NCC222891_NOI Application_20220812

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/10/2022 1:33:50 PM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 8/11/2022 7:47:55 AM (Review - NOI 101742 Duke Energy Toyota Tap 100kV
Transmission Line)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 8/10/2022 1:39 PM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 15, 2022 5:00
PM 8/10/2022 1:39 PM
by Workflow 8/11/2022 7:48:04 AM (Workflow Start Event)
Submit by Tran, Kieu M 8/12/2022 8:13:03 AM (Payment Verification for NCC222891)
F Jeffrey Goto
• Tran, Kieu M assigned the task to Tran, Kieu M 8/12/2022 8:12 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: September 22, 2022 5:00
PM 8/11/2022 7:48 AM

a
NORTH CAROLINA,
Enri--tn! C2-1;ly
A. Project Information
Part A.
Project Location and Waterbody Information
................................................................................................................... .
Are you submitting No
an NOI that was Yes
rejected before?
la. Project Name* Duke Energy Toyota Tap 100kV Transmission Line
1 b. Specific Lot This field may be used to list specifc lot numbers.
Numbers
1 c. Parcel ID List all PINs associated with this project.
Number(s) (PIN) 7778596524
7778596211
7778599543
7778593226
7778593009
7778582889
7778583620
7778489079
7778576967
7778586477
7778571012
7778671453
7778962738
7778960836
7778868992
7778867957
7778875094
7778873194
7778872254
7778834868
7778963923
7788063394
7788064546
7788064784
7778968900
7788069807
7788264086
7788167219
7788266778
7788169866
7788167756
7788264436
7788167993
7788366317
7788460131

7778470935
7788654595
7788567843
7788567118
7778452684
7778864184
7778566463
7778463295
7778457336
7778966175
7788357062
7788739290
7788546672
7788924128
7788451808
7788254951
7788732658
7788243302
7788644874
7798427917
7798710517
7798129585
7798611631
7798615994
8708111770
7798028817
7798817761
7798518582
7798718627
8708713423
8708723059
8708830438
8708836406
8708847337
7798215519
7798620389
7798712577
8708607893
8708713955
8708738300
8708800779
8708940260
8708114338
8708713756
8708716649
8708738605
8708805737
8708929917
7798516408
8708706808
8708734596
8708748290
8708937765
8708106667
8708311642
8708318860
8708830791
8708832126
8708944178
7798800869
8708216766
A nn')lRAgl

8708408823
8708718522
8708727822
8708735760
8708739791
8708743132
8708746407
8708812608
8708847188
7798320764
7798416293
7798919504
8708616529
8708738745
8708807291
8708822458
8708208905
8708212987
8708704424
8708710363
8708735798
8708942175
8718149344
8718326247
8718237946
8718042294
8718132433
8718137473
8718141285
8718144265
8718243375
8718247227
7798318856
8718232522
8718237518
8708836808
7798424587
7788830628
7788932964
7788629706
7788637578
8708738567
7788633204
7778553833
8708940226
7788446719
7798327273
8708803377
8708709448
7788355189
7788728875
8707191668
8708614323
8708722536
8708734021
8708723471
8708723262
8708724709
8708733381
8708724777
7788556654

2. County* Randolph
3. Highway or Street Hunt Road
Address* Street name only is acceptable if no address number assigned yet
4. City or Township* Climax
5. State* NC
6. Zip Code* 27313
7. Latitude* Enter the latitude in decimal degrees
35.9111
8. Longitude* Enter the longitude in decimal degrees (MUST be negative)
-79.7597
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*
08/23/2022
Estimated Construction Project Start Date
10. Date to End*
06/30/2023
Estimated Construction Project End Date
11. SIC (Primary)*
Industrial (1541)
Standard Industrial Classification for Development
12. Acres to be
106.36
disturbed *
(including off -site borrow and waste areas)
13. Total site area 117.00
(acres) *
14. Post -construction 0.00
impervious area (Estimated)
(acres) *
Project Tracking ID NCC-RAN DO-2022-Duke Energy Toyota Tap 100kV Transmission
Line
Assigned automatically (not used)
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 Little Polecat Creek
Waterbody* Name of waterbody into which stormwater runoff will discharge
15b. Waterbody Index 17-11-3
No. * NC Waterbody Index Number
Stormwater No
discharges will flow Yes
to additional waters*
15c. Additional Sandy Creek
Receiving Waterbody Waterbody name

15d. Waterbody Index 17-16-(1)
No. NC Waterbody Index Number
15e. Additional Waterbody name
Receiving Waterbody
15f. Waterbody Index NC Waterbody Index Number
No.
16a. Is this project Yes
subject to the NC No, not subject to NC SPCA
Sediment Pollution
Control Act?*

B. Permittee Information
Part B.
Permittee Information - Legally Responsible Entity and Individual
........................................................................................................................................................................
Important: The person who signs the NOI Certification Form and signs the Certification in Section E of this application
form must 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 NCGO10000 General Permit. For more information on signatory requirements, see Part IV, Section B,
Item (6) of that permit.
1. Permittee* Legally Responsible Entity
Duke Energy Carolinas, LLC
If permittee is an individual, enter first and last name in this field. Otherwise, enter organization/business name.
Note: If the permittee is a business, the business must be registered with the NC Secretary of State. You can verify the
registration here. Permittee must be the same entity that is responsible for the land -disturbing activity as listed on the NC
SPCA Financial Responsibility/Ownership (FRO) Form.
2. First Name* Jeffrey
If Corporation, enter Registered Agent First Name
3. Last Name* Goto
If Corporation, enter Registered Agent Last Name
3b. Title Lead Permitting Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 760-445-3332
Telephone No.*
6. Permittee Mailing Street Address
Address* EC09Q 526 South Church Street
Address Line 2
City State / Province / Region
Charlotte NC
Postal / Zip Code Country
28202-1006 us
Check box if the Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
526 South Church Street
Address Line 2
City
State / Province / Region
Charlotte
NC
Postal / Zip Code
Country
28202-1802
us
8. Type of
Ownership is only individual if an individual
is named in B.1. above.
Ownership*
Non -Government

C. Site Contact Information
Part C.
Project Site Contact Information
.................................................................................................................................................................................................................................................................................................................................................................................................
1. Primary Site Eric
Contact - First
Name*
2. Primary Site Shook
Contact - Last Name*
3. Title
4. Site Contact E-mail [e-mail]
Address*
5. Site Contact 336-971-4176
Telephone No.*
6. Organization Name Duke Energy Carolinas, LLC
7. Site Contact Street Address
Mailing Address* EC09Q 526 South Church Street
Address Line 2
City
Charlotte
Postal / Zip Code
28202-1006
8. Consultant Name (optional)
Brooke Ahrens
First and Last name
9. Consultant E-mail [e-mail]
This person will be copied on all correspondence.
10. Consultant [phone]
Telephone No.
11. Billing E-mail (For Annual Fee correspondence)
[e-mail]
Default is legally responsible person e-mail
12. Billing Telephone (For Annual Fee correspondence)
760-445-3332
Default is legally responsible person telephone
State / Province / Region
NC
Country
us

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Plan Approval Information
1. Date E&SC Plan 07/27/2022
Approved *
2. E&SC Plan Project RANDO-2022-041
Number/ID* Assigned by agency or local program
3. E&SC Plan State DEQ Office
Approved by* Local Program
4. State DEQ Office* Winston-Salem (WSRO)
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
RAN DO-2022-041_20220727_A-M.pdf 3.52MB
Approval letter or
Must be PDF format
Grading Permit
6. Signed FRO
Financial Responsibility/Ownership Form
04_FRO_Toyota Tap_SignedJG.pdf 1.19MB
Must be PDF format
7. Site Location Map
Must be PDF format (limit 20 MB)
Toyota Tap Vicinity Map.pdf 4.08MB
Please do not upload entire set of E&SC plans.
8. Notes (Optional)
Provide any additional information that might help the reviewer better understand how uploaded documents
support the application. Include additional waterbodies if necessary.
This is a linear project so the project location includes the existing
Duke Energy right-of-way (ROW) from start to end as shown with the
dashed blue line on our vicinity map. The project location coordinate
submitted is the start point at the western side as representative for
the entire limits of disturbance along the linear ROW to match the
FRO and Letter of Approval referenced County / Address.
9. NOI Certification
Toyota Tap NOI-.pdf 666.08KB
Form
Must be PDF format
This is an Express • No
Review Project* Yes

E. Certification
North Carolina General Statute 143-215.613 (i) provides that:
Any person who knowingly makes any false 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 guilty of a Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000).
Under penalty of law, I certify that:
* 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.
* 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.
* I will abide by all conditions of the NCG010000 General Permit and the approved
Erosion and Sediment Control Plan.
* 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:* The Legally Responsible Person named on this Notice of Intent
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* Jeff Goto
Title Lead Permitting Manager
Organization Legally Responsible Entity
Duke Energy Carolinas, LLC
Date * 08/10/2022

F. Tracking and COC Info
NOI Tracking No. 101742
NC Reference No. NCG01-2022-2891
Indicates NCG01 or NCG25. Uses NOI number until approved, then uses NUMBER incremented by SP (passed
from workflow if eNOI approved)
Certificate of NCC222891
Coverage (COC) No.* Uses NOI number until approved, then uses NUMBER incremented by SIP (formatted and passed from workflow if
eNOI approved)
Initial Invoice No. NCC222891-2022
Invoice Due Date 9/10/2022
Initial Fee $ 100.00
Invoice Status OPEN