NCC223257_FRO Submitted_20220916

FINANCIAL RESPONSIBILITYIOWNERSHIP FORD
SEDIMENTATION POLLUTION CONTROL ACT
EXPRESS PERMITTING OPTION
No person may initiate any land -disturbing activity on one or more acres as covered by the Act before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Land
Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the appropriate
Regional Office. (Please type or print and, if the question is not applicable or the e-mail address or phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project Name Reems Creek 115 kV Substation
2. Location of land -disturbing activity: County BunCOt7lbe City or Township Weayeryllle
Highway/Street Aiken Road (SR 1720) Latitude(decimaidegrees) 35.6828 Long itude(decimaidegrees) -82.5774
3. Approximate date land -disturbing activity will commence: September 1, 2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Industrial - Utility
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 14.52
$2,000 + $1,500 = $3,500
6. Amount of fee enclosed . The Express Permitting application fee is a dual charge.
The normal fee of $100.00 per acre (rounded up to the next acre) is assessed without a ceiling amount.
In addition, the Express Permitting supplement is $250 per acre up to eight acres, afterwhich the Express
Permitting supplemental fee is a fixed $2,000.00 (Example: 8.10-acre application fee is $2,900). Checks
should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes ❑ Enclosed ❑x No ❑
Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Reuben Jones
Phone: Office #
919-546-3459
E-mail Address [e-mail]
Mobile # N/A
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Duke Energy Progress, LLC
Name `Formerly known as Carolina Power & Light Company
411 Fayetteville St
Current Mailing Address
Raleigh NC 27601
City
State Zip
919-546-3459 N/A
Phone: Office # Mobile #
411 Fayetteville St
Current Street Address
Raleigh NC 27601
City
State
Zip
10. Deed Book No. 5729 Page No. 1868 Provide a copy of the most current deed.

Part B.
1. Company(ies) who are financially responsible for the land -disturbing activity (Provide a comprehensive list
of all responsible parties on accompanied page.) If the company yis a sole proprietorship or if the iandowner(s) is
an individual(s), the name(s) of the owner(s) may be listed as the financially responsible party(ies).
Duke Energy Progress, LLC [e-mail]
Company NameFormedy known as Carolina Power& Light Company E-mail Address
160 Mine Lake Ct Ste 200 410 S Wilmington St
Current Mailing Address
Raleigh NC 27615-6417
City State
Phone: Office # 919-546-3459
Current Street Address
Raleigh NC 27601-1849
Zip City State
Mobile # N/A
Zip
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
CT Corporation System [e-mail]
Name of Registered Agent E-mail Address
160 Mine Lake Court, Ste 200 N/A
Current Mailing Address Current Street Address
Raleigh NC 27615-6417 N/A
City State Zip City
Phone: Office # 919-844-8360
Karen Rozar
Mobile # N/A
Name of Individual to Contact (if Registered Agent is a company)
State Zip
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
N/A N/A
Name of Registered Agent
N/A
Current Mailing Address
N/A
City State Zip
Phone: Office # N/A
E-mail Address
N/A
Current Street Address
N/A
City
Mobile # N/A
N/A
Name of Individual to Contact (if Registered Agent is a company)
State Zip
(c) If the Financially Responsible Party is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General

Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
N/A
Company DBA Name
(d) If order to facilitate Express Permitting, it is necessary to be able to contact the engineer or other
consultant who can assist in providing any necessary information regarding the plan and its preparation:
HDR Inc.
Engineering firm or other consultant
David T. Baker
Individual contact person (type or print)
[e-mail]
E-mail Address
704-338-6724 980-505-0146
Phone: Office # Mobile #
The above information is true and correct to the best of my knowledge and belief and was provided
by me under oath. (This form must be signed by the Financially Responsible Person if an individual(s)
or his attorney -in -fact, or if not an individual, by an officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Party). I agree to provide
corrected information should there be any change in the information provided herein.
Phillip Vance Williams
Manager, Transmission Engineering
Type or print name Title or Authority
( &`/ Iz-o-z-7-
Sighature Date
I, S A le-- , a Notary Public of the County of jAlke-C-_
State of North Carolina, hereby certify that '?k dl,;' VeytcG appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/her.
Witness my hand and notarial seal, this _day of V'% 20 Z?�
Notary
NOA My commission expires 1 z 1 -7 �Z2
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