NCC202050_NOI Application_20200518

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 5/14/2020 12:06:43 PM (NCG01 NOI Submission)
Approve by Morman, Alaina 5/15/2020 1:10:17 PM (Review- Construction NOI 25627)
• The task was assigned to Morman, Alaina by round robin distribution 5/14/2020 12:06 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: May 18, 2020 5:00 PM
5/14/2020 12:06 PM
Submit by McCoy, Suzanne 5/18/2020 6:58:29 AM (Payment Verification for NCC202050)
* Sara S Kent
• McCoy, Suzanne assigned the task to McCoy, Suzanne 5/18/2020 6:57 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: June 26, 2020 5:00 PM
5/15/2020 1:10 PM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting
IT No
an NOI that was
r Yes
rejected before?
1a. Project Name *
Fayetteville Outer Loop, Lines 90 and 5 Relocation
1 b. Specific Lot
This field may be used to list specifc lot numbers.
Numbers
Deed Book #9152 Page 821-822, Deed
Book #3988 Page 355, Deed Book #3617
Page 578-580,
Deed Book #10292 Page 106-108, Deed
Book #7974 Page 05-06, Deed Book #10180
Page 639-641,
Deed Book #2454 Page 107-109, Deed
Book #9526 Page 847-849, Deed Book
#7696 Page 679-680,
Deed Book #10261 Page 404-405, Deed
Book #7037 Page 485-486, Deed Book
#5890 Page 599-600,
Deed Book #6010 Page 210-211, Deed
Book #4719 Page 403-404, Deed Book
#4719 Page 405-406,
Deed Book #8363 Page 484-485, Deed
Book #6293 Page 242, Deed Book #6297
Page 230,
Deed Book #8763 Page 770-772, Deed
Book#9721 Page 139-141, Deed Book
#2574 Page 202,
Deed Book #5371 Page 475-476 Deed Book
#9650 Page 656-658 Deed Book #9917
Page 662-663,
Deed Book #9667 Page 257-261, Deed
Book #8017 Page 233-235
2. County*
Cumberland
3. Highway or Street Grimes Road, Stoney Point Road, Doda Drive, Camden Road
Address * Street narre only is acceptable if no address number assigned yet
4. CityorTownship* Fayetteville
5. State * NC
6. Zip Code* 28306

7. Latitude* Enter the latitude in decimal degrees
34.9991
8. Longitude * Enter the longitude in decimal degrees (MJST be negative)
-79.0338
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*
08/01/2020
Estimated Construction Project Start Rate
10. Date to End *
08/01 /2021
Estimated Construction Project End Cate
11. SIC (Primary)*
Industrial (1541)
Standard Industrial aassification for Developrnent
12. Acres to be
10.84
disturbed*
(including off -site borrow and waste areas)
13. Total site area 10.84
(acres) *
14. Post- 0.00
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-CUMBE-2020-Fayetteville Outer Loop, Lines 90 and 5
Tracking ID Relocation
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 Stewarts Creek
Waterbody * %rre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 18-31-21
Index No.* NCWaterbody Index Number
Stormwater r No
discharges will flow pr Yes
to additional
wate rs *
15c. Additional Rockfish Creek
Receiving Waterbodynarre
Waterbody
15d. Waterbody 18-31-(18)
Index No. NCWaterbody Index Narrber
15e. Additional Lakewood Lake
Receiving Waterbody narre
Waterbody

15f. Waterbody
Index No.
18-31-24-3.5
NC Waterbody Index Narrber
16a. Is this project
subject to the NC
Sediment Pollution
Control Act?*
r Yes
r No, not subject to NC SPCA

B. Permittee Information
Part B. ^
Fbrnittee 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 Legally %sponsible Entity
Name * Piedmont Natural Gas Co. Inc.
It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name * Dave
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Vena
It Corporation, enter F;bgistered Agent Last %ne
3b. Title Project Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 704-731-4496
Telephone No.*
6. Permittee Mailing Street Address
Address* P.O. Box33068
Address Line 2
City State / Rovince / F;bgion
Charlotte NC
Fbstal / Zip Code Country
28233 United States
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
4720 Piedmont Row Drive
Address Line 2
City
State / Frovince / Region
Charlotte
NC
Fbstal / Zip Code
Country
28210
US
8. Type of
Non -Government
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Eddie
Contact - First
Name *
2. Primary Site
Oglesby
Contact - Last
Name *
3. Title
Site Superintendent
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
864-490-9946
Telephone No.
6. Organization
Piedmont Natural Gas Co. Inc.
Name
7. Site Contact
Street Address
Mailing Address*
P.O. Box33068
Address Line 2
city
Charlotte
Fbstal / Zip Code
22801
8. Consultant Name
(Optional)
Anthony McMullan
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
770.365.3996
Telephone No.
State / Rovince / Region
NC
Country
United States

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 05/12/2020
Approved *
2. E&SC Plan Project CUMBE-2020-169
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 * Fayetteville (FRO)
Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a
complete application. For linear projects, please also upload a site map showing the overall extent of the project or
include the beginning point and end point coordinates in the "Notes" box below.
5. E&SC Plan cumbe-2020-169_Letter of Approval.pdf 84.28KB
Approval letter or Mist beRDFformat
Grading Permit
6. Site Location Map Helpful for linear project review
(Optional) APPB1-FvilleDOT_TopoMaster_8x11_port.pdf 1.71MB
Mast be RDF format. Rease do not upload entire set of E&SCplans.
7. Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded docurrents support
the application. Include additional waterbodies for linear projects if necessary.
8. NOI Certification Fayetteville DOT NOI Cert Form_signed.pdf 44.65KB
Form Mast be RDF formal
This is an Express r 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
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 * Dave Vena
Title Project Manager
Organization Legally Flesponsible Entity
Piedmont Natural Gas Co. Inc.
Date * 05/14/2020

F. Tracking and COC Info
NOI Tracking No. 25627
NC Reference No. NCG01-2020-2050
Uses 'count number' variable (incremrented by SP)
Certificate of NCC202050
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 2050
Sequential number for submittal that is incremented by Stored Frocedure
COC Year 2020
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)