NCC192471_NOI Application_20191025

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 10/22/2019 6:08:34 AM (NCG01 NOI Submission)
Approve by Farkas, Jim J 10/23/2019 8:58:33 AM (Review- Construction NOI 17462)
• The task was assigned to Farkas, Jim J by round robin distribution 10/22/2019 6:09 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 24, 2019 5:00
PM. The priority is: High 10/22/2019 6:09 AM
Submit by McCoy, Suzanne 10/25/2019 8:14:46 AM (Payment Verification for NCC192471)
* Nuwan Wijesuriya
• McCoy, Suzanne assigned the task to McCoy, Suzanne 10/25/2019 8:14 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: December 4, 2019 5:00 PM.
The priority is: High 10/23/2019 8:58 AM

STME
NORTH CAROLINA
Errvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1 r-G) &T:M'G) M 1-11 117-_1iI a 1010
1. Project Name * NCDOT US 70 Havelock Bypass Existing Line Improvements (Areas
1-9)
2. County* Craven
3. Highway or Street US 70
Address* Street narre only is acceptable if no address nun-ber assigned yet
4. City or Township* Township 6
5. State * NC
6. Zip Code * 28532
7. Latitude* Enter the latitude in decimal degrees
34.9334
8. Longitude * Enter the longitude in decirral degrees (MJST be negative)
-76.9547
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*
10/21 /2019
Estimated Construction Project Start Date
10. Date to End *
08/01 /2021
Estimated Construction Project End Date
11. SIC (Primary)*
Commercial (1542)
Standard Industrial Cassification for Developrrent
12. Acres to be
37.50
disturbed*
(including off -site borrow and waste areas)
13. Total site area 37.50
(acres) *
14. Post- 0.00
construction (Estimated)
impervious area
(acres)*

NCC Project NCC-CRAVE-2019-NCDOT US 70 Havelock Bypass Existing Line
Tracking ID Improvements (Areas 1-9)
Assigned autorratically
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 Southwest Prong Slocum Creek
Waterbody* Narre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 27-112-1
Index No. * NC Waterbody Index Ninber
Stormwater r No
discharges will flow pr Yes
to additional
wate rs *
15c. Additional Daniels Branch
Receiving Waterbody nacre
Waterbody
15d. Waterbody 27-112-6-1
Index No. NCWaterbody Index Narrber
15e. Additional Tucker Creek
Receiving Waterbody nacre
Waterbody
15f. Waterbody 27-112-6
Index No. NCWaterbody Index Pbnber
16a. Is this project F Yes
subject to the NC r No, not subject to NC SPCA
Sediment Pollution
Control Act?*

B. Permittee Information
Part B.
Perrrittee Information - Legally Responsible Entity and Individual
.....................................................................................................................................................................
h
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
Duke Energy Progress, LLC
Name *
2. First Name*
Thomas
ff Corporation, enter Registered Agent First l\brre
3. Last Name *
Williarms
ff Corporation, enter Registered Agent Last Barre
3b. Title
Manager Line Engineering Carolinas East
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-546-2354
Telephone No.*
6. Permittee Mailing Street Address
Address* 410 South Wilmington Street
Address Line 2
City
Raleigh
Postal / Zip Code
27601-1849
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
fJ Yes
Street Address
410 South Wilmington Street
Address Line 2
City
Raleigh
Fbstal / Zip Code
27601-1849
State / Province / Region
NC
Country
us
State / Province / Region
NC
Country
us

C. Site Contact Information
Part C.
Froiect Site Contact Information
1. Type of Non -Government
Ownership*
2. Primary Site Nuwan
Contact - First
Name *
3. Primary Site Wijesuriya
Contact - Last
Name *
4. Title Sr. Transmission Permitting Specialist
5. Site Contact E- [e-mail]
mail Address*
6. Site Contact 919-546-2090
Telephone No.*
7. Organization Duke Energy Progress, LLC
Name
8. Site Contact Street Address
Mailing Address* 410 South Wilmington Street
Address Line 2
city
Raleigh
Pbstal/ Zip Code
27601-1849
9. Consultant Name (optional)
Elizabeth Steffens
First and Last narre
10. Consultant E- [e-mail]
mail This person will be copied on all correspondence.
11.Consultant 984-232-6795
Telephone No.
State / Province / Region
NC
Country
us

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 10/09/2019
Approved *
2. E&SC Plan Project CRAVE-2019-023
Number/ID* Assigned by agency or local program
3. E&SC Plan f• State DEQ Office
Approved by r Local Program
4. State DEQ Office * Washington (WaRO)
Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a
complete application.
5. E&SC Plan Crave-2019-023 NCDOT US 70 Havelock Bypass
Approval Ebsting Line Improvements (Areas #1-9) REV- 1.16MB
letter/documentation
EXPRESS- 10092019.pdf
Wst be RDF format
6. NOI Certification Havelock NOI signed by DEP.pdf 58.13KB
Form NUst be RDFforrrat
This is an Express r No
Review Project* f• Yes

E. Certification
North Carolina General Statute 143-215.613 (1) provides that:
Anyperson who knowinglymakes any false 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 under this Article; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring deice 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 not to exceed ten thousand
dollars ($10,000).
Under penalty of law, I certify that:
rJ 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.
* I7 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:* r The Responsible Person named on this Notice of Intent
r Authorized Responsible Person*
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 *
Thomas C. Williams, Jr.
Title
Manager Transmission Line Engineering
Organization
Duke Energy Progress
Date *
10/22/2019

F. Tracking and COC Info
NOI Tracking No. 17462
NC Reference No. NCG01-2019-2471
Uses 'count number variable (incremrented by SP)
Certificate of NCC192471
Coverage (COC) Uses'count_nunber'variable (incremrented by SF)
No. *
Count Number 2471
Sequential nunber for subrrittal that is incremented by Stored Procedure
COC Year 2019
Year of date reviewed (used to assign YY digits after "NGC' in OOCno.)