NCC204619_NOI Application_20201014

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/13/2020 9:29:25 AM (NCG01 NOI Submission)
Approve by Clark, Paul 10/13/2020 10:41:13 AM (Review- Construction NOI 33012)
• The task was assigned to Clark, Paul by round robin distribution 10/13/2020 9:29 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 15, 2020 5:00
PM 10/13/2020 9:29 AM
Submit by Selkane, Aziza 10/14/2020 9:29:14 AM (Payment Verification for NCC204619)
* Tracey S McDonald
• Selkane, Aziza assigned the task to Selkane, Aziza 10/14/2020 9:28 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 24, 2020 5:00
PM 10/13/2020 10:41 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 32867
NOI No.
Prior Reviewer Paul Clark
Name
1a. Project Name * Line 2064/2076 X Brace Replacement
1 b. Specific Lot This field may be used to list specffc lot numbers.
Numbers
2. County* Currituck
3. Highway or Street South of Currituck High School Road
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* N/A
5. State * NC
6. Zip Code * 27917
7. Latitude * Enter the latitude in decirral degrees
36.3693
8. Longitude* Enter the longitude in decir al degrees (M. ST be negative)
-75.9647
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* 10/15/2020
Estimated Construction Project Start Date
10. Date to End* 10/31/2021
Estimated Construction Project End Cute
11. SIC (Primary) * Other (9999)
Standard Industrial Classification for Ceveloprrent

12. Acres to be 15.02
disturbed* (including off -site borrow and waste areas)
13. Total site area 83.93
(acres) *
14. Post- 0.00
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-CURRI-2020-Line 2064/2076 X Brace Replacement
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 Coinjock Bay
Waterbody * %rre of waterbody into which stornwater runoff will discharge
15b. Waterbody 30-1-6
Index No.* NCWaterbody Index Nunber
Stormwater r No
discharges will flow Pf Yes
to additional
wate rs *
15c. Additional Intracoastal Waterway
Receiving Waterbody narre
Waterbody
15d. Waterbody 030102051304
Index No. NCWaterbody Index Nanber
15e. Additional Bump Landing Creek
Receiving Waterbody narre
Waterbody
15f. Waterbody 030102051002
Index No. NCWaterbody Index Mir ber
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 * Virginia Electric and Power Company
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 * Mark
IF Corporation, enter Faegistered Agent First Wre
3. Last Name* Allen
It Corporation, enter F;bgistered Agent Last %rre
3b. Title Director Electric Transmission Project Development & Execution
4. Permitee E-mail [e-mail]
Address*
5. Permittee [phone]
Telephone No.*
6. Permittee Mailing Street Address
Address* 10900 Nuckols Road, 4th Floor
Address Line 2
City State / Frovince / Fbgion
Glen Allen Virginia
Fbstal / Zip Code Country
23060 United States
Check box if the F Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
10900 Nuckols Road, 4th Floor
Address Line 2
City
State / Frovince / Region
Glen Allen
Virginia
Fbstal / Zip Code
Country
23060
United States
8. Type of
Non -Government
Ownership

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 [phone]
Telephone No.*
6. Organization Virginia Electric and Power Company
Name
7. Site Contact Street Address
Mailing Address* 10900 Nuckols Road, 4th Floor
Address Line 2
City
Glen Allen
Flostal / Zip Code
23060
8. Consultant Name (Optional)
Tracey McDonald
First and Last narre
9. Consultant E-mail [e-mail]
This person will be copied on all correspondence.
10. Consultant 757-234-9329
Telephone No.
State / Rovince / Fbgion
Virginia
Country
United States

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 Curri-2021-005
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
Curri-2021-005 Line 2064&2073 X Brace -
Approval letter or
778.52KB
09242020. pdf
Grading Permit
Mast be RDFforrrat
6. Site Location Map
Helpful for linear project review
(Optional)
Site Location Map.pdf 279.04KB
Mast be RDFfornat. Rease do not upload entire set of E&SCplans.
7. Notes (Optional)
Provide 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-eNO1-Certification-Form-20190919-DEMLR-
Form
766.93KB
SW.pdf
Mast be R7Ffon-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 * Mark Allen
Title Director Electric Transmission Project Development & Execution
Organization Legally Plesponsible Entity
Virginia Electric and Power Company
Date * 10/13/2020

F. Tracking and COC Info
NOI Tracking No. 33012
NC Reference No.
NCG01-2020-4619
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC204619
Coverage (COC)
Uses 'count number' variable (increrrented by SP)
No.*
Count Number 4619
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. NCC204619-2020
Invoice Due Date 11/12/2020
Initial Fee $ 100.00
Invoice Status OPEN