NCC214095_Modification Review LOD EXPANDED_20211008

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/6/2021 4:04:48 PM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany A 10/8/2021 8:54:24 AM (Construction COC ADD TO FILE Review -
NCC214095)
• The task was assigned to Georgoulias, Bethany A. The due date is: October 11, 2021 5:00 PM
10/6/2021 4:04 PM

Y . Ta4M1
w,
NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of NCC214095
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
Information associated with this permit
Project Name
Active Ash Basin Removal Haul Route Improvements
Address
McCraw Road, Mooresboro, NC
County
Cleveland
Latitude
35.2100
Longitude
-81.7600
Permittee Listed
Duke Energy Carolinas, LLC
Legally Responsible
David Dellario
Individual
NC Reference No.
NCG01-2021-4095
E&SC Plan ID
CLEVE-2022-001
Original NOI
58884
Tracking No.*
Date COC Issued*
07/14/2021
Prior Rescission
This field will populate only if CCChas already been rescinded.
Date
Modification Information:
Reason for r Closed -Out Lots/Outparcels in E&SC Plan
Modification * F Additional Lots/Outparcels Approved - E&SC Revised
r Other Revision(s) to E&SC Plan
r Legally Responsible Individual and/or Site Contact Has Changed
r Multiple Reasons (List)
Addional We inforrration (e.g., new Site Contact details). If lots are being added, please include specific lot nunbers.
Explanation LOD expanded to include additional 0.2 acres
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 Documentation (%vised ERSC Approval, (lose -Out Doc, etc.)
Documentation CLEVE-2022-001 Duke 10-4-2021.pdf 190.79KB
Mast be FDFformat
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 Article; 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 Article shall be guiltyofa Class 2 misdemeanor which may include a fine not to exceed ten thousand
dollars ($10,000).
17 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* David Dellario
Title * GM CCP Project Management
Organization * Duke Energy Carolinas LLC
Date * 10/06/2021
Email Address* [e-mail]
Errail for confirmation
Telephone Number* 980 242-1764
Contact nurrber 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 10/08/2021
Rescinded Since
Submitted?

Request Date 20211006
Formatted
Review Date 20211008
Formatted