NCC203387_NOI Application_20200810

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/4/2020 4:56:40 PM (NCG01 NOI Submission)
Approve by Garcia, Lauren V 8/7/2020 4:13:28 PM (Review- Construction NOI 29451)
• Georgoulias, Bethany reassigned the task to Garcia, Lauren V 8/6/2020 8:58 AM
* Lauren, this is one of Paul's that's due today. Could you take it? He's out the rest of the week for
his daughter's wedding.
• The task was assigned to Clark, Paul by round robin distribution 8/4/2020 4:57 PM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 6, 2020 5:00
PM 8/4/2020 4:57 PM
Submit by Selkane, Aziza 8/10/2020 10:10:39 AM (Payment Verification for NCC203387)
* THOMAS PALADINO
• Selkane, Aziza assigned the task to Selkane, Aziza 8/10/2020 10:09 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: September 18, 2020 5:00
PM 8/7/2020 4:13 PM

.• SThF� ';
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 * North Greensboro Tie Substation Security Improvements
1 b. Specific Lot This field rray be used to list specifc lot nunbers.
Numbers
2. County* Guilford
3. Highway or Street 3400 Derby place
Address* Street narre only is acceptable if no address number assigned yet
4. City or Township* North Greensboro
5. State * NC
6. Zip Code * 27405
7. Latitude* Enter the latitude in decinal degrees
36.1225
8. Longitude* Enter the longitude in decir al degrees (M.JST be negative)
-79.7822
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*
08/17/2020
Estimated Construction Project Start Date
10. Date to End *
12/17/2020
Estinated Construction Project End Date
11. SIC (Primary)*
Industrial (1541)
Standard Industrial aassification for Developrrent
12. Acres to be
6.20
disturbed*
(including off -site borrow and waste areas)
13. Total site area 31.11
(acres) *

14. Post- 1.00
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-GUILF-2020-North Greensboro Tie Substation Security
Tracking ID Improvements
Assigned autorretically
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 Buffalo Make
Waterbody* Ibrreofwaterbodyinto whichstornwaterrunoff will discharge
15b. Waterbody 16-11-14-1-2
Index No.* NCWaterbody Index Nunber
Stormwater r No
discharges will flow Pf Yes
to additional
wate rs *
15c. Additional Jordan Branch
Receiving Waterbody narre
Waterbody
15d. Waterbody 16-11-14-1-4
Index No. NCWaterbody Index Nurrber
15e. Additional Waterbody narre
Receiving
Waterbody
15f. Waterbody NCWaterbody Index Nunber
Index No.
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 * Duke Energy Carolinas, LLC
It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name * Michael
IF Corporation, enter Faegistered Agent First %rre
3. Last Name* Robinson
It Corporation, enter F;bgistered Agent Last %ne
3b. Title Manager, Substation Engineering
4. Permitee E-mail Mike. [e-mail]
Address*
5. Permittee 980-373-4228
Telephone No.*
6. Permittee Mailing Street Address
Address* PO BOX1006
Address Line 2
C7ty
State / Rovince / F;bgion
Charlotte
NC
Fbstal / Zip Code
Country
28201
us
Check box if the F Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
525 South Church Street
Address Line 2
Oty
State / Frovince / Region
Charlotte
NC
Fbstal / Zip Code
Country
28202
us
8. Type of
Non -Government
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
David
Contact - First
Name *
2. Primary Site
Autrey
Contact - Last
Name *
3. Title
Construction Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
772-828-9471
Telephone No.
6. Organization
Dickerson Construction
Name
7. Site Contact
Street Address
Mailing Address*
PO Box910
Address Line 2
city
Ft. Pierce
Postal / Zip Code
34954
8. Consultant Name
(Optional)
Thomas Paladino
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
4195091630
Telephone No.
State / Rovince / Region
Florida
Country
us

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 06/12/2020
Approved *
2. E&SC Plan Project GUILF-2020-044
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 * Winston-Salem (WSRO)
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 NCDEQ Certificate of Plan Approval.pdf 210.33KB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Helpful for linear project review
(Optional) Mast be RDFform3t. 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 eNO1-Certification-Form-N Greensboro-signed.pdf 740.42KB
Form Mist 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 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 * Michael D Robinson
Title Manager, Substation Engineering
Organization Legally Plesponsible Entity
Duke Energy Carolinas, LLC
Date * 08/04/2020

F. Tracking and COC Info
NOI Tracking No. 29451
NC Reference No.
NCG01-2020-3387
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC203387
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 3387
Sequential nurrber for subrrittal 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. NCC203387-2020
Invoice Due Date 9/6/2020
Initial Fee $ 100.00
Invoice Status OPEN