NCC203485_NOI Application_20200813

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 8/11/2020 2:30:36 PM (NCG01 NOI Submission)
Approve by Morman, Alaina 8/12/2020 9:56:39 AM (Review- Construction NOI 29770)
• Clark, Paul reassigned the task to Morman, Alaina 8/11/2020 2:37 PM
* thx
• The task was assigned to Clark, Paul by round robin distribution 8/11/2020 2:32 PM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 13, 2020 5:00
PM. The priority is: High 8/11/2020 2:32 PM
Subnut by Selkane, Aziza 8/13/2020 7:53:12 AM (Payment Verification for NCC203485)
* Craig Robert Hurd
• Selkane, Aziza assigned the task to Selkane, Aziza 8/13/2020 7:52 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: September 23, 2020 5:00
PM. The priority is: High 8/12/2020 9:56 AM

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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 29471
NOI No.
Prior Reviewer Alaina Morman
Name
1a. Project Name* Line 182 Removal Wharton -Washington
1 b. Specific Lot This field may be used to list specffc lot numbers.
Numbers
2. County* Beaufort
3. Highway or Street Multiple
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* Washington
5. State * NC
6. Zip Code * 27889
7. Latitude * Enter the latitude in decimal degrees
35.6411
8. Longitude* Enter the longitude in decimal degrees (M. ST be negative)
-77.1109
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* 09/01/2020
Estimated Construction Project Start Date
10. Date to End* 09/01/2021
Estimated Construction Project End Cute
11. SIC (Primary) * Other (9999)
Standard Industrial Classification for Ceveloprrent

12. Acres to be 30.07
disturbed* (including off -site borrow and waste areas)
13. Total site area 161.19
(acres) *
14. Post- 0.00
construction (Estinated)
impervious area
(acres) *
NCC Project NCC-BEAUF-2020-Line 182 Removal Wharton -Washington
Tracking ID Assigned autorratically
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 Cherry Run
Waterbody * %rre of waterbody into which stornwater runoff will discharge
15b. Waterbody 28-103-17
Index No.* NCWaterbody Index Ninber
Stormwater r No
discharges will flow Pf Yes
to additional
wate rs *
15c. Additional Mitchell Branch
Receiving Waterbody narre
Waterbody
15d. Waterbody 28-103-16
Index No. NCWaterbody Index Narber
15e. Additional Aggie Run
Receiving Waterbody narre
Waterbody
15f. Waterbody 28-103-14
Index No. NCWaterbody Index Nunber
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. ^
Fternittee 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 *
Virginia Electric and Power Company d/b/a Dominion Energy North
Carolina
It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name *
Kevin
If Corporation, enter Fegistered Agent First %rre
3. Last Name*
Fields
It Corporation, enter Registered Agent Last Iona
3b. Title Authorized Representative
4. Permitee E-mail [e-mail]
Address*
5. Permittee 804-771-3769
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*
Pbstal / Zip Code
23060
V Yes
Street Address
10900 Nuckols Road
Address Line 2
4th Floor
city
Glen Allen
Postal / Zip Code
23060
8. Type of Non -Government
Ownership*
State / Province / Region
Virginia
Country
United States
State / Province / Faegion
Virginia
Country
United States

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 Electric Transmission 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
Cty
Glen Allen
Fbstal / Zip Code
23060
State / Rovince / Fbegion
VA
Country
us
8. Consultant Name (Optional)
C2 Environmental, Inc. c/o Jennifer Johnson
First and Last narre
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 07/29/2020
Approved *
2. E&SC Plan Project Beauf-2021-001
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 * Washington (WaRO)
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
prm_deq_esc_approval_Beauf-2021-001.pdf 1.35MB
Approval letter or
Mast beRDFfornat
Grading Permit
6. Site Location Map
Helpful for linear project review
(Optional)
location_map.pdf 1.11MB
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.
Receiving waters: Cherry Run (28-103-17), Mitchell Branch (28-
103-16), Aggie Run (28-103-14), Snoad Branch (28-103-14-3),
Maple Branch (28-103-15) and Kennedy Creek (28-104)
8. NOI Certification
NCG01-eNO1-Certification-Form-20190919-DEMLR-
Form
2.03MB
SW.pdf
Mast be RDFfornat
This is an Express
f 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 * Kevin Fields
Title Authorized Representative
Organization Legally Responsible Entity
Virginia Electric and Power Company d/b/a Dominion Energy North
Carolina
Date * 08/11 /2020

F. Tracking and COC Info
NOI Tracking No. 29770
NC Reference No.
NCG01-2020-3485
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC203485
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 3485
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. NCC203485-2020
Invoice Due Date 9/11/2020
Initial Fee $ 100.00
Invoice Status OPEN