NCC205288_NOI Application_20201120

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 11/17/2020 12:19:27 PM (NCG01 NOI Submission)
Approve by Meloy, Michael 11/18/2020 8:37:02 AM (Review- Construction NOI 36389)
• The task was assigned to Meloy, Michael by round robin distribution 11/17/2020 12:20 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: November 19, 2020 5:00
PM 11/17/2020 12:20 PM
Submit by Selkane, Aziza 11/20/2020 7:46:49 AM (Payment Verification for NCC205288)
* Holly Ntemann
• Selkane, Aziza assigned the task to Selkane, Aziza 11/20/2020 7:45 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: December 30, 2020 5:00
PM 11/18/2020 8:37 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 * Cape Fear Steam Station 1956 Basin Haul Rd Widening
1 b. Specific Lot This field rray be used to list specifc lot numbers.
Numbers
2. County* Chatham
3. Highway or Street 500 CP&L Road
Address* Street narre only is acceptable if no address number assigned yet
4. City or Township* Moncure
5. State * NC
6. Zip Code * 27559
7. Latitude* Enter the latitude in decimal degrees
35.5949
8. Longitude* Enter the longitude in decimal degrees (MJST be negative)
-79.0510
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*
12/04/2020
Estimated Construction Project Start Date
10. Date to End *
12/08/2023
Estinated Construction Project End Date
11. SIC (Primary) *
Other (9999)
Standard Industrial aassification for Developrrent
12. Acres to be
2.52
disturbed*
(including off -site borrow and waste areas)
13. Total site area 477.00
(acres) *

14. Post- 0.00
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-CHATI-I-2020-Cape Fear Steam Station 1956 Basin Haul Rd
Tracking ID Widening
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 Cape Fear
Waterbody* Ibrre of w aterbody into w hich storrrw ater runoff w ill discharge
15b. Waterbody 18-(1)
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 Progress, LLC
IF 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 * Issa
If Corporation, enter Faegistered Agent First Wre
3. Last Name* Zarzar
IF Corporation, enter F;bgistered Agent Last %rre
3b. Title GM CCP Project Management
4. Permitee E-mail [e-mail]
Address*
5. Permittee 9195467574
Telephone No.*
6. Permittee Mailing Street Address
Address* 411 Fayetteville Street
Address Line 2
City
Raleigh
Fbstal / Zip Code
27601
Check box if the F Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 411 Fayetteville Street
Address Line 2
State / Frovince / Fbgion
NC
Country
us
city State / Frovince / Region
Raleigh NC
Fbstal / Zip Code Country
27601 us
8. Type of Non -Government
Ownership *

C. Site Contact Information
Part C.
^
Roject Site Contact Inforrration
.......................................................................................................................................................................................................................................................................................................................................................................................
1. Primary Site
Joyce
Contact - First
Name *
2. Primary Site
Dishmon
Contact - Last
Name *
3. Title
Permtting and Compliance - Carolinas East
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
3363945524
Telephone No.*
6.Organization
EHS
Name
7. Site Contact
Street Address
Mailing Address*
864 South Edgewood Road
Address Line 2
City
State / Rovince / Region
Eden
NC
Postal / Zip Code
Country
27288
us
8. Consultant Name
(Optional)
Joyce Dishmon
First and Last nacre
9. Consultant E-mail
This person will be copied on all correspondence.
10. Consultant
Telephone No.

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 11/13/2020
Approved *
2. E&SC Plan Project CHATH-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 * Raleigh (RRO)
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 CHATH-2021-005_20201113_LOA (002).pdf 257.88KB
Approval letter or Mist beRDFfornat
Grading Permit
6. Site Location Map NUst be RDFfornat (lint 201VB)
Pages from CF-157 Design Drawings - 1956 Basin
1.45MB
Haul Road Final.pdf
Rease do not upload entire set of E&SC plans.
7. Notes (Optional) Ffovide any additional information that night help the reviewer better understand how uploaded documents support
the application. Include additional w aterbodies for linear projects if necessary.
8. NOI Certification Cape Fear Steam Station 1956 Basin Haul Rd
Form 91.18KB
Widening -Signed Form.pdf
%st be RDFfornat
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 * Issa J. Zarzar
Title GM CCP Project Management
Organization Legally Plesponsible Entity
Duke Energy Progress, LLC
Date * 11/17/2020

F. Tracking and COC Info
NOI Tracking No. 36389
NC Reference No.
NCG01-2020-5288
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC205288
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5288
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. NCC205288-2020
Invoice Due Date 12/18/2020
Initial Fee $ 100.00
Invoice Status OPEN