NCC192923_NOI Application_20191126

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 11/21/2019 2:47:32 PM (NCG01 NOI Submission)
Approve by Farkas, Jim J 11/25/2019 11:12:02 AM (Review- Construction NOI 18794)
• The task was assigned to Farkas, Jim J by round robin distribution 11/21/2019 2:47 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: November 25, 2019 5:00
PM 11 /21 /2019 2:47 PM
Submit by McCoy, Suzanne 11/26/2019 7:22:40 AM (Payment Verification for NCC192923)
* Caroline N DeBruhl
• McCoy, Suzanne assigned the task to McCoy, Suzanne 11/26/2019 7:22 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: January 6, 2020 5:00 PM
11 /25/2019 11:12 AM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name * Windy Road Access and Bridge
2. County* Cabarrus
3. Highway or Street 9001 Mooresville Road
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* Concord
5. State * NC
6. Zip Code * 28027
7. Latitude * Enter the latitude in decimal degrees
35.4817
8. Longitude* Enter the longitude in decimal degrees (M. ST be negative)
-80.7291
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*
11/25/2019
Estimated Construction Project Start Date
10. Date to End*
06/17/2020
Estimated Construction Project End Cute
11. SIC (Primary)*
Other (0000)
Standard Industrial Classification for Ceveloprrent
12. Acres to be
2.50
disturbed*
(including off -site borrow and waste areas)
13. Total site area
15.15
(acres) *
14. Post-
0.62
construction
(Estimated)
impervious area
(acres) *
NCC Project
NCC-CABAR-2019-Windy Road Access and Bridge
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 Coddle Creek Tributary 4
Waterbody * %rre of waterbody into which stornwater runoff will discharge
15b. Waterbody 13-17-6-4-(2)
Index No.* NCWaterbody Index Nunber
Stormwater r No
discharges will flow Pf Yes
to additional
wate rs *
15c. Additional Coddle Creek
Receiving Waterbody narre
Waterbody
15d. Waterbody 13-17-6-(1.5)
Index No. NCWaterbody Index Nunber
15e. Additional Waterbody narre
Receiving
Waterbody
15f. Waterbody NCWaterbody Index Nunber
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. ^
Flarnittee 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 Duke Energy
Name *
2. First Name* Mayur
IF Corporation, enter Fbgistered Agent First Barre
3. Last Name* Patel
IF Corporation, enter F3egistered Agent Last %rre
3b. Title Lead Engineer
4. Permitee E-mail [e-mail]
Address *
5. Permittee 704-382-2381
Telephone No.*
6. Permittee Mailing Street Address
Address* 526 S, Church street, EC I- 08Q
Address Line 2
City State / F rovince / Faegion
Charlotte NC
Fbstal / Zip Code Country
28202 us
Check box if the rJ Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 526 S, Church street, EC I- 08Q
Address Line 2
City
State / Frovince / Fbgion
Charlotte
NC
Fbstal / Zip Code
Country
28202
us

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Type of
Non -Government
Ownership *
2. Primary Site
Neal
Contact - First
Name *
3. Primary Site
Cary
Contact - Last
Name *
4. Title
Lead Environmental Oversight
5. Site Contact E-
[e-mail]
mail Address*
6. Site Contact
980 373-0826
Telephone No.*
7. Organization
Duke Energy
Name
8. Site Contact
Street Address
Mailing Address*
526 S. Church Street, EC 108Q
Address Line 2
City
charlotte
Fbstal / Zip Code
28202
9. Consultant Name
(Optional)
Caroline Debruhl
First and Last narre
10. Consultant E-
[e-mail]
mail
This person will be copied on all correspondence.
11. Consultant
803.835.6147
Telephone No.
State / Rovince / Fbgion
nc
Country
us

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 09/04/2019
Approved *
2. E&SC Plan Project CABAR-2017-090
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 * Mooresville (MRO)
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 Letter of approval_S&E Plan.pdf 622.65KB
Approval Wst be RDFfornat
letter/documentation
6. NOI Certification Signed NCNOI Form111919.pdf 99.6KB
Form Mist be R7Ffon-rat
This is an Express F No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.6E (i) 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:* r The Responsible Person named on this Notice of Intent
f 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 * Mayur T. Patel
Title Lead Engineer, CW
Organization Duke Energy Carolinas
Date * 11 /21 /2019

F. Tracking and COC Info
NOI Tracking No. 18794
NC Reference No. NCG01-2019-2923
Uses 'count number' variable (incremrented by SP)
Certificate of NCC192923
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 2923
Sequential number for submittal that is incremented by Stored Frocedure
COC Year 2019
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)