NCC202364_NOI Application_20200608

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 6/2/2020 5:08:23 PM (NCG01 NOI Submission)
Approve by Garcia, Lauren V 6/5/2020 12:02:41 PM (Review- Construction NOI 26499)
• McCoy, Suzanne reassigned the task to Garcia, Lauren V 6/5/2020 11:36 AM
• The task was assigned to Farkas, Jim J by round robin distribution 6/2/2020 5:08 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: June 4, 2020 5:00 PM
6/2/2020 5:08 PM
Submit by McCoy, Suzanne 6/8/2020 7:51:09 AM (Payment Verification for NCC202364)
* Sara S Kent
• McCoy, Suzanne assigned the task to McCoy, Suzanne 6/8/2020 7:50 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: July 17, 2020 5:00 PM
6/5/2020 12:03 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 * RLNG Pipelines, Lines 456 (8") and 457 (24")
1 b. Specific Lot This field may be used to list specifc lot numbers.
Numbers Deed Book #00741 Page 0773, Deed Book
#01294 Page 0413, Deed Book # 00582
Page 0499,
Deed Book # 01669 Page 0275, Deed Book
#01720 Page 0818, Deed Book #01193
Page 0819,
Deed Book #01294 Page 0410, Deed Book
#00582 Page 0507, Deed Book #01834
Page 0160,
Deed Book #02028 Page 0829, Deed Book
#00984 Page 0082, Deed Book #01708
Page 0277,
Deed Book #01936 Page 0179, Deed Book
#00667 Page 0115 Deed Book #00715 Page
0304,
Deed Book #01775 Page 0567, Deed Book
#01775 Page 0549, Deed Book #01775
Page 0543,
Deed Book #02034 Page 0756, Deed Book
#02107 Page 0358, Deed Book #01695
Page 0485
2. County* Robeson
3. Highway or Street NC-71
Address *
Street narre only is acceptable if no address number assigned yet
4. City or Township*
Walluka
5. State *
NC
6. Zip Code *
28377
7. Latitude *
Enter the latitude in decimal degrees
34.7431

8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-79.2827
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. Date to End *
11. SIC (Primary) *
12. Acres to be
disturbed *
13. Total site area
(acres) *
14. Post -
construction
impervious area
(acres) *
06/08/2020
Estimated Construction Roject Start Rate
12/31 /2020
Estimated Construction Project End Cate
Industrial (1541)
Standard Industrial aassification for Development
68.45
(including off -site borrow and waste areas)
68.45
0.00
(Estimated)
NCC Project NCC-ROBES-2020-RLNG Pipelines, Lines 456 (8") and 457 (24")
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 Gum Swamp
Waterbody * %rre of waterbody into which stormwater runoff will discharge
15b. Waterbody 14-5
Index No.* NCWaterbody Index Number
Stormwater
r No
discharges will flow
Pf Yes
to additional
wate rs *
15c. Additional
Jordan Swamp
Receiving
Waterbody name
Waterbody
15d. Waterbody
14-5-1
Index No.
NCWaterbody Index Number
15e. Additional
Receiving
Waterbody
15f. Waterbody
Index No.
Waterbody nacre
NCWaterbody Index Number

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. ^
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 Responsible Entity
Name * Piedmont Natural Gas Company
It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name * Tom
If Corporation, enter Registered Agent First %rre
3. Last Name* Morris
It Corporation, enter F;bgistered Agent Last %ne
3b. Title Project Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 704-731-4245
Telephone No.*
6. Permittee Mailing Street Address
Address* 4720 Piedmont Row Drive
Address Line 2
City State / Rovince / F;bgion
Charlotte NC
Fbstal / Zip Code Country
28210 us
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
Bryan
Contact - First
Name *
2. Primary Site
Lemons
Contact - Last
Name *
3. Title
Implementation Superintendent
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
704-913-3377
Telephone No.
6. Organization
Piedmont Natural Gas Company
Name
7. Site Contact
Street Address
Mailing Address*
PO 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
Mecklenburg

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 05/22/2020
Approved *
2. E&SC Plan Project ROBES-2020-022
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
ESC Approval_robes-2020-022ap.pdf 387.31 KB
Approval letter or
Mast beRDFformat
Grading Permit
6. Site Location Map
Helpful for linear project review
(Optional)
RLNGpipeline_Topov2.pdf 1.37MB
Mast be RFformat. Rease do not upload entire set of E&SCplans.
7. Notes (Optional)
Rovide 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
NCG01-eNO1-Certification-Form-20190919-DEMLR-
Form
149.08KB
SW_signed.pdf
Mast be R7Fformat
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
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 * Tom Morris
Title Project Manager
Organization Legally Responsible Entity
Piedmont Natural Gas Company
Date * 06/02/2020

F. Tracking and COC Info
NOI Tracking No. 26499
NC Reference No. NCG01-2020-2364
Uses 'count number' variable (incremrented by SP)
Certificate of NCC202364
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 2364
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.)