NCC205534_Modification Review_20210428

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 4/27/2021 9:08:27 AM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany A 4/28/2021 7:44:23 AM (Construction COC ADD TO FILE Review -
NCC205534)
• The task was assigned to Georgoulias, Bethany A. The due date is: April 30, 2021 5:00 PM
4/27/2021 9:08 AM

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NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of NCC205534
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
Information associated with this permit
Project Name Golf Links System Strengthening
Address Along Tom Short Road and Golf Links Drive, Charlotte, NC
County Mecklenburg
Latitude 35.0540
Longitude-80.7768
Permittee Listed Piedmont Natural Gas Company, Inc.
Legally Responsible Khalid Boston
Individual
NC Reference No. NCG01-2020-5534
E&SC Plan ID
Original NOI
Tracking No.
MECKL-2021-030
37485
Date COC Issued* 12/03/2020
Prior Rescission This field will populate only if CCChas already been rescinded.
Date
Modification Information:
Reason for r Closed -Out Lots/Outparcels in E&SC Plan
Modification * r Additional Lots/Outparcels Approved - E&SC Revised
F Other Revision(s) to E&SC Plan
r Legally Responsible Individual and/or Site Contact Has Changed
r Multiple Reasons (List)
Addional Wre information (e.g., new Site Contact details). If lots are being added, please include specific lot numbers.
Explanation THIS E&SC PLAN WAS EXPANDED TO INCLUDE ADDITIONAL PIPELINE
CONSTRUCTION TO TIE THE PROJECT TOGETHER. THE LIMITS OF
DISTURBANCE INCREASED FROM 4.4 ACRES TO 8.7 ACRES.
You must upload supporting documentation below. Do not upload E&SC Plans unless specific plan
sheets are the only documentation with approval for revised acres of disturbance, etc. (only upload applicable
sheets).

For changes to the legally responsible individual, you must upload this form.
Supporting upload Supporting Documentation (%vised ERSC Approval, (lose -Out Doc, etc.)
Documentation GOLF LINKS-04192021-001.pdf 4.13MB
Mast be FDFfon-rat
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 Article; 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 Article shall be guiltyofa Class 2 misdemeanor which may include a fine not to exceed ten thousand
dollars ($10,000).
rJ I hereby request modification to coverage under the NPDES Stormwater Permit
for the subject project site. I am familiar with the information contained in this
request and to the best of my knowledge and belief such information is true,
complete and accurate.
Specify if you are:* IT The Legally Responsible Individual
f Authorized Responsible Person*
*This form must be signed by a responsible corporate officer that 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* Khalid Boston
Title * Distribution Project Specialist
Organization* Piedmont Natural Gas Company, Inc.
Date * 04/27/2021
Email Address* [e-mail]
Errail for confirmation
Telephone Number* 704-587-6941
Contact nunter if we need to reach you
Note: Original permittee and site contact are copied on modification correspondence.
Additional Email [e-mail]
(Optional) Additional email for confirmation
Original Permittee [e-mail]
Email
Original Site Contact [e-mail]
Email
Review Date 04/28/2021
Rescinded Since
Submitted?

Request Date 20210427
Formatted
Review Date 20210428
Formatted