NCC202907_NOI Application_20200710

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 7/8/2020 5:01:01 PM (NCG01 NOI Submission)
Approve by Garcia, Lauren V 7/9/2020 6:59:03 PM (Review- Construction NOI 27982)
• Farkas, Jim J reassigned the task to Garcia, Lauren V 7/9/2020 2:22 PM
. The task was assigned to Farkas, Jim J by round robin distribution 7/8/2020 5:01 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: July 10, 2020 5:00 PM.
The priority is: High 7/8/2020 5:01 PM
Submit by Selkane, Aziza 7/10/2020 8:11:14 AM (Payment Verification for NCC202907)
* Nancy R Teid
• Selkane, Aziza assigned the task to Selkane, Aziza 7/10/2020 8:10 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: August 20, 2020 5:00 PM.
The priority is: High 7/9/2020 7:22 PM

.• SThF� ';
1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting r No
an NOI that was r Yes
rejected before?
Previous Rejected 27911
NOI No.
Prior Reviewer Lauren Garcia
Name
1a. Project Name * Harts Mill Solar Connector
1 b. Specific Lot This field may be used to list specffc lot numbers.
Numbers
2. County* Edgecombe
3. Highway or Street Howard Avenue
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* Edgecombe County
5. State * NC
6. Zip Code * 27886
7. Latitude * Enter the latitude in decimal degrees
35.9120
8. Longitude* Enter the longitude in decinal degrees (M. ST be negative)
-77.6196
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* 07/09/2020
Estimated Construction Project Start Date
10. Date to End* 07/01/2021
Estimated Construction Project End Cute
11. SIC (Primary) * Other (9999)
Standard Industrial Classification for Ceveloprrent

12. Acres to be 4.64
disturbed* (including off -site borrow and waste areas)
13. Total site area 19.81
(acres) *
14. Post- 0.00
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-EDGEC-2020-Harts Mill Solar Connector
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 Penders Mill Run/ Harts Mill
Wate rbody* %rre of waterbody into which stormwater runoff will discharge
15b. Waterbody 28-77
Index No.* NCWaterbody Index Nunber
Stormwater rJ No
discharges will flow r- Yes
to additional
wate rs *
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. ^
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 * Virginia Electric & Power Company
IF pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name * Mark
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Allen
IF Corporation, enter F;bgistered Agent Last %rre
3b. Title Director ET Project Development and Execution
4. Permitee E-mail [e-mail]
Address*
5. Permittee 434-532-7579
Telephone No.*
6. Permittee Mailing Street Address
Address* 10900 Nuckols Road
Address Line 2
4th Floor
City
Glen Allen
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
Fbstal / Zip Code
23060
V Yes
Street Address
10900 Nuckols Road
Address Line 2
4th Floor
city
Glen Allen
Fbstal / Zip Code
23060
8. Type of Non -Government
Ownership *
State / Frovince / Pegion
Virginia
Country
us
State / Ftovince / Region
Virginia
Country
us

C. Site Contact Information
Part C.
^
Roject Site Contact Inforrration
.......................................................................................................................................................................................................................................................................................................................................................................................
1. Primary Site
Eric
Contact - First
Name *
2. Primary Site
Clay
Contact - Last
Name *
3. Title
Construction Consultant
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
804-335-9534
Telephone No.*
6. Organization
Dominion Energy North Carolina
Name
7. Site Contact
Street Address
Mailing Address*
10900 Nuckols Road
Address Line 2
4th Floor
city
State / Rovince / Region
Glen Allen
Virginia
Flostal / Zip Code
Country
23060
us
8. Consultant Name
(Optional)
C2 Environmental, Inc. c/o Jennifer Johnson
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
757-636-5047
Telephone No.

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 06/29/2020
Approved *
2. E&SC Plan Project EDGEC-2020-003
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
EDGEC-2020-003_20200629_LOA_revised.pdf 378.26KB
Approval letter or
Mist be RDF format
Grading Permit
6. Site Location Map
Helpful for linear project review
(Optional)
0048_loc_quad.pdf 1.111VIB
Mast be RDF format. 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
440.63KB
SW.pdf
Mast be RDFfon-rat
This is an Express
r No
Review Project*
F 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 * Mark Allen
Title Director ET Project Development & Execution
Organization Legally Responsible Entity
Virginia Electric & Power Company
Date * 07/08/2020

F. Tracking and COC Info
NOI Tracking No. 27982
NC Reference No.
NCG01-2020-2907
Uses 'count_nunber' variable (increrrented by SP)
Certificate of
NCC202907
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 2907
Sequential nunber for subnittal that is incremented by Stored Frocedure
COC Year 2020
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)
Initial Invoice No. NCC202907-2020
Invoice Due Date 8/8/2020
Initial Fee $ 100.00
Invoice Status OPEN