NCC191691_Modification Review_20210223

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 2/18/2021 4:20:49 PM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 2/23/2021 5:33:26 PM (Construction COC ADD TO FILE Review- NCC191691)
p This revision will be added as a Mod to existing COC NCC191691. Verified with Duke Energy (J.
Dishmon) on 212312021 that NOI 41155 (assigned COC NCC210322 but not yet issued) can be cancelled
instead.
• The task was assigned to Georgoulias, Bethany. The due date is: February 23, 2021 5:00 PM
2/18/2021 4:20 PM

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NORTH CAPOLINA
EnYlrenmemf& Qnalay
Certificate of NCC191691
Coverage (COC) Enter the Certificate of Coverage N nber (Use capital letters)
No.*
Information associated with this permit:
Project Name Cape Fear Beneficial Ash
Address 500 CP&L Drive, Moncure, NC
County Chatham
Latitude 35.5876
Longitude-79.0327
Permittee Listed Duke Energy Progress, LLC
Legally Responsible John Smith
Individual
NC Reference No. NCG01-2019-1691
E&SC Plan ID
Original NOI
Tracking No.
CHATH-2019-005
15439
Date COC Issued* 09/09/2019
Prior Rescission This field will populate only if COChas already been rescinded.
Date
Modification Information:
Reason for r Closed -Out Lots/Outparcels in E&SC Plan
Modification * r Additional Lots/Outparcels Approved - E&SC Revised
F Other Revision(s) to E&SC Plan
r Legally Responsible Individual and/or Site Contact Has Changed
r Multiple Reasons (List)
Addional Nbre inforrration (e.g., new Site Contact details). If lots are being added, please include specific lot nunbers.
Explanation A revision for this permit was issued 1/12/2021 with a new NCC210322. Project
Name on revision is Cape Fear Ash Beneficiation Facility. We were sent a reminder
of a issuance fee. I need to confirm that there is not a fee for revisions and the
revision has not be rescinded. The annual fee for NCC191691 has been paid.
You must upload supporting documentation below. Do not upload E&SC Plans unless specific plan
sheets are the only documentation with approval for revised acres of disturbance, etc. (only upload applicable
sheets).

For changes to the legally responsible individual, you must upload this form.
Supporting upload Supporting Lbcurrentation (%vised I&SC Approval, (lose -Out Doc, etc.)
Documentation CHATI-k2019-005_20210112_LODbD (002).pdf 258.43KB
COC for CHATH-2019-005 Revision.pdf 182.92KB
Mast be RYformat
North Carolina General Statute 143-215.6B (i) provides that:
Anyperson who knowinglymakes anyfalse statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained under this Article or a rule implementing this Article; or who knowinglymakes a false statement
of a material fact in a rulemaking proceeding or contested case underthis Article; orwho falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine notto exceed ten thousand
dollars ($10,000).
rJ I hereby request modification to coverage under the NPDES Stormwater Permit
for the subject project site. I am familiar with the information contained in this
request and to the best of my knowledge and belief such information is true,
complete and accurate.
Specify if you are:* r The Legally Responsible Individual
f Authorized Responsible Person*
*This form must be signed by a responsible corporate officer that owns or operates the construction activity, such as a
president, secretary, treasurer, or vice president, or a manager that is authorized in accordance with Part IV, Section B,
Item (6) of the NCG010000 General Permit. For more information on signatory requirements, see Part IV, Section B,
Item (6) of that permit.
Signature
Type Name* John Smith
Title * Project Director
Organization* Duke Energy Progress, LLC
Date * 02/18/2021
Email Address* [e-mail]
En -ail for confirmation
Telephone Number* 704-382-4738
Contact number if we need to reach you
Note: Original permittee and site contact are copied on modification correspondence.
Additional Email [e-mail]
(Optional) Additional email for confirmation
Original Permittee [e-mail]
Email
Original Site Contact [e-mail]
Email
Review Date 02/23/2021

Rescinded Since
Submitted?
Request Date 20210218
Formatted
Review Date 20210223
Formatted