NCC204747_NOI Application_20201021

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/20/2020 8:20:11 AM (NCG01 NOI Submission)
Approve by Clark, Paul 10/20/2020 3:47:08 PM (Review- Construction NOI 33367)
• The task was assigned to Clark, Paul by round robin distribution 10/20/2020 8:20 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 22, 2020 5:00
PM. The priority is: High 10/20/2020 8:20 AM
Submit by Selkane, Aziza 10/21/2020 10:40:21 AM (Payment Verification for NCC204747)
* Kenneth Darr
• Selkane, Aziza assigned the task to Selkane, Aziza 10/21/2020 10:39 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: December 1, 2020 5:00 PM.
The priority is: High 10/20/2020 3:47 PM

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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 * Line 452 - Line 20 Natural Gas Pipeline Replacement
1 b. Specific Lot This field nay be used to list specifc lot nunbers.
Numbers N/A- Piedmont Natural Gas Utility Right -of -
Way
2. County* Cumberland
3. Highway or Street All American Freeway
Address * Street narre only is acceptable if no address nunber assigned yet
4. City or Township* Fayetteville
5. State * NC
6. Zip Code * 28303
7. Latitude * Enter the latitude in decirral degrees
35.0972
8. Longitude* Enter the longitude in decir al degrees (MJST be negative)
-78.9652
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*
11/16/2020
Estinated Construction Project Start Date
10. Date to End*
04/30/2021
Estimated Construction Project End Cute
11. SIC (Primary) *
Other (9999)
Standard Industrial aassification for Ceveloprrent
12. Acres to be
22.00
disturbed*
(including off -site borrow and waste areas)
13. Total site area 22.00
(acres) *

14. Post- 0.20
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-CUMBE-2020-1-ine 452 - Line 20 Natural Gas Pipeline
Tracking ID Replacement
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 Jacks Ford Branch
Waterbody* Ibrreofwaterbodyinto whichstormwaterrunoff will discharge
15b. Waterbody 18-31-24-5-2
Index No.* NCWaterbody Index Number
Stormwater r No
discharges will flow Pf Yes
to additional
wate rs *
15c. Additional Beaver Creek (Beaver Creek Pond)
Receiving Waterbody narre
Waterbody
15d. Waterbody 18-31-24-5
Index No. NCWaterbody Index Nurrber
15e. Additional Waterbody narre
Receiving
Waterbody
15f. Waterbody NCWaterbody Index Number
Index No.
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. ^
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 * Aaron
IF Corporation, enter Faegistered Agent First %rre
3. Last Name* Weldon
It Corporation, enter F;bgistered Agent Last %rre
3b. Title Project Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 7047314153
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
28210-4269 us
Check box if the V 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
28210-4269
us
8. Type of
Non -Government
Ownership

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Aaron
Contact - First
Name *
2. Primary Site
Weldon
Contact - Last
Name *
3. Title
Project Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
7047314153
Telephone No.
6. Organization
Piedmont Natural Gas Company, Inc.
Name
7. Site Contact
Street Address
Mailing Address*
4720 Piedmont Row Drive
Address Line 2
City
Charlotte
Fbstal / Zip Code
28210-4269
8. Consultant Name
(Optional)
Alex Darr
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
4706788899
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 05/28/2020
Approved *
2. E&SC Plan Project CUMBE-2020-186
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 * Fayetteville (FRO)
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 Line452_ESPC_Approval.pdf 495.38KB
Approval letter or Mist be RF format
Grading Permit
6. Site Location Map Helpful for linear project review
(Optional) Figure 1_LocationMap.pdf 1.25MB
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.
Piedmont Natural Gas Company, Inc. has established a "Delegation
of Signature Responsibility for Water Permits; National Pollutant
Discharge Elimination System (NPDES), U.S. Army Corps of
Engineers, and other Federal, State, and/or Local Water - related
Regulatory Programs". This document authorizes Aaron Weldon
and other project managers to sign permitting documents on behalf
of their Senior Vice President, Brian Weisker. This document is
attached to the #8 below.
8. NOI Certification 2020-10-16 11-26_page_1.pdf 305.93KB
Form Delegation of Signatory Responsibility.pdf 33.99KB
Mast be R7Ffon-rat
This is an Express r 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 * Aaron Weldon
Title Project Manager
Organization Legally Flesponsible Entity
Piedmont Natural Gas Company, Inc.
Date * 10/20/2020

F. Tracking and COC Info
NOI Tracking No. 33367
NC Reference No.
NCG01-2020-4747
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC204747
Coverage (COC)
Uses 'count number' variable (increrrented by SP)
No.*
Count Number 4747
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. NCC204747-2020
Invoice Due Date 11/19/2020
Initial Fee $ 100.00
Invoice Status OPEN