNESS WHEREOF, the Grantor has hereunto set his hand and seal, the day and year first above written.
(SEAL)
William Irwin Belk
(SEAL)
Christopher W. Belk
(SEAL)
Irwin Belk II
(SEAL)
Suzanne St. Clair Bowron Belk a/k/a Suzanne St. Clair
Bowman Belk
,oary v
Z=
Pub\\'
burg�
STATE OF
COUNTY OF NkV—L
I certify that the following person(s) personally appeared before me this day,
each acknowledging to me that he or she voluntarily signed the foregoing
document for the purpose stated herein and in the capacity indicated:
Irwin Belk II, Individually as Grantor
Date:
Official Signature of tart'
My Comm Exp:
Notary's Printed or Typed Name

If initialed, the property includes the primary residence of at least one of the Grantors.
(NC GS § 105-317.2)
The property hereinabove described was acquired by Grantor by instrument recorded in Book 2140, Page
1209 and Book 2045, Page 681 and Book 2045, Page 678 and Book 1167, Page 547.
A map showing the above described property is recorded in Map Book, Page.
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 lawU claims of all persons whomsoever, except
for the exceptions hereinafter stated
Title to the property hereinabove described is subject to the following exceptions:
Enforceable easements, restrictions and rights of way of record.
Current Year Ad Valorem Taxes
IN WITNESS WHEREOF, the Grantor has hereunto set his hand and seal, the day and year first above written.
(SEAL)
William Irwin Belk
Christopher W. Belk
(SEAL)
Irwin Belk II
�) See Attached Certificate
SuhAne t air Bowron Belk wk/a K95e St. Clair
Bowman Belk
Georgia Belk
STATE OF COUNTY OF
SEAL -STAMP
1 certify that the following persons)�-�n�all�aredbefore me this day,
each acknowledging to me or soluntarily signed the foregoing
document for the purpose herein and in the capacity indicated:
Suzanne St. C Bowron Belk a/k/a Suzanne St. Clair Bowman Belk,
Individual Grantor
My Comm Exp:
r`
Official Signature of Notary
Notary's Printed or Typed Name

CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CML CODE § 1189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document
State of Califomia
County of /gin ss
On� before me, � ao Old oi. Nota P�jC
Date ,� Here Insert Name and Title of the Officer
personalty appeared ! ["Zeryllle//�ca;rewra 061A
Name(s) of Signers)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(es), and that by his/her/their signature(s) on the instrument the person(s),
or the entity upon behalf of which the person(s) acted, executed the instrument.
OSCAR YONGHWAN CHOI
Notary Public - California Z
Los Angeles County
i +
Commission # 2165950
My Comm. Expires Sep 26.2020
I certify under PENALTY OF PERJURY under the laws
of the State of Califomia that the foregoing paragraph
is true and correct.
WITNESS my hand and official seal.
Signature �.���►
ignature of Notary Public
Place Notary Seal Above
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document: �/Vo✓%li CGri-o
Document Date: 0 2/ 1 f
Signer(s) Other Than Named Above:
Capactty(ies) Claimed by Signer(s)
Signer's Name:
❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attomey in Fact
❑ Trustee ❑ Guardian or Conservator
1-1 ether -
Signer Is Representing:
Signer's Name:
❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
02016 National Notary Association • www.NationalNotary.org • 1 -800 -US NOTARY (1-800-876-6827) Rem #5907

r m rr.r
x�m� a.x•vv�.m�
i,vr�w�iamwrq�, was yml�aas
�aYR mem s M�.R1PR xm� s
�i:�1E.am0il�iP4W i6tlYtml�milRR
G$"'
jmLv
plot • "• "v.. •••��'? e
oau
--.W
GRAPHIC SCALE
1 rNa w. niwusml
r...em os.m 1 6RCI1V AW >r�evaao/
.aow.araauc FlaPILGTm
I
Ie[T 1
Yn/i 1
rp R
Ki►` �1 R
w«
IJORDAN
JOr IwMr:
Jason Shoff
Total Area:
GRANT
352,003-05 Sq. ft.
ENGINEERING • SURVEYING • PLANNING
®ve noluv A,,,a xvsovax
8.081 acres
JORDAN GRANT 6 ASSOCIATES, PLLC
naawu:oww> saverare v»v
.
P.O. BOX 151' STATESVILLE, NC 28887
r¢Mftrd-ga — rl" 2287919
FIRM #P-1227
iev�c am6lte
wvxowa.ao-"""�•"��
avow mxmo—r®e�mwry—vurx w
_
,...
:�
R`
e bna: a.m
.1
n>L ii R n
sve uo
r1
Nq�
w•ao�rnanao
a : rwvw Au
� , �`,t
44
I
• .mwrtoimir
,
t
-•-_-
Op���w i1at�� Lvn
lml.Y.Da
; F ---
I
1
lOwbinrse.Yniaru.
�`
o�.r�nue orvmoaq
6 •ar ea:r.
, pi%11
`1
1
Yiaxml wU!mNUTR
i
1
,'1
Ww
aOAnlYtmfM}RR.ASWm.T.Mr
111F.
i�
rt»Kxs
1
mwasmn
/ Z
\
ivrc
/
O
•
lRA"�nu
mw:am-wo.vunv
e'."m.minwo���rww we�anic
SLRVEYDR CER77FlCATIDN
1
r m rr.r
x�m� a.x•vv�.m�
i,vr�w�iamwrq�, was yml�aas
�aYR mem s M�.R1PR xm� s
�i:�1E.am0il�iP4W i6tlYtml�milRR
G$"'
jmLv
plot • "• "v.. •••��'? e
oau
--.W
GRAPHIC SCALE
1 rNa w. niwusml
r...em os.m 1 6RCI1V AW >r�evaao/
.aow.araauc FlaPILGTm
I
Ie[T 1
Yn/i 1
rp R
'
IJORDAN
JOr IwMr:
Jason Shoff
Total Area:
GRANT
352,003-05 Sq. ft.
ENGINEERING • SURVEYING • PLANNING
®ve noluv A,,,a xvsovax
8.081 acres
JORDAN GRANT 6 ASSOCIATES, PLLC
naawu:oww> saverare v»v
P.O. BOX 151' STATESVILLE, NC 28887
r¢Mftrd-ga — rl" 2287919
FIRM #P-1227
iev�c am6lte
wvxowa.ao-"""�•"��
avow mxmo—r®e�mwry—vurx w

EXHIBIT A
Davidson Towrnhip, Iredclf County, North Carolina
Beginning al a point new the southern edge of the pavement of NCSR No. 1181, northwest
comer of the property of Shackleton (Book 820, Page 264h (said point being located South 80
deg. 48 min. 55 sec. West 301.9I fret from an existing iron pin at Shaddeton's northeasterly
line) and running thence with Sbacklcton's line South 14 deg. 45 min. 55 sec. East (passing
through an existing iron pin at 2243 fed in the southern margin of the mad right-of-way and
passing dwough mxka hun, pin at 262.32 fed) and con*aftg with the line of Lon No. 7 of the
Cove Subdivision, a total distance of 761.25 feet to an iron pin in contour elevation 760 feet
above mean sea level as established by Duke Power Cornparry; thence with contour elevation
760 fed above mean sea Ievd as established by Duke Power Company as follows: (1) South 83
deg. 07 renin. 37 sec. West 144.66 feet to an iron pin; (2) South 00 deg. 34 min. 19 sec. Fast
226.00 feet to an Iran pin; and (3) Sou lh 10 dcg. 14 min. 41 sec. West 78.46 feet to an iron pin,
comet of property of Travis and Travis Company (Book 983, Page 431k thence with said Travis
lino North 61 dug. 59 min. 08 lace. West (passing through an old iron in at 7.45 fit) a total
disbmce of 261.95 feet to as iron pipe in the western margin of a 40 foot tight -of -sway
{Book 641, Page 473); thence withthe western margin of said right-of-way as follows; (1)
in a northerly direction on a curve to the left having a radius of 35.24 feet, an arc distance of
3137 fed (Chord: North 13 deg. 24 min_ 39 see. East 30.35 feet to a point; (2) ther=North 12
deg, 05 min. 32 sec. West 573.10 feet to a point; (3) in a northerly ducorion on. a curve to the
left having a radius of 176.03 fort, an ate distance of 79.44 feet (Chord: Noxth 25 deg. Of min. 17
sec. West 78.77 feet) to a point; (4) North 37 deg. 56 min. 22 sce. West 18.94 feet to a point;
(5) in a northerly direction on a cum to the right having a radius of 198.14 feet, an arc distance
of 8329 fed (Chord; North 25 deg. 54 min. 33 no. West 82.67 (ad) to a point; and (6) North 13
deg 52 min. 02 sec. last (passing through an iron pin at 63.38 feat) a total dhoance of 93.38
fed to a point in NCSR No.l 181; thence within the paved portion ofsaid road, North 77 deg. 16
ruin. 41 sec. Pmt 419.35 feet to the point of beginning, containing 8.0765 acres, and being ail of
Tract I as shower on plat of survey prepared by Andrew G. Zdutcwclic, a North Carolina
Registered Surveyor, dated Jane 14,1999.
The right, titte, use and estate of the grantors, (but not covered by the covrxtants and warrantdrs
herein ser forth}, to the driveways and pains, and the retaining wall aktending betwecct the Travis
property and Lot No. 7 of Ile Cove Subdivision (Meal property; Book 955, Page 1940) and any
property bdwem the line at cc atour devad m 760 feet above meansea level as described
berxivabove and the actual edge of tie water of 1 akc Nauman at its "full pond" elevation.
This conveyance is subject to the flood easements and other rights of Duke Power Compuuhy
de:mn'bed in Book 346, Page 532, Iredell County Reglsuy, and this conveyance is finriher
subject to all rights of way and ease raents for power fines, telephone lines, other utilities lines
of record or which nue currently physically located ort, upon or underground art= said property
and reshictiomafrecord.
It is also subject to d3c tight to use a 40 foot right-uf-weq contiguous with acrd east of the easterrr
property I= of the abcnm desan'bed 13.3985 aces tract, for iogss, egress and regress, odesndigg
fiam NC Seeondaty Road Na 1181 to the aotthem line of property of Travis and Travis
Company (Book 983, Page 4811 as said easement is describod in dad recorded in Book 641, at
page 747, ir+e&U County Registry. Said easement to be used in common with the graotms herein
and their heirs and awcessms m title and K Watson Stewart and wilt, Travis W. Ste;wmt and
their belts and suacessom in title to the properties a4aining said 40 foot right-of-way.
For buck title, sce dards recorded in Deed Book 386, Page 81 and Deed Book 479, Page 121,
fredell County Registry.

EMI BIT A
Davidson Township, hedeli County, Nath Carolina
Be;.ginning at a point new the southern edge of the pavenunt ofNCSR No. 1181, northwest
corner of the property of Stmddeton (Book 820, Page 2641 (said point being located South 80
deg. 48 min. 55 sex. West 301.91 feet from an c*dsdng iron pin at Shackleton's fly
H=) and running thence with 5hackletca's line Srnrth 14 deg. 45 min. 55 sec. East (Passn8
through an existing iron pin at 22.43 feet in the southern margin of the road right -of --way and
passing trough another ban, pin at 26232 feet) and coo toting with the lino of Lot No. 7 of The
Cove Subdivision, a total distance of 761.25 foot to an iron pin in contour elevation 760 feet
above mean sea level as established by Duke Power Company; dace with contour clevation
760 foci above mean sea level as estab[ished by Duke Power Company as follw x (1) South 83
deg 07 min. 37 sec. West 144.66 feet to an iron pin; (2) South 00 de6.34 min. 19 sec. East
226.00 fed to an iron pin; and (3) South 10 deg. 14 min. 41 sec. West 78.46 fed to an icon pin,
coma of peopetty of Travis and Travis Company (Book 983, Page 481k theace with said Travis
line North 61 deg. 59 min. 08 sec. West (pasting through an old iron put at 7,45 fact) a total
distance of 261.95 feet to an iron pipe in the was= nmargia of a 40 fed ti fat -of way
{Book 641, Page 473); thence with the western margin of said right-of-way as follows: (1)
in a northerly direction on a curve to the teff having a radius of 35.24 feet, an we diozace of
3137 fact (Chord North 13 deg. 24 nim. 39 see. East 30.35 Ext to a point; (2) thence North 12
deg. 05 min. 32 see. West 573.10 feet to a point; (3) in a nord=iy duction on a curve to the
M having a radius of 176.03 feet, an aro office of 79.44 Ext (Chou Nath 25 dcg 01 rnin. 17
sec. West 78.77 feet) to a polio; (4) North 37 deg 56 min. 22 sec. West 18.94 fed to a point'
M in a northerly direction on a curve to the right having a radius of 198.14 fact, in arc distance
of 83.29 fed (Chord: North 25 deg. 54 min. 33 sco. West 82.67 fed) to a poi and (6) North 13
deg 52 min. 02 sec. East (pasting through an iron pin at 63.38 &d) a total distance of 9338
feet to a point in NCSR Na 1181; thence within the paved portion ofsaid mad, North 77 deg. 16
rain 41 sec. least 4t9.35 fed to the paid of beginning, containing 8.0765 acres, and being all of
Tract I as shown on plat of survey prepared by Andrew G. Zouwvclle, a North Carolina
Regi acd Surveyor, Mad June 14,1999.
The: right, da -, use and estate of the graotorr, (but. not covered by the covenants and wacrandes
becan cox forth), to the driveways and pedf>s,, and the retaining wall odeading bdwmm the Travis
property and IA No. 7 of The Covt: Subdivision (Neal property: Book 956, Page 1940) sun any
property betwam the line at contour elevation 760 fret above mean seri level as described
berriaabove and the actual edge aftbe water of Lake Norman at its ":Rill pond" elevation.
This oonveymm is subject to the flood easements and educe rights of Duke Power Canpany
desaibcd in Book 346, Page 532, lredell County Registry; and this rmaveyanDe is father
sutiCa to all rights of way and onememts for power lines, telephone lines, other utilities tines
of record or which am currently physically bested on, upon or umdergroumd acmes said property
and restriction ofrec ni.
It is also sutltjax to the right to use a 40 foot d& -of --way contiguous with and east of the eastern
property riot of the above-descabed 13-IM5 area tract, for bWesess, eg era and tegess, etdernd tg
firm NC Secondary Road No. 1181 to the nathan line of property of Travis and Travis
Company (Boole 983, Page 4SI X as said casement is described in dad recorded in Book 641, at
page 747, lreddl County Registry. Sold casement to be used in comma with the grantors herein
and Zw heirs and successors In We and Ii. Watson Stewart mad wife, Travis W. Stewart and
their heirs and successors in title to the peopades adjoining said 40 foot rislkof-way.
For back title, see dads recorded in Deed Book 386, Page 81 and Deed Book 479, Page 121,
bcdeD County RgOstsy.

EXHIBIT B
STATE OF NORTH CAROLINA SEPARATION AGREEMENT AND
COUNTY OF MECKLENBURG IPROPERTY SETTLEMENT
This Separation Agreement and Property Settlement (hereinafter referred
to as the "AGREEMENT") between Monica Rose Belk (hereinafter referred to as
"Wife'), a resident of the State of North Carolina, and Irwin (`fie") Belk H
(hereinafter referred to as "Husband"), a resident of the State of North Carolina;
WITNESSETH:
WHEREAS, the parties to this AGREEMENT were lawfully married on June
7, 2014, and separated on September 28, 2016; and
WHEREAS, there were no children born of the marriage, and the parties
are not expecting children; and
WHEREAS; because of various unfortunate and unhappy difficulties,
disputes, and irreconcilable differences between them, the parties determined
that they could no longer live together in peace and harmony, and that it was
necessary for the health, happiness, and well being of both parties that they
should separate and live separate and apart from each other; and
WHEREAS, the parties desire to enter into this AGREEMENT- for the
purpose of confirming their separation and making agreements concerning their
property and spousal support in connection therewith; and
WHEREAS, the parties are satisfied with the disclosures that have been
made and the information on which they are relying in entering into this
AGREEMEr7T. Each party acknowledges that the other party has actually,
reasonably, and materially relied on the representations and disclosures made to
that party in entering into this AGREEMENT; and
WHEREAS, the parties agree that such property division and distribution
as hereinafter set out shall be deemed to be equitable as between the parties
under the provisions of North Carolina General Statutes (hereinafter, (N.C.G.S.)
$ 50-20(d) and not dependent upon the separation of the parties. Each party
represents that he or she enters into this AGREEMENT after considering the legal,
equitable, and financial facts and cirdumstances of the marriage, including his or
her rights under the Equitable Distribution Act, N.C.G.S. Chapter 50-20, and
after complete and thorough review of all those facts and circumstances; and
WHEREAS, Wife and Husband have engaged in direct negotiations
resulting in their reaching this AGREEMENT and Wife has employed the services
of Anastasia Cowan, Esq., of the Charlotte, North Carolina firm of ARNoLD &
SMtM PLLC (hereafter, at times, ATTORmw CowvO, and Husband has

Belk Separation & Property Agreement
Page 2 of 18
employed the services of Michael F. Anderson, Esq.; of the North Carolina firm
THE ANDERSON LAW FMM {hereafter, at times, APTORM ANDERSON');
WHEREAS, both parties have had the opportunity to review this
AGREEMENT and have done so; and
WHEREAS, both parties fully understand the terms, conditions, and
provisions of this: AGREEMENT and believe and agree that the same are just, fair,
adequate and reasonable in all respects.
NOW, THEREFORE, in consideration of the reason recited above and the
mutual promises and covenants of the parties hereinafter set forth, and other
good and valuable consideration, receipt of which is hereby acknowledged by the
parties, Husband and Wife hereby agree as follows:
CONFIRMATION OF SEPARATION
1. SEPARATION. The parties separated on September 28, 2016, and it shall
be lawful at all times thereafter for each party to live separate and apart from
the other at such place or places as each may deem fit, or as each may desire,
and as he or she may freely choose, from all interference, authority, and control,
direct or indirect, by the other party. Neither party shall' molest or interfere
with the other party in any manner at any time, nor shall either party compel or
- attempt to compel the other party to cohabit or dwell with him or her in any way
whatsoever.
2. RIGHT TO CONTRACT AND EWLOYMENT. Each party shall have
the right to contract in the future and be contracted with independently of the
Other in all respects and to engage in any employment, business, trade or
profession he or she may choose as if he or she were unmarried. Except as
otherwise set forth herein, all income and profits earned by either party from
and after the date of separation shall be that party's sole and separate property.
3. - H U7UAL RELEASE: Wife and Husband hereby waive, release,
discharge, quitclaim, and renounce unto the other, their heirs, and assigns the
following:
a. All and every right to share in the estate of the other party upon
said party's death as provided in N.C.G.S. $ 29-14 or otherwise,
now and hereafter, by law provided.
b. All and every right to elect a life estate in real estate upon the
death of the party in lieu of the share provided in N.C.G.S. $ 29.14,
as provided in N.C.G.S. $ 29-30, or otherwise, now and hereafter,
by law provided.

Belk Separation & PropertyAgreement
Page 3 of 18
C. All and every right to a year's allowance on the death of the other
party as provided by N.C.G.S. $ 30-15 or otherwise, now and
hereafter, by law provided.
d. All and every right to dissent from the -will or to take an elective
share .of the other party as provided .by N.C.G.S. $ 30-1 or
otherwise, now and hereafter, by law provided.
e. All and. every right to administer the estate of the other party as
provided by N.C.G.S. $ 28A-41 or otherwise, now and hereafter, by
law provided.
€ All and every right to an equitable distribution of property as
provided by N.C.G.S. 50-20 et. seq., or otherwise, now and
hereafter, by law provided, except as set forth herein.
g. All other rights and interests in property, both real and personal,
which either party now has or may hereafter acquire out or
accruing to either party by reason_ of death of the other party,
testate or intestate.
h. Except as expressly provided herein, all causes of action, claims,
rights, or demands whatsoever at law or equity, which either of the
parties ever had or now has against the other, known or unknown.
ALIMONY AND SPOUSAL SUPPORT BY HUSBAND AND WWE
XXXXXXXXXXXXXXXXXXXX
PROPERTY SETTLEMENT AGREEMENT
5. PROPERTY DIVISION. The parties are mindful of their rights to an
equitable distribution of their property as provided under N.C.G.S. $ 50-20, et.
seg. It is, however, the intent of the parties to reach an agreement between
themselves by means of the property settlement portion of this AGR NT as to
the division of their marital, separate and divisible property and debt, both real
and personal, tangible and intangible, and all other property rights arising out of
their marital relationship. In view of the foregoing, the parties have agreed to
the division of their assets and liabilities as set forth hereinafter.

Belk Separation & Property Agreement
Page 4 of 18

Bello Separation & Property Agreement
Page S of 18
a

Belk Separation & Property Agreement
Page 6 of 18

Belk Separation & Property Agreement
Page 7 of 18
7. POST SEPARATION AND OTHER DEBTS. Except as may be specifically
set forth herein, neither party shall charge or cause or permit to be charged to,
or against, the other party any purchase which either of them may hereafter
make, nor create any obligations in the name of or against the other, nor secure
or attempt to secure any credit upon or in connection with the other, or in his or
her name. Each party shall pay all debts and discharge all financial obligations
which he or she may incur for himself or herself'; and does hereby agree to
indemnify the other against all debts and other obligations which he or she may
incur.
Husband represents that he does have current debts from the
parties' marriage. Husband agrees to indemnify Wife and bold her
harmless with respect to any and all debts in his individual name
and shall be responsible for any and all credit card debts in his
name, as well as any debts or liabilities incurred and to be incurred
in connection with any and all property being conveyed to him
pursuant to this AGREEMENT.
Husband represents that he did not incur any debt since the
parties' date of separation for which Wife is or could be liable. To
the extent Husband has incurred any debt since the parties date of
separation, he shall also indemnify Wife and hold her harmless
with respect to the same.
Wife represents that she does have current debts from the parties'
marriage. Wife agrees to indemnify Husband and hold him
harmless with respect to any and all debts in her individual name
and shall be responsible for any and all credit card debts in her
name, as well as any debts or liabilities incurred and to be incurred
in connection with any and all property being conveyed to her
pursuant to this AGREEMENT.

Belk Separation & Property Agreement
Page 8 of 18
d. Wife represents that she did not incur any debt since the parties'
date of separation for which Husband is or could be liable. To the
extent Wife has incurred any debt since the parties date of
separation, she shall also indemnify Husband and hold him
harmless with respect to the same.
XXXXXXXXXXXXXXXXXXXXXX

Belle Separation & Property Agreement
Page 9 of 18
Wife hereby releases claims to any and all other real property to which she
and/or Husband might have an interest. This includes any and all real property
in which Husband has an interest, whether. individually, in trust, or in the form
of a corporate entity, partnership, or other entity, whether acquired before or
during the marriage. Such real property is deemed to be Husband's separate
property and includes, but is not necessarily limited to, land owned — in whole or
in part — by Husband on Camino Real Road in Mooresville (fredell County)
(n2cluding but not limited to Parcel 4646-06-4246.000), and additionally a lot or
lots comprised of.1.6640 acres situated on Ballantyne Commons Parkway in
Charlotte (Mecklenburg County). Husband represents and warrants that no such
real property is encumbered by any indebtedness for which Wife is or. may be
responsible; in the event any such property may be discovered to be encumbered,
Husband agrees to indemnify and hold harmless Wife from any obligations on
such land or lands.

Belk: Separation & Property Agreement
Page 10 of 18
YY
XXXXXXXXXXXXXXXXXXXXXX
14. TRITS—T OR INHERITANCE INTERESTS. Husband has or may have
interests as a beneficiary of various trusts or other inheritance interests created
by members of his family or third -parties. Wife does hereby waive, disclaim,
release, and renounce any interests in any such trust, estate, or inheritance
interest (or family -limited -partnerships, limited liability companies, or other
business entities utilized as estate -planning vehicles) of Husband's, which shall
be his separate property and to which Wife releases any and all claims or
interest. Reciprocally, Husband does waive, disclaim, release, and renounce any
similar interests that Wife may have.
15. LIFE INSURANCE & HEALTH INSURANCE. Husband and Wife both
waive any and all rights, claims or interest in the others whole life and/or
universal life insurance policy with any cash surrender value. Neither party
shall be obligated to maintain life insurance for the benefit of the other spouse..

Belk. Separation & Property Agreement
Page 11 of 18
Neither party shall be obligated to maintain any health insurance on the other
spouse.
18. ADDITIONAL INSTRUMENTS. Each party shall execute all
instruments, including QDR.O's, deeds, car titles, stock certificates, assignment
forms for tax exemptions, Memorandums of Property Settlement and Separation

Bell, Separation_ & Property Agreement
Page 12 of 18
Agreement and the like, that may be necessary from time to time to confirm such
transfers as are set forth herein and to effect the terms of this AGREEMW1'. The
preparation and signing of these instruments shall be construed merely as a
confirmation of a property division properly executed by the parties at the date
of the final execution of this AG3=mNT. It is agreed on the part of each party
hereto that, in the event of a sale, transfer or other conveyance of property (real,
personal or mixed), now owned or hereafter acquired by either party, if it should
become necessary in order to guarantee or pass good title thereto for the other
party to this AGREEMENT to execute any deed, conveyance, bill of sale, or other
legal instrument concerning the dealing in such property, then in such event the
other party to this AGRzmaNT agrees to and will sign any instrument or
conveyance which may be reasonably required to. perfect title in the party to
whom it is sought to be conveyed. It is covenanted and agreed between the
parties that each of them shall and will, at any time or times hereafter, make,
execute and deliver any and all such other farther assurances as either of said
parties shall reasonably require for the purpose of giving full effect to these
agreements and to this covenant, so long as no obligation is thereby imposed
upon the party whose signature is sought by the other.
19. FREE TRADER CLAUSE. Each party shall hereafter own, free and clear
of the other, all such properties which each now owns, or which each may
hereafter acquire, and each shall be free to convey and dispose of his or her
separate property now owned or which may be hereafter acquired as separate
property, without the joinder of the other as fully and effectively as if he or she
were unmarried.

Belk Separation & Property Agreement
Page 13 of 18

Belic: Separation & PropertyAgreement
Page 14 of 18
XXXXXXXXXXXXXXXXXXXXXX
or ePtvFaARTr.rmv nF ARTTCTk78_ Each and every Aaraarraph of this
AGREEMENT is important to Husband and wife. Each paragraph and the
performance of the same is directly related to each other paragraph and the
performance of the same. The. paragraphs are interrelated to each other and
performance of one is dependent upon performance of all others. Should either
party materially breach a specific paragraph, then the other party may at his or
her election sue for specific performance, sue for damages, or seek other
remedies, as by law provided.
26. VOLUNTARY EXECUTION. The provisions of this AGREEMENT and their
legal effect have been fully explained to or studied by each party. Each party
acknowledges that this AG=wENP is fair and equitable, that it is being entered
into voluntarily, that it is not the result of duress or undue influence, and that
each party believes that both parties are capable of performing each and every
obligation imposed upon them by this AGREEMENT.
XXXXXXXXXXXXXXXXXXXXXX

Belk Separation & Property Agreement
Page 15 of 18
31. INTERPRETATION_ No provision of this AGREEMENT shall be
interpreted for or against a party because. said party's legal representative or
agent drafted the AGREEmENT or a particular provision of the AGREEMENT, and
Husband and Wife hereby waive all claims or defenses which they may have
regarding interpretation of documents based upon who drafted the same.
32 INFORMATION. Both parties believe this AGREEMENT to be fair and
equitable and consistent with the length of their marriage, health, education,
estates, earnings, and their mutual desire to go their separate ways without
litigation or controversy.

Belk. -Separation & Property Agreement
Page 16 of 18
33. EFFECT OF RECONCILIATION. In the event the parties were to
reconcile and resume the marital relationship (resume living together as
Husband and Wife) and then later separate, the parties acknowledge and agree
that the property settlement provisions of this AGREMMU shall continue in full
force and effect and shall be binding on both parties. Each party commits that,
in the event of reconciliation is not successful, they shall be governed by the
property settlement provisions of this document insofar as it relates to this
separation or a later separation. All provisions contained herein regarding the
property division shall be deemed to Have been executed upon the signing of this
AGRMdRNT and shall not be affected by a reconciliation of the parties. The
property transferred and assigned pursuant to the property settlement
provisions of this AGREEKENT shall remain the separate property of the parties
as stated herein.
34. SITUS. This AGREEMENT shall be construed, interpreted, and governed
by the laws of the State of North Carolina and has been executed in the State of
North Carolina
35. BINDING EFFECT. Except as otherwise stated herein, all provisions of
this AGREEMENT shall be binding upon the respective heirs, next of kin,
executors, administrators and assigns of the parties.
36. ATTORNEY FEES AND COSTS. Each party shall pay their own
attorney fees and costs related to the negotiation, preparation and execution of
this AGREEMENT.
37. TAX ADVICE. It is agreed that the parties to this AGREEMENT did
not receive any tax advice or consultation from ATTORNEY ANDERSON or
ATTORNEY CowAN concerning any tax consequences of executing this
AGREEMENT. Further, the parties to this AGREEMENT aclmOwledge that it has
been recommended that the parties seek advice and counsel from a tax
consultant of their respective choice concerning the tax consequences that may
arise from executing this AGREEMENT.
38. ENTIRE AGREEMENT. This AGREzmFxr and the ancillary deeds and
other documents executed in connection with this AGREEMMT contain the entire
understanding of the pasties, and there are no representations, warranties,
covenants or undertakings other than those expressly set forth in this
AGREEMENT.
IN WITNESS WHEREOF, said parties have set their hands and seals to
this AGRE MNT in duplicate originals, one of which is retained by each of the
parties. The `EFFECTIVE DATr of this AGREEMENT shall be the date that this
AGREEMENT is signed by each Husband and Wife, or if each does not execute on
the same day, then on the date that it is executed by the latter of them.

Belk: Separation & Property Agreement
Page 1," of 18
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
SIGNATURES ON THE FOLLOWING PAGE
f
TJ " ary 2d.
Iv TC BE
STATE OF NORTH CAROLINA
COUNTY OF MECKLENBURG
The undersigned, a notary Public of the County and State aforesaid,
certifies that MONICA ROSE BELK personally appeared before me this day and
acknowledged the execution of the foregoing instrument.
WITNESS my hand and official stamp or seal, this the ZV day of
January, 2017_
�. KRISTIN A. PIERCE
Notary Public. North Carolina
Notary Public Mecklenburg County
5 My Commission Expires
Printed Name of Notary: t 'e ---------
IVIy Commission Expires:
This the of January,2017.
IRWIN BELK II
STATE OF NORTH CAROLINA
COUNTY OF MECKLENBURG
The undersigned, a notary Public of the County and State aforesaid,
certifies that IRWIN BELI{ II personally appeared before me this day and
acknowledged the execution of the foregoing instrument.

Belk: Separation & Property Agreement
Page 17 of 18
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
SIGNATURES ON THE FOLLOWING PAGE
This the of January, 2017.
MONICA ROSE BELK
STATE OF NORTH CAROLINA
COUNTY OF MECKLENBURG
The undersigned, a notary Public of the County and State aforesaid,
certifies that MONicA ROSE BELK personally appeared before me this day and
acknowledged the execution of the foregoing instrument.
WITNESS my hand and official stamp or seal, this the day of
January, 2017.
Notary Public
Printed Name of Notary:
My Commission Expires:
This the _(_� of January, 2017.
IRWIN BELK II
STATE OF NORTH CAROLINA
COUNTY OF MECKLENBURG
(SEAL)
The undersigned, a notary Public of the County and State aforesaid,
certifies that IRWIN BELK H personally appeared before me this day and
acknowledged the execution of the foregoing instrument.

Belk Separation & PropertyAgreement
Page 18 of 18
WITNESS my hand and official stamp or seal, this the il'" day of
January, 2017.
lgotary Public
Printed Name of Notary: n,gAai F_ Ar,Dtafr* (SEAL)
My Commission Expires: *VALQ4 wts

Belk Separation & Property Agreement
Addendum
This?Sday of September, 2017.
Irwin Belk Il
State of North Carolina
County of Mecklenburg
The undersigned, a notary Public of the county and state aforesaid, certifies that Irwin
Belk 11 personally appeared before me this day and acknowledged his previous signature on the
foregoing instrument.
WITNESS my hand and official stamp or seal, this the � day of September, 2017.
f��
otary Public p,r
Printed Name of Notary: (•der /WY (/�W 1��
My Commission Expires:
0.
-

ZONING:
PROPERTY IS SUBJECT TO A 35' FRONT (FY), LS' SIDE (SY3, 25 SIDE STREET (SSV,,
35' REAR JAY) 6 60' - 760' CONTOUR BUFFER - MI2NMUT Sul D0 SETBACIt-
LiEE PER IREDEtl. COUNTY ZONIlG ORDINANCE.
6¢pre cRGeOawal Oaa Ps��
�Le
W
I HEIM CERnP I., THE SUBDIVISIDN RAT
SHOWN H9REDnl Mm STEN M m TO COM" -Y
WITH THE SUBDMSION REG TUOF THE
COUNTY OF DUDELL. NORTH CAROLINA, AND
THAT THIS PUT HAS BEEN APPROVED BY THE
waDlY CN Ap(cNSMATOR FOR RPCORD04G 1
THE OFFICE OF THE REGISTER CF DEEDS OF
IPEDPII Cot2OY.
Ta Ba � � 41915 tots! .3
Irl7*3 (3� jl weolvslDN ADMrxlmuTat
•�� ' IREDELL COUNTY, NC
18'.P J�Y1 ��35� a£ CATE
mw—
IPF 1
(,T
� 4
i
in.
1
sO IFF
9
y
k 263656.8': Sq. Feel tk
, 6.053 Acres (k
11
272.94e.7c w. rt
6.266 acres ik
352.003.05 sq. ft
8.081 acres
2 1
TPr !
AC
PJ1AL AREA
AREA INSIDE
NCDOT RfN
MEA OUTSIDE
NCDEJT RNI
AREA ABOVE 760' CONTtNIF. '
212,948.70 W. R.
9,291.69 m. R.
263.656.61 sa. C
TRACT I
6.266 atter
0.213 ave
fi.053 ares
79 054.35 za. R.
1,372.69 > R
71,68/.66 sp. R.
TRACT 2
1.815 ayes
0.032 sae
1.783 ayes
t
l
/�`•' \ ii
LINE TABLE
LINE LENGTH I BEARING } \
Ll 18.94 1 N3>•56'44"W
L2 19.19 1 53T•58'44'•E 1•� N �.: \, ,k '45\ _ J
t5' 0.Y
CURVE TABLE %4l y50 t %r _ --14A.TT IRF
CURVE LENGTH RADNS CH 8RG C. DIS
cl 31.63 35.24 H13.23'43'E 30.58' �} I, y n5 ; T
U 1 79.42 176A3 N24•56' 56 >Z.V
C3 i 83.43 198.14 N25•S65fi Bz.81'`1 30^ �5. •`l
C9 101.23 2Z6.o3 SZaro3'i6•E 1110.38' Ut l ; \ It J{'.
CS 62 oe 346 14 525.56'11'E 61.62' C ` 4 1 \ 11 ` OUE POLVER n l
T-04'. Ra
gs
UKE HORr4AN \ 1 a�
V_MI• Mev - Na m Scale
$rote d NartN (J'OMN
Cwnty CI lmdO
I, Rewew Orfav d 1.•e0a1
Cowry, cMJY tlut ma auv Or Pbt m wh<h cab
cer6fimtwn n affren nK![s as statVtaD'ratnvertNnn
hP tRVGeg
Daze Rawer, CfTssl
THE w81ECT PROPERTY, TO THE BEST
OF MY MOw1EDGE, LIES WRF¢N THE WS -N CA
OF THE URO: NORMAN - CATAWBA RIVER BASIN
AS DESIGNATED BY THE NORTH CMOLWA DM-
SION OF ENVIRONMENTAL MANAGEMENT ANO AS
APPEARS ON WAT3ISHED RROTECRON MAP DF
IREDELL CO:NTY
DATE %SOMSION ADMQiISTRATOR
owner's Ce 1—aw NObMntlan:
KNOW ALL MEN SY' THE$ PRESQ . Cut
nerety <et60es COM S em me — aF me
property mown Or, NB da,6vt I NHeby
knowlenx N6 plat aw a8olnNra M W TY
�ree act ens na IHrmv ad+ota m wtRc pas
siretls, a9ees, meat I aM sour fv
sl r. pn tl4s plat I rurtuv ¢Me can
Mam,lw I Gram Ssva'eyM arin mace tNN plat
aI Y O,nttian. aq tNa ma emlre su11l9 d
Ism Y' me bpanaarN6 d a tract cpm 14' m
try a need remrled in Deet/ •--. 2514.
pax 16s, 6b6 wen me 1NdeE town Re9ser
d Deets.
ate
Qac
Sbta d Norm Caroms . Rome' Caunry
TI' N q'Wew
b Cwnry, aw Stam. na Iterety c ly cart
came babe me ens lav am oda led ed me
execvrion d me rars9aa9 NstrN,N•nt.
W'9ness v Naw a L dell sea. Naz m .
nay d
zaie
Cb m6 3 85.24 S1O 1715'W 64.6T
f ``
iM1 �• 1
?• \ \ ml
IRF UtOt4 REBM FOURq
IRS-iROH RESAR SET
IPF - IRINI PIPE NO
RTlw'
- POWER POLE POLE
-mNPu ED Po1N
AREA ABOVE 760' CONTtNIF. '
NbN.Y R,tic
:REVISION: DRAWING FILE: 20177903
REAL ROAD- MCOREVI LE, N.0 28'117 (p2
DAWI)SON 7OVINSHIP - IREDELL CGDNIY - NORTt:ARO INA
- -. OVERHEAD ELECTRIC LINE
FEET )
GRAPEEC SCALE. 1 ince - 60 R
c
0.5r4 ACRES
MY—
'Oers,0�
t. S -@I
t 6 C
\ I� /
% I
Tr4C35 ti
IPS
Ih-btedType d Sun�es•
I hereby ce.cry mat tmF snney veatea a svmnas.m a Rml
bag 1
1
79.054.35 5 ,. fl. yT/
r
`
na.: Ne
raftn me area d a m„rsy a �
1.815 aDreS �
V �
�� /, �
aamante mat re9aates parotls d Nrq�
.
NOTES:
iR5 C
J/
l I Cs
/n
J
AND L'7,T03 EASEMENT A@D55 T c YArt. iEAi MO E:O. \ 'Sgt
\ J�'p /!
. Y ,
IPF
V
O
¢rte Martnew f. Grab t1T15 05208
STHE�l�DE_TIE �DRAB:AGE
RO11'BDULL N8151MRTd:IL i TSEaY®WfTR 35PNERM
743
o�g� 9 �4e JE$ \
6 95 Tom/ \J/� 1
1N=9AVEYB3 PROPET('I]CES rA'ItE NITN;P THE U.S:F3WTEeli:Y:N'ER:GRS
NATIDNY RE(� BI fF HLSTg11CR�.
� 4-166 r,�
�M�S J�� v
Afi DF TX=_DATE aF iM16 aB"IRDBG. RIE LD[S REIA582r8s CRTNb RAT
O
s a ro.
_V,9E3E:x
TN-3EEM0 AS9laINCETNAT ABUILJYG•PWI(r MRL E M' . .:NT:B,9KrL.
S.4 J3� I
4
ROOD, ZONE 'AE'
.
/ a-2�
PANEL NO: 371G4645OW
Minor S.bcYisian For crYrrcR OLtC ER )
EFFECTIVE GATE: 3/1BR006
.. A` '
Roy;
JORDAN
9NCtiIN 5.
,Jason Shott Holdings, LLC;vYF',iEla::x
FIELD LOCATED
,
E
:20Q'01 SSf''•y9-=-
I
'' CRAZVN BY: SMS 01EOED 8Y:
N8G
'
LEGf2RR
AQP •IY;
(-5278
GRANT
ENGINEERING • SURVEYING • PLANNING
JORDAN GRANT & ASSOCIATES, PLLCj
P.O. BOX 151 ' STATESVILLE, NC 28687
SCALE. I' 67
DEED Rt/: 2534.765
D,1
LATE OF MAP: -10-18
! PIN NO: 4645-064246
sU(YF! DATE: C9.OB-v
IRF UtOt4 REBM FOURq
IRS-iROH RESAR SET
IPF - IRINI PIPE NO
RTlw'
- POWER POLE POLE
-mNPu ED Po1N
Yp '• p�j
'• y .,,,,,•GQ-`�.
fDHtt9�¢fOTdHR-yranLNm [phone]
FIRM # P-1227CAMINO
:REVISION: DRAWING FILE: 20177903
REAL ROAD- MCOREVI LE, N.0 28'117 (p2
DAWI)SON 7OVINSHIP - IREDELL CGDNIY - NORTt:ARO INA
- -. OVERHEAD ELECTRIC LINE
FEET )
GRAPEEC SCALE. 1 ince - 60 R

r m4.
SPSj.
X ' �'$. i 'M h#4 Sfx�36A s.�[�+.. ;K�r .S {•�n1„�!�IA
M ARI,
in
n
S �
4"
Google earth
201„ Gf x-�-ji;.
!t
" - v�y '• 'fit s ;'"> dH
i `i iia •;. M s
a r�; a2•ti �-9,w rt �, y'�- ',� �'� ?' � � F t t , � . ,
�.
i .r` 6 �` gta3 .� . 1. s �"1y. a `k " " ;y +bt� - +. o- i�•� +�
•{�?�"',ke'Yv ay f � ;.a �' .�. 4, � 4�' �Ma • �g',�, .. y�,. °%"4 `� -::,.
'�T. [� "4 L �§' t f ., yam' ♦ .-A
ri�•y�' w �`f `� r.+„r. %v 3'r' � .�•' a,�., y 4� �,. 1, :��� Q..y _
44
I
1
rrLL
Yh. 6�° a.A. ..�"° V•.i A" j J
sr -
^r

DUKE ENERGY DIRECTIONS BY ROAD FORM
Lake Use Permit Applicants and Contractors: Ease of locating the proposed project
site canhavea big impact on permitting processing time. Please complete this form and
return it along with your completed application to:
DUKE ENERGY
C/O LAKE SERVICES — EC 12 Q
526 SOUTH CHURCH STREET
CHARLOTTE, NC 28202
Applicant's Name: J Shott Holdings LLC (Jason C. Shoff)
Street Address (at lake): 0 Camino Real Road Mooresville, NC 28117
Lake Name: Norman
Subdivision Name: J Shott Holdings LLC
Property Section:
City: Mooresville
Lot #: Tract 1
County: Iredell
State: NC Zip: 28117
Telephone: [phone]
Directions (from major road or highway):
From I-77 North Bound, take Exit 33, left onto Williamson Road,
Left onto Alcove Road, Right onto Templeton Road, Left onto
Camino Real Road. Property is on the left just before Travis Pointe
Drive.
Descriptive Structure(s) on Property (i.e. brick garage, white fence,
mobile home, etc.)
*Note: Please use the back of this form if desired to draw us a map to the site.

F Iwo
uiqlommfS
�. �j1'10�T i�o lC1 i ✓1 S, L.Lc,
I�C�o✓'esv i ! e, N C, ZB 11 -7
TEM PLETON -
_
mom
mm
WE
,
RD -
50. 560 5D3
D-.
50.5605D3
ftww a by e[ ftw states Ge wat sisivey * SCALE 1:24 000 row a1ssFlL1te11I
mMo[ria9a■d 19U @NODI EV--" moltwaaa�
mlleG00ousysm2W-9MltkGS[l.0m .Z-: r'; I a5 0 000YE1FIfS 1 I �1
IOmwwd. NDd CM rWCw"WMd0)S —, - --- — •_S!'tl'Ky' Sruidryer0 mGlb,0
q Omlmltlds Nrd hiN Cadamfyeadl9U IY■t N00 S[ � 0 ,e1EK mW mm —
I %
,..biar,kpl m[wR.Av�lla ■1'� NlES ,Ilmltul0 R0I10 16RWla 'S1r0bLLo
plr9hd Mmb mpt..Vm,m 1p—J. d. 1000 0 1000 1100 1000 ,0[ SOm ,Om 10[ 1000 9000 10000 a+.■eisv y _
wrgl6rwy ■lhe ha Mtn Or1961a1 bdOr0
�MO"'dD mlef. h111i/1[a,MgF11CI00tl Fu
[Cmrme[mIIR[e@i
Yyry._.._._.__...._...._.___............pIH, lw i[, ICS
mi- .__.._.___.......... U.S. 0—ki 4IDR-2mmmww4l9Fm
■M+..`., "n ul9lCw YWXXUT[0fiw I t', 1 IT.W.
xpOryYl...._..._......._maw IRs4+fM D*... 1[,
ta+ra
Oaws........ ... __..... .xrlar 111 -to Oral. >•/0[ar
eaa.a..._.....wuylosartSawtldn Om MR mm [ 701,0q ■t0,00.a/mmhr wmmo S SmraY
-: mxwrGap9WlRgalei�o�WrlYaWl mll. /lawMY
,wtl0,tl flm,acWNwm d6'a4[I' trrt vptp04n
■u[a._......es x,mle wrrW may 19n � ml, '', 1 twrx.wlswa LAKE NORMAII NORiH, NC
rn marc �Irasw 2016

J Shott Holdings, LLC
0 Camino Real Road —Tract #1
Mooresville, NC 28117
Excavation Neighbors
J Shott Holdings LLC
139 Travis Point Rd.
Mooresville, NC 28117
Mailing Address:
104 Onslow Ct
Mooresville, NC 28117
Joseph and Kathryn Mabry
114 Iron Gate Circle
Mooresville, NC 28117
Charles C II & Wendy G Shackleton
219 Camino Real Rd
Mooresville, NC 28117
Disposal Neighbors
Finley William M III + Jeanne T Revoc TR ETA
1178 River Highway
Mooresville, NC 28117
Hager Sidney 6 + Hallie
139 Robinson Road
Mooresville, NC 28117

Excavation Project User's Agreement Letter
(Please fill in the blanks. Please Print)
TO: Duke Energy
c/o Lake Services - EC12Q
526 S. Church Street
Charlotte, NC 28202
RE: Excavation For (Subdivision and Lot #'s or Other Project Name)
(Lake/County/City)
(Applicant's full name) _S_ jdir(r' 6 Spyl C9l*ereby agrees to comply with all
recommendations, requirements and/or co itions of Duke Energy Lake Services, General
Permit(s) (if applicable) and other federal, state and local agency requirements pertaining to the
application to excavate for the purpose of a _ -E- S i 7 acce55
In addition, I/we have read and agree to comply with Duke's current Shoreline Management Plan
(SMP), much of which is repeated herein, 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 1/we obtain approval for
a single, time extension (maximum of one year) in writing from Duke Energy Lake Services.
I/we understand that if the SMP or other applicable rules change during any extension period,
Uwe will be expected to comply with the new requirements to the maximum extent practicable.
Uwe also recognize that failure to complete the excavation within this build -out period will
require the filing of a new application within the then -current SMP and the new application must
include any applicable fees and security deposits.
I/we attest to be the owner(s) or lease holder(s) of the land immediately adjoining the project
boundary or Duke -owned peripheral strip where the excavation activity is to take place, or if not
the owner or lease holder, Uwe 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, Uwe have included
proof of title to the property and written authorization from the owner(s) or lease holder(s) to
carry out the work on their land.
Duke Energy Page 1 Rev: 6/16/17

I/we 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.
I/we 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. I/we understand that
written authorization and/or other permits may be required by some of these agencies and such
required authorizations must be obtained before I/we submit the final application to Duke
Energy Lake Services.
1/we 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.
I/we 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.
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.
1/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.
Duke Energy Page 2 Rev: 6/16/17

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.
Uwe 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.
Uwe 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.
Uwe agree that the proposed excavation will not be for the purpose of creating additional
shoreline, will not alter the project boundary or the full pond contour, and will not impact
threatened or endangered species, historic properties, or environmentally -important areas, unless
special public entity provisions were made in the application.
I/we recognize that it is my/our responsibility to clearly locate in the field and label on my/our
work area drawings any areas that require specific protection or avoidance during this excavation
work. Examples of these protection/avoidance areas include but are not limited to, any
Environmental Areas, Natural Areas or Impact Minimization Zones as identified by Duke;
jurisdictional wetlands; historic properties; rare or threatened species; and buried gas, water,
sewer, electric or communications lines. Uwe 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 determine what measures, if
any, Uwe 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.
Uwe agree to be fully responsible for the permitted lake use and Uwe understand that this
responsibility is considered to transfer automatically along with ownership and leases of the
adjoining tract.
I/we understand Duke Energy representatives may issue Stop Work Directives for violations of
the SMP and 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
Duke Energy Page 3 Rev. 6/16/17

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, Uwe will post Duke Energy's approval letter in a clear waterproof
ba at t 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 recognize security deposits will not be refunded if any violations of the SMP or this user's
agreement occur.
1/we understand 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.
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,
Y Shrsl-� l 013126 L
,�aib C 5�QA7
Applicant's Name (Print) Applicant's Signature
Co -Applicant's Name (Print)
Co -Applicant's Name (Print)
Co -Applicant's Name (Print)
Co -Applicant's Name (Print)
Co -Applicant's Signature
Co -Applicant's Signature
Co -Applicant's Signature
Co -Applicant's Signature
Duke Energy Page 4 Rev 6/16/17