NCC213020_NOI Application_20210519

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 5/18/2021 9:36:54 AM (NCG01 NOI Submission)
Approve by Meloy, Michael K 5/18/2021 3:04:04 PM (Review- Construction NOI 53032)
• The task was assigned to Meloy, Michael K by round robin distribution 5/18/2021 9:37 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: May 20, 2021 5:00 PM.
The priority is: High 5/18/2021 9:37 AM
Submit by Selkane, Aziza 5/19/2021 10:17:27 AM (Payment Verification for NCC213020)
* Joseph W. Witherspoon
• Selkane, Aziza assigned the task to Selkane, Aziza 5/19/2021 10:16 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: June 29, 2021 5:00 PM.
The priority is: High 5/18/2021 3:04 PM

d� #
NORTH CAROLINA
Ernvlronmental qualily
A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting
r No
an NOI that was
r Yes
rejected before?
1a. Project Name *
Elizabethtown Cogentrix 115kV Switching Station Decommission
1 b. Specific Lot
This field nay be used to list specffc lot nunbers.
Numbers
1 c. Parcel ID List all PINS associated w ith this project.
Number(s) (PIN) 131100101670, 131113135217, 131113044086, 131113045194, 131113043294,
131113046306,131113044501,131113041581,131113041671,131113042712,
131113041894,131109052048,130116949955,130112959364,130112956256,
130112869228, 130108887684, 130108797373, 130107794828,130220705076,
130200817124,130107695841,130200507793,130200512460,130200515751,
130200526963,130200532683,130200531830,130200324647,130200322799,
130200334307,130200769935,130200734771
2. County* Bladen
3. Highway or Street West Broad Street (SR 41)
Address* Street name only is acceptable if no address nunber assigned yet
4. City or Township* Elizabethtown
5. State *
NC
6. Zip Code*
28337
7. Latitude*
Enter the latitude in decimal degrees
34.6472
8. Longitude *
Enter the longitude in decimal degrees (MJST be negative)
-78.6419
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* 07/01/2021
Estir ated Construction Project Start Rate
10. Date to End * 09/01 /2021
Estinated Construction Project End Cate

11. SIC (Primary)* Other (9999)
Standard Industrial (aassification for Development
12. Acres to be 36.02
disturbed* (including off -site borrow and waste areas)
13. Total site area 36.02
(acres) *
14. Post- 0.00
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-BLADE-2021-Elizabethtown Cogentrix 115kV Switching Station
Tracking ID Decommission
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 Browns Creek (Cross Pond)
Waterbody* Plarreof waterbody into which stormwater runoff will discharge
15b. Waterbody 18-45
Index No. * NCWaterbody Index Number
Stormwater F No
discharges will flow 17 Yes
to additional
wate rs *
15c. Additional Cape Fear River
Receiving Waterbody narre
Waterbody
15d. Waterbody 18-(26.75)
Index No. NCWaterbody Index Number
15e. Additional Waterbody name
Receiving
Waterbody
15f. Waterbody NCWaterbody Index Number
Index No.
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
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 * Randy
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Veltri
It Corporation, enter Registered Agent Last %rre
3b. Title Director of Transmission Permitting
4. Permitee E-mail [e-mail]
Address*
5. Permittee 704-382-2741
Telephone No.*
6. Permittee Mailing Street Address
Address* 550 South Tryon Street
Address Line 2
Suite 4500
Cty
Charlotte
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
Fbstal / Zip Code
28202
F Yes
Street Address
526 South Church Street
Address Line 2
city
Charlotte
Fbstal / Zip Code
28202-1802
State / Ffovince / Fbgion
NC
Country
us
State / Ftovince / Region
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 Josh
Contact - First
Name *
2. Primary Site Witherspoon
Contact - Last
Name *
3. Title Senior Transmission Permitting Specialist
4. Site Contact E- [e-mail]
mail Address*
5. Site Contact
[phone]
Telephone No.
6. Organization
Duke Energy Progress
Name
7. Site Contact
Street Address
Mailing Address*
410 South Wilmington Street
Address Line 2
NCRH 5
City
Raleigh
Fbstal / Zip Code
27601-1849
8. Consultant Name
(Optional)
McAdams
First and Last nave
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
919-210-2912
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
919-546-2177
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 05/04/2021
Approved *
2. E&SC Plan Project BLADE-2021-012
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. 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 blade-2021-012exap.pdf 846.75KB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Mist be RDFforrret (lint 20 NB)
2020110170 - Topo Map.pdf 270.9KB
Rease do not upload entire set of E&SC plans.
7. Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded docurrents support
the application. Include additional waterbodies if necessary.
8. NOI Certification Signed NOI Cert Form.pdf 514.79KB
Form Must be RDFforrret
This is an Express f 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 Atide; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case under this Atcle; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring device or method required to be operated or maintained under this Atide or rules of the
Commission implementing this Atcle 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 * Randy Veltri
Title Director of Transmission Permitting
Organization Legally Responsible Entity
Duke Energy Progress, LLC
Date * 05/18/2021

F. Tracking and COC Info
NOI Tracking No. 53032
NC Reference No.
NCG01-2021-3020
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC213020
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 3020
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. NCC213020-2021
Invoice Due Date 6/17/2021
Initial Fee $ 100.00
Invoice Status OPEN