NCC200825_Modification Review_20200505

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 5/4/2020 1:43:40 PM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 5/5/2020 7:56:32 AM (Construction COC ADD TO FILE Review- NCC200825)
• The task was assigned to Georgoulias, Bethany. The due date is: May 7, 2020 5:00 PM
5/4/2020 1:43 PM

Y. ,
NORTH CAPCLINA
Emlremmentel Quality
Certificate of NCC200825
Coverage (COC) Enter the Certificate of Coverage N nber (Use capital letters)
No.*
Information associated with this permit
Project Name
Rockford 44kV Level Cross Line Rebuild
Address
6116 Siloam Road, Siloam, NC
County
Surry
Latitude
36.3018
Longitude
-80.5867
Permittee Listed
Duke Energy Carolinas LLC
Legally Responsible
Randy Veltri
Individual
NC Reference No.
NCG01-2020-0825
E&SC Plan ID
SURRY-2020-022
Original NOI
22561
Tracking No.*
Date COC Issued*
03/06/2020
Prior Rescission
This field will populate only ff OOChas already been rescinded.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
r Other Revision(s) to E&SC Plan
r Multiple Reasons (List)
Addional ivbre infornation if necessary
Explanation Additional disturbance needed for alternate access points.
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 (%vised ERSC Approval, (lose -Cut Doc, etc.)
Documentation SURRY-2020-022 - Revised - Signed (002).pdf 3.12MB
Mast be FDFformat
North Carolina General Statute 143-215.66 (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 knowingly makes 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 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).
17 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
,j (2 ttc
Type Name* Randy Veltri
Title * Manager, Line Permtting
Organization * Duke Energy Carolinas LLC
Date * 05/04/2020
Email Address* [e-mail]
57ail for Confirmation
Telephone Number* 704-382-2741
Contact Nbrrber if we need to reach you
Review Date 05/05/2020
Request Date 20200504
Formatted
Review Date 20200505
Formatted