NCC202583_NOI Application_20200618

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/18/2020 9:11:07 AM (NCG01 NOI Submission)
Approve by Clark, Paul 6/18/2020 11:50:30 AM (Review- Construction NOI 27193)
• The task was assigned to Clark, Paul by round robin distribution 6/18/2020 9:11 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: June 22, 2020 5:00 PM
6/18/2020 9:11 AM
Submit by Garcia, Lauren V 6/18/2020 2:47:30 PM (Payment Verification for NCC202583)
* Black Creek Volunteer Fire Dept
• Garcia, Lauren V assigned the task to Garcia, Lauren V 6/18/2020 2:47 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: July 30, 2020 5:00 PM
6/18/2020 11:50 AM

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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 * Black Creek - Wilson 115kV Realignment
1 b. Specific Lot This field rray be used to list specifc lot numbers.
Numbers
2. County* Wilson
3. Highway or Street 4031 Ward Blvd
Address* Street narre only is acceptable if no address number assigned yet
4.CityorTownship* Wilson
5. State * NC
6. Zip Code * 27893
7. Latitude* Enter the latitude in decimal degrees
35.7382
8. Longitude* Enter the longitude in decimal degrees (M.JST be negative)
-77.9031
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*
10/01/2020
Estimated Construction Project Start Date
10. Date to End*
10/01/2021
Estinated Construction Project End Date
11. SIC (Primary)*
Commercial (1542)
Standard Industrial Classification for Developrrent
12. Acres to be
4.70
disturbed*
(including off -site borrow and waste areas)
13. Total site area 4.70
(acres) *

14. Post- 0.00
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-WILSO-2020-Black Creek -Wilson 115kV Realignment
Tracking ID Assignedautorraticaly
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 Toisnot Swamp
Waterbody* Klarre of waterbody into which stornwater runoff will discharge
15b. Waterbody 27-86-11-(5)
Index No.* NCWaterbody Index Nunber
Stormwater V No
discharges will flow r Yes
to additional
wate rs *
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. ^
F2rnittee 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 Pesponsible Entity
Name *
Duke Energy Progress, LLC
It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name *
Randy
IF Corporation, enter Faegistered Agent First %rre
3. Last Name*
Veltri
It Corporation, enter F;bgistered Agent Last %ne
3b. Title
Manager - Transmission Permitting
4. Permitee E-mail [e-mail]
Address*
5. Permittee 704-382-2741
Telephone No.*
6. Permittee Mailing Street Address
Address* 410 South Wilmington Street NC 02
Address Line 2
City State / Rovince / F;bgion
Raleigh NC
Fbstal / Zip Code Country
27601 USA
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
410 South Wilmington Street NC 02
Address Line 2
city
State / Frovince / Region
Raleigh
NC
Fbstal / Zip Code
Country
27601
USA
8. Type of
Non -Government
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Nuwan
Contact - First
Name *
2. Primary Site
Wijesuriya
Contact - Last
Name *
3. Title
Sr. Transmission Permitting Specialist
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
919-546-2090
Telephone No.
6. Organization
Duke Energy Progress, LLC
Name
7. Site Contact
Street Address
Mailing Address*
410 South Wilmington Street NCO2
Address Line 2
city
Raleigh
Fbstal / Zip Code
27601
8. Consultant Name
(Optional)
Beth Steffens
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
984-232-6795
Telephone No.
State / Rovince / Region
NC
Country
USA

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 06/15/2020
Approved *
2. E&SC Plan Project WILSO-2020-016
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 * Raleigh (RRO)
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 WILSO-2020-016_20200615_LOA.pdf 66.3KB
Approval letter or Mast beRDFformal
Grading Permit
6. Site Location Map Helpful for linear project review
(Optional) C-03-Layout1.pdf 2.12MB
Mast be RDFformat. 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 NCG01-eNO1-BlackCk-Wilson-signed.pdf 421.23KB
Form Wst be RDFfornat
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 Atide; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case under this Atcle; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring device or method required to be operated or maintained under this Atide or rules of the
Commission implementing this Atcle 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 * Randy Veltri
Title Manager, Permitting
Organization Legally Responsible Entity
Duke Energy
Date * 06/18/2020

F. Tracking and COC Info
NOI Tracking No. 27193
NC Reference No. NCG01-2020-2583
Uses 'count number' variable (incremrented by SP)
Certificate of NCC202583
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 2583
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.)