NCC191630_Modification Review_20190904

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/3/2019 3:06:01 PM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 9/4/2019 9:12:14 AM (Construction COC ADD TO FILE Review- NCC191630)
• The task was assigned to Georgoulias, Bethany. The due date is: September 6, 2019 5:00 PM
9/3/2019 3:06 PM

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NORTH CAROUNA
e'vorwMienfal Quanty
Certificate of
NCC191630
Coverage (COC)
Enter the Certificate of Coverage Min -per (Use capital letters)
No. *
Information associated
with this permit:
Project Name
Line 451 - Duke Marshall Steam Plant
Pipeline (Express)
Address
7275 Kidville Road, Denver, NC
County
Lincoln
Latitude
35.5084
Longitude
-81.0380
Permittee Listed
Piedmont Natural Gas Company
Legally Responsible
Jason Brown
Individual
NC Reference No.
NCG01-2019-1630
E&SC Plan ID
LINCO-2020-003
Original NOI
15351
Tracking No.*
Date COC Issued *
08/28/2019
Prior Rescission
This field will populate only if OOChas already been rescinded.
Date
Modification Information:
Reason for f 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 Multiple Reasons (List)
Addional Nbre inforrration if necessary
Explanation Added additional access road and Hwy 73 crossing.
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).

Supporting Upload Supporting Documentation (Revised E&SCApproval, dose -Out Doc, etc.)
Documentation Pipeline —Erosion Control Permit_LINCO-2020
1.49MB
006. pdf
Wst be FDFfornat
North Carolina General Statute 143-215.6113 (i) provides that:
Any person who knowingly makes any false statement, representation, orcertification in anyapplication, record, report, plan, orother
documentfiled or required to be maintained underthis Article or a rule implementing this Article; orwho knowinglymakes a false statement
of a material fact in a rulemaking proceeding or contested case underthis Article; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring device or method required to be operated or maintained underthis Article or rules of the
Commission implementing this Article shall be guiltyof a Class 2 misdemeanor which mayinclude a fine not to e)ceed ten thousand
dollars ($10,000).
rJ I, as an authorized representative, 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.
'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 *
Jason A. Brown
Title *
Project Manager
Organization *
Piedmont Natural Gas Company
Date *
09/03/2019
Email Address*
[e-mail]
Email for Confirmation
Telephone Number*
704-731-4681
Contact Pbnber if we need to reach you
Date Formatted
20190903