NCC205219_NOI Application_20201211

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 11/12/2020 5:28:09 PM (NCG01 NOI Submission)
Approve by Clark, Paul 11/13/2020 9:15:13 AM (Review- Construction NOI 35934)
• The task was assigned to Clark, Paul by round robin distribution 11/12/2020 5:29 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: November 16, 2020 5:00
PM 11/12/2020 5:29 PM
Submit by Selkane, Aziza 12/11/2020 9:46:37 AM (Payment Verification for NCC205219)
* Sara S Kent
• Selkane, Aziza assigned the task to Selkane, Aziza 12/11/2020 9:45 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: December 25, 2020 5:00
PM 11/13/2020 9:16 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 * PNG Line 466 Laydown Yard
1 b. Specific Lot This field rray be used to list specifc lot nunbers.
Numbers
2. County* Lenoir
3. Highway or Street Brooks Farm Road & Odham Road
Address* Street narre only is acceptable if no address number assigned yet
4. City or Township* Contentnea Neck
5. State * NC
6. Zip Code * 28501
7. Latitude* Enter the latitude in decinal degrees
35.3564
8. Longitude* Enter the longitude in decir al degrees (MUST be negative)
-77.4743
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*
11/20/2020
Estinated Construction Project Start Date
10. Date to End*
11/01/2021
Estimated Construction Project End Date
11. SIC (Primary)*
Industrial (1541)
Standard Industrial Classification for Developrrent
12. Acres to be
6.35
disturbed*
(including off -site borrow and waste areas)
13. Total site area 6.35
(acres) *

14. Post- 0.00
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-LENOI-2020-PNG Line 466 Laydown Yard
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 Alligator Canal
Waterbody* Name of waterbody into which stormwater runoff will discharge
15b. Waterbody 27-83-1
Index No.* NCWaterbody Index Number
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 Co. 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 F;bgistered Agent Last %rre
3b. Title Project Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 704-731-4496
Telephone No.*
6. Permittee Mailing Street Address
Address* P.O. Box33068
Address Line 2
City
State / Frovince / Fbgion
Charlotte
NC
Fbstal / Zip Code
Country
28233
USA
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
28210-4269
US
8. Type of
Non -Government
Ownership

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Michael
Contact - First
Name *
2. Primary Site
Parham
Contact - Last
Name *
3. Title
Site Superintendent
4. Site Contact E-
Michael. [e-mail]
mail Address*
5. Site Contact
865-771-9841
Telephone No.
6. Organization
Piedmont Natural Gas Co. Inc.
Name
7. Site Contact
Street Address
Mailing Address*
P.O. Box33068
Address Line 2
City
Charlotte
Fbstal / Zip Code
28233
8. Consultant Name
(Optional)
Anthony McMullan
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
770-365-3996
Telephone No.
State / Rovince / Region
NC
Country
USA

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 10/29/2020
Approved *
2. E&SC Plan Project Lenoi-2021-011
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 Lenoi-2021-011 PNG Line 466 Laydown Yard -
Approval letter or 763.54KB
10292020.pdf
Grading Permit
Mist be FL7Fforrrat
6. Site Location Map Mist be RDFforrret (lint 201VB)
Line466_Laydown_TopoQuad.pdf 2.92MB
Rease do not upload entire set of E&SC plans.
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-466
Form 819.37KB
LDY_signed.pdf
Mast be PDFfon-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 Project Manager
Organization Legally Responsible Entity
Piedmont Natural Gas Co. Inc.
Date * 11/12/2020

F. Tracking and COC Info
NOI Tracking No. 35934
NC Reference No.
NCG01-2020-5219
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC205219
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5219
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. NCC205219-2020
Invoice Due Date 12/13/2020
Initial Fee $ 100.00
Invoice Status OPEN