NCC213658_NOI Application_20210617

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/16/2021 9:53:39 AM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 6/16/2021 11:01:07 AM (Review- Construction NOI 56612)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 6/16/2021 9:54 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: June 18, 2021 5:00 PM.
The priority is: High 6/16/2021 9:54 AM
Submit by Selkane, Aziza 6/17/2021 9:24:57 AM (Payment Verification for NCC213658)
* Joshua Peeler
• Selkane, Aziza assigned the task to Selkane, Aziza 6/17/2021 9:24 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: July 28, 2021 5:00 PM. The
priority is: High 6/16/2021 11:01 AM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting IT No
an NOI that was r Yes
rejected before?
1a. Project Name * Wilkes Tie Substation
1 b. Specific Lot This field nay be used to list specifc lot nunbers.
Numbers
1 c. Parcel ID List all Rim associated w ith this project.
Number(s) (PIN) 1405261
2. County* Wilkes
3. Highway or Street 1649 River Road
Address* Street name only is acceptable if no address nunber assigned yet
4. City or Township* North Wilkesboro
5. State * NC
6. Zip Code* 28659
7. Latitude* Enter the latitude in decinal degrees
36.1761
8. Longitude * Enter the longitude in decinal degrees (MJSTbe negative)
-81.1081
If you do not know the latitude and longitude coordinates for this project, you can search the location on this map of
North Carolina. Look for the coordinates in the bottom left corner.
9. Date to Begin*
06/18/2021
Estinated Construction Project Start Late
10. Date to End *
12/30/2022
Estinated Construction Project End Date
11. SIC (Primary) *
Other (9999)
Standard Industrial C]assification for Development
12. Acres to be
11.30
disturbed*
(including off -site borrow and waste areas)

13. Total site area 40.70
(acres) *
14. Post- 7.44
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-WILKE-2021-Wilkes Tie Substation
Tracking ID Assigned automatically
Below you must enter waterbody information for surface waters affected by this project. Please consult
DWR's Surface Water Classifications Map Viewer to find waterbody name and corresponding index number. Please
enter only immediate receiving waterbodies - not waters downstream of those unless the project extends there. You
may enter up to 3 waterbodies if needed.
15a. Receiving Yadkin River
Waterbody* Narreof waterbody into which stormwater runoff will discharge
15b. Waterbody 12-(38)
Index No. * NCWaterbody Index Number
Stormwater F No
discharges will flow 17 Yes
to additional
wate rs *
15c. Additional Mulberry Creek
Receiving Waterbody narre
Waterbody
15d. Waterbody 12-42
Index No. NCWaterbody Index Number
15e. Additional Waterbody name
Receiving
Waterbody
15f. Waterbody NCWaterbody Index Number
Index No.
16a. Is this project r Yes
subject to the NC r No, not subject to NC SPCA
Sediment Pollution
Control Act?*

B. Permittee Information
Part B. ^
F2rnittee Inforrration - Legally Fbsponsible Entity and Individual
Important: The person who signs the NOI Certification Form and signs the Certification in Section E of this application
form should be the same person as listed in THIS SECTION, or an authorized responsible individual within the same
organization. That person must be a responsible corporate officer who 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.
1. Organization Legally Pesponsible Entity
Name * Duke Energy Carolinas, LLC
It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
Note: The organization name must match the business entity name registered with the NC Secretary of State. You can
verify the registration here.
2. First Name * Michael
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Robinson
It Corporation, enter Pbegistered Agent Last %rre
3b. Title Manager, Substation Engineering
4. Permitee E-mail [e-mail]
Address*
5. Permittee 980-373-4228
Telephone No.*
6. Permittee Mailing Street Address
Address* 160 Mine Lake Court
Address Line 2
Suite 200
Cty
Raleigh
Fbstal / Zip Code
27615
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
F Yes
Street Address
526 South Church Street
Address Line 2
EC08Q
Qty
Charlotte
Fbstal / Zip Code
28202-1802
State / Ffovince / Fbgion
NC
Country
Wake
State / Frovince / Region
NC
Country
us
8. Type of Ownership is only individual if an individual is naned in B.1. above.
Ownership* Non -Government

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Eric
Contact - First
Name *
2. Primary Site
Shook
Contact - Last
Name *
3. Title
Environmental Oversight
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
336 416-9168
Telephone No.
6. Organization
Duke Energy Carolinas, LLC
Name
7. Site Contact
Street Address
Mailing Address*
526 South Church Street
Address Line 2
EC08Q
City
Charlotte
Fbstal / Zip Code
28202-1802
8. Consultant Name
(Optional)
William Deichert
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
Telephone No.
11. Billing E-mail
(For Annual Fee correspondence)
[e-mail]
Default is legally responsible person a-rrail
12. Billing
(For Annual Fee correspondence)
Telephone
980-373-4228
Default is legally responsible person telephone
State / Rovince / Region
NC
Country
us

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 05/10/2021
Approved *
2. E&SC Plan Project WILKE-2021-011
Number/ID * Assigned by agency or local program
3. E&SC Plan r State DEQ Office
Approved by* r Local Program
4. State DEQ Office * Winston-Salem (WSRO)
Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a
complete application. Please also upload a site map showing the overall extent of the project (for linear projects, can
include the beginning point and end point coordinates in the "Notes" box below).
5. E&SC Plan Wilkes Tie Letter of Approval.pdf 93.43KB
Approval letter or Mist beRDFformat
Grading Permit
6. Site Location Map Wst be RDFforrret (lint 20 NB)
Site Vicinity Map.pdf 354.84KB
Rease do not upload entire set of E&SC plans.
7. Notes (Optional) Rovide any additional information that night help the reviewer better understand how uploaded docurrents support
the application. Include additional waterbodies if necessary.
8. NOI Certification NCG01-eNO1-Certification-Form-20210514-DEMLR-
Form 765KB
SW.pdf
Wilkes Tie Signed NOI.pdf 88.6KB
%st be RDFforrret
This is an Express f No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.66 (1) provides that:
Any person who knowingly makes anyfalse statement, representation, or certification in any application, record, report, plan, or other
document filed or required to be maintained under this Article or a rule implementing this Article; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case under this Artcle; or who 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 Artcle shall be guilty ofa Class 2 misdemeanor which may include a fine not to exceed ten thousand
dollars ($10,000).
Under penalty of law, I certify that:
17 I am the person responsible for the construction activities of this project, for
satisfying the requirements of this permit, and for any civil or criminal penalties
incurred due to violations of this permit.
rJ The information submitted in this NOI is, to the best of my knowledge and belief,
true, accurate, and complete based on my inquiry of the person or persons who
manage the system, or those persons directly responsible for gathering the
information.
* 17 I will abide by all conditions of the NCG010000 General Permit and the
approved Erosion and Sediment Control Plan.
* rJ I hereby request coverage under the NCG010000 General Permit and
understand that coverage under this permit will constitute the permit
requirements for the discharge(s) and is enforceable in the same manner as an
individual permit.
Specify if you are:* IT The Legally Responsible Person named on this Notice of Intent
f Authorized Responsible Person* (signing on behalf of Legally Responsible
Person named in Part B)
Important: The person who electronically signs this Certification above must be the same person who signs the NOI
Certification Form. If that person is signing on behalf of the Permittee, that individual must be an authorized responsible
person within the same organization as the Permittee. *An authorized individual is a responsible corporate officer who
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* Michael D. Robinson
Title Manager, Substation Engineering
Organization Legally Responsible Entity
Duke Energy Carolinas, LLC
Date * 06/16/2021

F. Tracking and COC Info
NOI Tracking No. 56612
NC Reference No.
NCG01-2021-3658
Uses 'count_nunber' variable (increrrented by SP)
Certificate of
NCC213658
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 3658
Sequential nunber for subnittal that is incremented by Stored Frocedure
COC Year 2021
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)
Initial Invoice No. NCC213658-2021
Invoice Due Date 7/16/2021
Initial Fee $ 100.00
Invoice Status OPEN