NCC204347_NOI Application_20201001

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/29/2020 4:46:29 PM (NCG01 NOI Submission)
Approve by Meloy, Michael 9/30/2020 8:03:29 AM (Review- Construction NOI 32228)
• The task was assigned to Meloy, Michael by round robin distribution 9/29/2020 4:47 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 1, 2020 5:00
PM 9/29/2020 4:47 PM
Submit by Selkane, Aziza 10/1/2020 8:58:32 AM (Payment Verification for NCC204347)
* Farmworth GRP Inc
• Selkane, Aziza assigned the task to Selkane, Aziza 10/1/2020 8:57 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 11, 2020 5:00
PM 9/30/2020 8:03 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 32150
NOI No.
Prior Reviewer Michael Meloy
Name
1a. Project Name * Piedmont Natural Gas Havelock Station
1 b. Specific Lot This field may be used to list specffc lot numbers.
Numbers
2. County* Craven
3. Highway or Street McCotter Blvd
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* Havelock
5. State * NC
6. Zip Code * 28532
7. Latitude * Enter the latitude in decimal degrees
34.8593
8. Longitude* Enter the longitude in decimal degrees (M. ST be negative)
-76.8909
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* 11/02/2020
Estimated Construction Project Start Date
10. Date to End* 04/30/2021
Estimated Construction Project End Cute
11. SIC (Primary)* Industrial (1541)
Standard Industrial aassification for Developrrent

12. Acres to be 1.66
disturbed* (including off -site borrow and waste areas)
13. Total site area 0.60
(acres) *
14. Post- 0.30
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-CRAVE-2020-Piedmont Natural Gas Havelock Station
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 Shop Branch
Waterbody* Name of waterbody into which stormwater runoff will discharge
15b. Waterbody 27-115-3
Index No.* NCWaterbody Index Ninber
Stormwater V No
discharges will flow r Yes
to additional
wate rs *
16a. Is this project F Yes
subject to the NC r No, not subject to NC SPCA
Sediment Pollution
Control Act?*

B. Permittee Information
Part B. ^
Fbrnittee 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 %sponsible Entity
Name * Piedmont Natural Gas Company, Inc.
It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
Note: The organization name must match the business entity name registered with the NC Secretary of State. You can
verify the registration here.
2. First Name * Dave
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Vena
It Corporation, enter Pbegistered Agent Last %rre
3b. Title Senior Project Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 704-731-4496
Telephone No.*
6. Permittee Mailing Street Address
Address* 4720 Piedmont Row Drive
Address Line 2
City State / Frovince / Fbgion
Charlotte NC
Fbstal / Zip Code Country
28210 us
Check box if the F Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
4720 Piedmont Row Drive
Address Line 2
City
State / Frovince / Region
Charlotte
NC
Fbstal / Zip Code
Country
28210
us
8. Type of
Non -Government
Ownership

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Dennis
Contact - First
Name *
2. Primary Site
Robertson
Contact - Last
Name *
3. Title
Implementation Superintendent
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
803-917-6577
Telephone No.
6. Organization
Piedmont Natural Gas
Name
7. Site Contact
Street Address
Mailing Address*
108 Berly Street
Address Line 2
city
Lexington
Fbstal / Zip Code
29072-2602
8. Consultant Name
(Optional)
Darren Mitchell
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
901-827-3135
Telephone No.
State / Rovince / Region
SC
Country
us

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 09/24/2020
Approved *
2. E&SC Plan Project Crave-2021-013
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
Crave-2021-013 Piedmont Natural Gas Havelock
Approval letter or
864.39KB
Station - 09242020 (EXP).pdf
Grading Permit
Mast be FDFfon-rat
6. Site Location Map
Helpful for linear project review
(Optional)
PNG- Havelock Station ESC Plan Cover Page.pdf 958.95KB
Mast be RDFfornat. 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
PNG - Havelock NCG01-eNO1-Certification-Form -
Form
42.39KB
Signed Dave Vena.pdf
Mast be FCFfon-rat
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 * Dave Vena
Title Senior Project Manager
Organization Legally Plesponsible Entity
Piedmont Natural Gas Company, Inc.
Date * 09/29/2020

F. Tracking and COC Info
NOI Tracking No. 32228
NC Reference No.
NCG01-2020-4347
Uses 'count_nunber' variable (increrrented by SP)
Certificate of
NCC204347
Coverage (COC)
Uses 'count nurrber' variable (increrrented by SP)
No.*
Count Number 4347
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. NCC204347-2020
Invoice Due Date 10/30/2020
Initial Fee $ 100.00
Invoice Status OPEN