NCC205860_NOI Application_20201222

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/16/2020 1:29:25 PM (NCG01 NOI Submission)
Approve by Morman, Alaina 12/17/2020 3:46:59 PM (Review- Construction NOI 39289)
• The task was assigned to Morman, Alaina by round robin distribution 12/16/2020 1:29 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: December 18, 2020 5:00
PM 12/16/2020 1:29 PM
Submit by Selkane, Aziza 12/22/2020 9:36:52 AM (Payment Verification for NCC205860)
* Joseph Barbee
• Selkane, Aziza assigned the task to Selkane, Aziza 12/22/2020 9:36 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: January 28, 2021 5:00 PM
12/17/2020 3:47 PM

.• SThF� ';
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 75 MAOP Replacement
1 b. Specific Lot
This field rray be used to list specifc lot nunbers.
Numbers
1 c. Parcel ID
List all Rios associated w ith this project.
Number(s) (PIN)
6484-00-58-9577
6484-00-58-3338
6484-00-57-6767
6484-06-47-7770
6484-05-17-2992
6474-08-87-1753
6474-08-89-5117
6474-08-89-9084
6474-08-99-3346
6474-08-99-1052
2. County*
Anson
3. Highway or Street N Green Street
Address* Street name only is acceptable if no address nunber assigned yet
4. Cityor Township* Wadesboro
5. State * NC
6. Zip Code* 28170
7. Latitude* Enter the latitude in decinal degrees
34.9771
8. Longitude * Enter the longitude in decinal degrees (MJSTbe negative)
-80.0729
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* 01/05/2021
Estir ated Construction Project Start Date

10. Date to End * 03/29/2021
Estinated Construction Project End Cate
11. SIC (Primary)* Industrial (1541)
Standard Industrial aassification for Developrnent
12. Acres to be 4.10
disturbed* (including off -site borrow and waste areas)
13. Total site area
4.10
(acres) *
14. Post-
1.00
construction
(Estirrated)
impervious area
(acres) *
NCC Project
NCC-ANSON-2021-Line 75 MAOP Replacement
Tracking ID
Assignedautorraticaly
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 Grindstone Branch
Waterbody * %rre of waterbody into which story water runoff will discharge
15b. Waterbody 13-20-15-3
Index No.* NCWaterbody Index Nunber
Stormwater r No
discharges will flow pr Yes
to additional
wate rs *
15c. Additional
Brush Fork
Receiving
Waterbody narre
Waterbody
15d. Waterbody
13-42-1-3-1
Index No.
NCWaterbody Index Nurrber
15e. Additional
Derita Creek
Receiving
Waterbody narre
Waterbody
15f. Waterbody
13-42-1-3-1-1
Index No.
NCWaterbody Index Nunber
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 Carolinas, 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 * Joseph
If Corporation, enter Faegistered Agent First Wre
3. Last Name* Barbee
IF Corporation, enter F;bgistered Agent Last %rre
3b. Title Project Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 704-731-4403
Telephone No.*
6. Permittee Mailing Street Address
Address* 4720 Piedmont Row Drive
Address Line 2
City
Charlotte
Fbstal / Zip Code
28210-4269
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
4720 Piedmont Row Drive
Address Line 2
city
Charlotte
Fbstal / Zip Code
28210-4269
State / Frovince / Fbgion
NC
Country
us
State / Frovince / Faegion
NC
Country
us
8. Type of Ownership is only individual if an individual is naned in B.1. above.
Ownership* Non -Government

C. Site Contact Information
Part C.
Project Site Contact Inforrration
_....................................................................................................................................................................
1. Primary Site
Ted
Contact - First
Name *
2. Primary Site
Cagle
Contact - Last
Name *
3. Title
Distribution Project Specialist
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
910-220-3268
Telephone No.
6. Organization
Name
7. Site Contact
Street Address
Mailing Address*
185 Enterprise Drive
Address Line 2
City
State / Province / Region
Rockingham
NC
Postal / Zip Code
Country
28379
us
8. Consultant Name
(Optional)
Ryan Parker
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
919-653-7057
Telephone No.
11. Billing E-mail (For Annual Fee correspondence)
Default is legally responsible person e-n-ail (older NCAs rray not populate)
12. Billing (For Annual Fee correspondence)
Telephone Default is legally responsible person telephone (older NOls rray not populate)

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 11/20/2020
Approved *
2. E&SC Plan Project ANSON-2021-003
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 NCDEQ Letter of Approval.pdf 845.09KB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Mist be RDFformat (lint 20 NB)
Line 75 MAOP Replacement —Site Location Map.pdf 1.06MB
Rease do not upload entire set of E&SC plans.
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.
8. NOI Certification NCG01-eNO1-Certification-Form-20201210-DEMLR-
Form 102.71 KB
SW (Signed).pdf
Mast be RDFformat
This is an Express r No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.66 (1) 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:* IT The Legally Responsible Person named on this Notice of Intent
f Authorized Responsible Person* (signing on behalf of Legally Responsible
Person named in Part B)
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* Joseph Barbee
Title Project Manager
Organization Legally Responsible Entity
Duke Energy Carolinas, LLC
Date * 12/16/2020

F. Tracking and COC Info
NOI Tracking No. 39289
NC Reference No.
NCG01-2020-5860
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC205860
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5860
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. NCC205860-2020
Invoice Due Date 1/16/2021
Initial Fee $ 100.00
Invoice Status OPEN