NCC201603_Modification Review_20200812

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/11/2020 3:56:21 PM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 8/12/2020 2:37:19 PM (Construction COC ADD TO FILE Review- NCC201603)
• The task was assigned to Georgoulias, Bethany. The due date is: August 14, 2020 5:00 PM
8/11/2020 3:56 PM

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NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of NCC201603
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
Information associated with this permit
Project Name
Huntersville Liquefier Upgrade
Address
11001 McCoy Rd, Huntersville, NC
County
Mecklenburg
Latitude
35.3771
Longitude
-80.8901
Permittee Listed
Piedmont Natural Gas
Legally Responsible
Bradley Patterson
Individual
NC Reference No.
NCG01-2020-1603
E&SC Plan ID
MECKL-2020-078
Original NOI
24564
Tracking No.*
Date COC Issued*
04/22/2020
Prior Rescission
This field will populate only if CCChas already been rescinded.
Date
Modification Information:
Reason for r Closed -Out Lots/Outparcels in E&SC Plan
Modification * r Additional Lots/Outparcels Approved - E&SC Revised
F Other Revision(s) to E&SC Plan
r Legally Responsible Individual Has Changed
r Multiple Reasons (List)
Addional We information if necessary
Explanation LOD has been increased.
You must upload supporting documentation below. Do not upload E&SC Plans unless specific plan
sheets are the only documentation with approval for revised acres of disturbance, etc. (only upload applicable
sheets). For changes to the legally responsible individual, you must upload this form.

Supporting Upload Supporting Documentation (%vised ERSC Approval, (lose -Out Doc, etc.)
Documentation MECKL-2020-078-08112020.pdf 2.06MB
Mast be FDFformat
North Carolina General Statute 143-215.66 (1) provides that:
Anyperson who knowinglymakes any false statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained under this Article or a rule implementing this Artide; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case underthis Article; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring device or method required to be operated or maintained under this Artide or rules of the
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine not to e)ceed ten thousand
dollars ($10,000).
rJ I hereby request modification to coverage under the NPDES Stormwater Permit
for the subject project site. I am familiar with the information contained in this
request and to the best of my knowledge and belief such information is true,
complete and accurate.
Specify if you are:* r The Legally Responsible Individual
r Authorized Responsible Person*
*This form must be signed by a responsible corporate officer that 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
tlzril�� �1��t�Pc�[
Type Name* Bradley Patterson
Title * Project Director / Delegate
Organization* Piedmont Natural Gas Company, Inc.
Date * 08/11 /2020
Email Address* [e-mail]
Errail for confirrration
Telephone Number* 7047314068
Contact nun ber if we need to reach you
Note: Original permittee and site contact are copied on modification correspondence.
Additional Email [e-mail]
(Optional) Additional errail for confirrration
Original Permittee [e-mail]
Email
Original Site Contact Tony. [e-mail]
Email
Review Date 08/12/2020
Rescinded Since
Submitted?

Request Date 20200811
Formatted
Review Date 20200812
Formatted