NCC190409_Modification Review_20210701

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/29/2021 9:26:17 AM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany A 7/1/2021 3:15:25 PM (Construction COC ADD TO FILE Review- NCC190409)
* Legally responsible individual and site contact information updated on 71112021.
• The task was assigned to Georgoulias, Bethany A. The due date is: July 2, 2021 5:00 PM
6/29/2021 9:26 AM

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NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of NCC190409
Coverage (COC) Enter the Certificate of Coverage Ninber (use capital letters)
No.*
Information associated with this permit
Project Name
Duke Energy - Cleveland Matthews Laydown Yard
Address
Lassiter Road, Four Oaks, NC
County
Johnston
Latitude
35.4992
Longitude
-78.5053
Permittee Listed
Duke Energy Progress
Legally Responsible
Thomas Williams, Jr.
Individual
NC Reference No.
NCG01-2019-0409
E&SC Plan ID
JOHNS-2019-028
Original NOI
11519
Tracking No.*
Date COC Issued*
05/29/2019
Prior Rescission
This field will populate only if COChas already been rescinded.
Date
Modification Information:
Reason for
r Closed -Out Lots/Outparcels in E&SC Plan
Modification *
a Additional Lots/Outparcels Approved - E&SC Revised
O Other Revision(s) to E&SC Plan
r Legally Responsible Individual and/or Site Contact Has Changed
F Multiple Reasons (List)
Other Revision(s) to E&SC Plan, Legally Responsible Individual
and/or Site Contact Has Changed
Addional IVbre information (e.g., new Site Contact details). If lots are being added, please include specific lot nunbers.
Explanation
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 (Fevised E&SCApproval, nose -Out Doc, etc.)
Documentation JOHNS-2019-028_20210612_LOA.pdf 227.79KB
SW Legally res change form.pdf 2.18MB
NUst be FDFfornat
North Carolina General Statute 143-215.66 (1) provides that:
Anyperson who knowinglymakes anyfalse statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained under this Article or a rule implementing this Article; or who knowinglymakes a false statement
of a material fact in a rulemaking proceeding or contested case underthis Article; orwho 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 mayinclude a fine notto exceed ten thousand
dollars ($10,000).
17 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:* r 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 NCGO10000 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, Transmission Permitting
Organization* Duke Energy Progress, LLC
Date * 06/29/2021
Email Address* [e-mail]
Errail for confin-ration
Telephone Number* 17045775807
Contact number if we need to reach you
Note: Original permittee and site contact are copied on modification correspondence.
Additional Email [e-mail]
(Optional) Additional errail for confirrration
Original Permittee [e-mail]
Email
Original Site Contact [e-mail]
Email
Review Date 07/01/2021
Rescinded Since
Submitted?

Request Date 20210629
Formatted
Review Date 20210701
Formatted