NCC203493_NOI Application_20200819

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 8/12/2020 1:47:37 PM (NCG01 NOI Submission)
Approve by Gwinn, Matt 8/13/2020 8:43:08 AM (Review- Construction NOI 29822)
• The task was assigned to Gwinn, Matt by round robin distribution 8/12/2020 1:48 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 14, 2020 5:00
PM. The priority is: High 8/12/2020 1:48 PM
Submit by McCoy, Suzanne 8/19/2020 8:08:05 AM (Payment Verification for NCC203493)
* Kevin T Mason
• McCoy, Suzanne assigned the task to McCoy, Suzanne 8/19/2020 8:07 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: September 24, 2020 5:00
PM. The priority is: High 8/13/2020 8:44 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 * Duke Energy Stamey to Statesville Tie to Marshall #80 OPGW
1 b. Specific Lot This field rray be used to list specifc lot numbers.
Numbers
2. County* Iredell
3. Highway or Street 1403 Seventh St
Address* Street narre only is acceptable if no address number assigned yet
4.CityorTownship* Statesville
5. State * NC
6. Zip Code * 28677
7. Latitude* Enter the latitude in decimal degrees
35.7660
8. Longitude* Enter the longitude in decimal degrees (M.JST be negative)
-80.8936
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*
08/24/2020
Estinated Construction Project Start Date
10. Date to End*
11/24/2020
Estimated Construction Project End Date
11. SIC (Primary) *
Other (9999)
Standard Industrial aassification for Leveloprrent
12. Acres to be
45.30
disturbed*
(including off -site borrow and waste areas)
13. Total site area 100.00
(acres) *

14. Post- 0.00
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-IREDE-2020-Duke Energy Stamey to Statesville Tie to
Tracking ID Marshall #80 OPGW
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 Third Creek
Waterbody* Ibrre of w aterbody into w hich storrrw ater runoff w ill discharge
15b. Waterbody 12-108-20-4
Index No.* NCWaterbody Index Number
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 * Duke Energy Carolinas, LLC
IF 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
IF Corporation, enter F;bgistered Agent Last %ne
3b. Title Manager, Permitting
4. Permitee E-mail [e-mail]
Address*
5. Permittee 704-373-2741
Telephone No.*
6. Permittee Mailing Street Address
Address* 525 South Church Street
Address Line 2
Mail Code EC09QMaM
City
State / Frovince / Fbgion
Charlotte
NC
Fbstal / Zip Code
Country
28202
us
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
525 South Church Street
Address Line 2
Mail Code EC09Q
City
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
Neal
Contact - First
Name *
2. Primary Site
Cary
Contact - Last
Name *
3. Title
Environmental Oversight
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
704-575-3424
Telephone No.
6. Organization
Duke Energy
Name
7. Site Contact
Street Address
Mailing Address*
610 Toddville Road
Address Line 2
Building 5635
city
Charlotte
Postal / Zip Code
28214-1836
8. Consultant Name
(Optional)
First and Last narre
9. Consultant E-mail
This person will be copied on all correspondence.
10. Consultant
Telephone No.
State / Rovince / Region
NC
Country
us

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 07/30/2020
Approved *
2. E&SC Plan Project IREDE-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 * Mooresville (MRO)
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
IREDE-2021-001-07302020.pdf 2.07MB
Approval letter or
Mast beRDFformat
Grading Permit
6. Site Location Map
Helpful for linear project review
(Optional)
Vicinity Map.pdf 411.2KB
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 Notice of Intent (NOI) Certification Form.pdf 543.32KB
Form
Wst be RDFfornat
This is an Express
f 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 Manger, Permitting
Organization Legally Plesponsible Entity
Duke Energy Carolinas, LLC
Date * 08/12/2020

F. Tracking and COC Info
NOI Tracking No. 29822
NC Reference No.
NCG01-2020-3493
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC203493
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 3493
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. NCC203493-2020
Invoice Due Date 9/12/2020
Initial Fee $ 100.00
Invoice Status OPEN