NCC212294_NOI Application_20210423

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 4/12/2021 3:15:22 PM (NCG01 NOI Submission)
Approve by Clark, Paul 4/15/2021 12:59:08 PM (Review- Construction NOI 50079)
• Gamble, Aana C reassigned the task to Clark, Paul 4/13/2021 8:42 PM
• The task was assigned to Gamble, Aana C by round robin distribution 4/12/2021 3:17 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: April 14, 2021 5:00 PM
4/12/2021 3:17 PM
Submit by Selkane, Aziza 4/23/2021 9:27:17 AM (Payment Verification for NCC212294)
* Kelsey Pace
• Selkane, Aziza assigned the task to Selkane, Aziza 4/23/2021 9:25 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: May 27, 2021 5:00 PM
4/15/2021 1:00 PM

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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 48059
NOI No.
Prior Reviewer Paul Clark
Name
1a. Project Name * PNG Line 470 Phase 1
1 b. Specific Lot This field rray be used to list specifc lot numbers.
Numbers
1 c. Parcel ID
List all R% associated w ith this project.
Number(s) (PIN)
14106103
14106125
14106121
14106142
14106140
14124101
14107109
20101169
20101197
20101192
20101191
20101190 20145102
20129160
20129159
20129158
20137293
20137291
20137/214 20137213
20137212
20137211
20137204
20137203
20137202
20130151 20137290
20130111
20130120
20301128
20301127
20301105
20301104
2. County*
Mecklenburg
3. Highway or Street W Arrowood Rd, Charlotte, NC 28273
Address* Street name only is acceptable if no address nunber assigned yet
4. CityorTownship* Charlotte
5. State * NC
6. Zip Code* 28273
7. Latitude* Enter the latitude in decirral degrees
35.1478
8. Longitude * Enter the longitude in decinal degrees (MJST be negative)
-80.9285
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* 04/26/2021
Estinated Construction Project Start Date

10. Date to End *
12/31 /2021
Estinated Construction Project End Cate
11. SIC (Primary) *
Other (9999)
Standard Industrial aassification for Developrnent
12. Acres to be
43.10
disturbed*
(including off -site borrow and waste areas)
13. Total site area 43.10
(acres) *
14. Post- 0.70
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-MECKL-2021-PNG Line 470 Phase 1
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 Coffey Creek
Wate rbody* %rre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 11-137-4
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. ^
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
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 * Kelsey
IF Corporation, enter Faegistered Agent First Wre
3. Last Name* Pace
IF Corporation, enter F;bgistered Agent Last %rre
3b. Title Project Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 7047314705
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.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Shaun
Contact - First
Name *
2. Primary Site
Huneycutt
Contact - Last
Name *
3. Title
Implementation Superintendent
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
7044380036
Telephone No.
6. Organization
Piedmont Natural Gas
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)
Ryan Parker
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
9196537057
Telephone No.
11. Billing E-mail
(For Annual Fee correspondence)
[e-mail]
Default is legally responsible person a-rrail
12. Billing
(For Annual Fee correspondence)
Telephone
7047314705
Default is legally responsible person telephone
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 10/13/2020
Approved *
2. E&SC Plan Project MECKL-2021-022
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 * Mooresville (MRO)
Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a
complete application. Please also upload a site map showing the overall extent of the project (for linear projects, can
include the beginning point and end point coordinates in the "Notes" box below).
5. E&SC Plan MECKL-2021-022-10132020.pdf 2MB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Mist be RDFforrret (lint 20 NB)
Line 470 Phase 1_USGS Map_Reduced.pdf 8.71 MB
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 if necessary.
8. NOI Certification NCG01-eNO1-Certification-Form-20210212-DEMLR-
Form 866.22KB
SW.pd.pdf
Mast be FDFformat
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
` K6:-9�
Type Name* Kelsey Pace
Title Project Manager
Organization Legally Responsible Entity
Duke Energy
Date * 04/12/2021

F. Tracking and COC Info
NOI Tracking No. 50079
NC Reference No.
NCG01-2021-2294
Uses 'count_nurber' variable (increrrented by SP)
Certificate of
NCC212294
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 2294
Sequential nurrber for subrrittal that is incremented by Stored Frocedure
COC Year 2021
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)
Initial Invoice No. NCC212294-2021
Invoice Due Date 5/15/2021
Initial Fee $ 100.00
Invoice Status OPEN