NCC232655_NOI Application_20230901

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 8/31/2023 3:18:17 PM (NCG01 NOI Submission)
Approve by Brooklyn.Broussard 9/1/2023 8:45:40 AM(Review-NOI 158070 Line 105 Tarboro-Parmele Rebuild
Phase 1)
• The task was assigned to DEMLR NCG01 NOI Review Team.The due date is: September 5,2023 5:00
PM 8/31/2023 3:18:25 PM
• The task was assigned to Brooklyn.Broussard by round robin distribution 8/31/2023 3:18:25 PM
Submit by Tev.Holloman 9/1/2023 3:10:57 PM(Payment Verification for NCC232655)
0 Jennifer Johnson
• The task was assigned to DEMLR NCG01 Payment Team.The due date is:October 13,2023 5:00 PM
9/1/2023 8:45:55 AM
• Tev.Holloman assigned the task to Tev.Holloman 9/1/2023 3:10:22 PM

applicationConstruction Stormwater: Notice of Intent (NOI)
National Pollutant Discharge Elimination System(NPDES)
General Permit 1 OOOO:STORMWATER DISCHARGES associated with construction activities
NORTH CAROUNA
Environmental Quality
A. Project Information
Part A.
Project Location and Waterbody Information
...................................................................................................................................................................................................................................................................................................................................................................................................
Are you submitting an NOI that was rejected before?
No
Yes
1a.Project Name*
Line 105 Tarboro-Parmele Rebuild Phase 1
1b.Specific Lot Numbers
This field may be used to list specifc lot numbers.
4737-49-1553
4746-54-6975
4756-11-7610
4737-48-4794
4746-54-9465
4755-19-1215
4737-47-3924
4746-74-8374
4756-00-6484
4737-55-6577
4746-64-4149
4756-00-8752
4737-64-7786
4746-63-4907
4756-00-9823
4737-44-6480
4746-63-7974
4756-00-9962
4737-63-0804
4746-63-5895
4756-11-0021
4737-63-0702
4746-63-9818
4756-11-0181
4737-53-9681
4746-73-0854
4756-11-1220
4737-53-9560
4746-73-1782
4756-11-1289
4737-53-9450
4746-63-4612
4756-10-2157
4737-53-9330
4746-63-7559
n7r;c -in nnr)

4737-53-9129
4746-73-2620
4755-29-2422
4737-53-9016
4746-73-3513
4755-28-2597
4737-63-2134
4746-63-9560
4755-26-2345
4737-62-4726
4746-73-3496
4755-46-2914
4737-71-7101
4746-73-4470
4755-64-7912
4746-08-5768
4746-73-1366
4755-65-9164
4746-28-2795
4746-73-5397
4755-74-0835
4736-88-1762
4746-73-1230
4755-64-7519
4746-43-9888
4746-73-3171
4755-74-3672
4746-37-2079
4746-73-4062
4755-73-4276
4746-46-9128
4746-72-5984
4755-97-0249
4746-58-5027
4746-72-6850
4755-93-8936
4746-67-2497
4746-83-8017
4755-71-4437
1c. Parcel ID Number(s)(PIN)
List all PINS associated with this project.
4737-49-1553
4746-54-6975
4756-11-7610
4737-48-4794
4746-54-9465
4755-19-1215
4737-47-3924
4746-74-8374
4756-00-6484
4737-55-6577
4746-64-4149
4756-00-8752
4737-64-7786
4746-63-4907
4756-00-9823
4737-44-6480
4746-63-7974
4756-00-9962
4737-63-0804

4746-63-5895
4756-11-0021
4737-63-0702
4746-63-9818
4756-11-0181
4737-53-9681
4746-73-0854
4756-11-1220
4737-53-9560
4746-73-1782
4756-11-1289
4737-53-9450
4746-63-4612
4756-10-2157
4737-53-9330
4746-63-7559
4756-10-0052
4737-53-9129
4746-73-2620
4755-29-2422
4737-53-9016
4746-73-3513
4755-28-2597
4737-63-2134
4746-63-9560
4755-26-2345
4737-62-4726
4746-73-3496
4755-46-2914
4737-71-7101
4746-73-4470
4755-64-7912
4746-08-5768
4746-73-1366
4755-65-9164
4746-28-2795
4746-73-5397
4755-74-0835
4736-88-1762
4746-73-1230
4755-64-7519
4746-43-9888
4746-73-3171
4755-74-3672
4746-37-2079
4746-73-4062
4755-73-4276
4746-46-9128
4746-72-5984
4755-97-0249
4746-58-5027
4746-72-6850
4755-93-8936
4746-67-2497
4746-83-8017
4755-71-4437
2.County*
Edgecombe

3. Highway or Street Address*
Southern Terminus is near intersection of Hicks Street and Warren Street in Conetoe
Street name only is acceptable if no address number assigned yet
4.City or Township*
Conetoe
5.State* NC
6.Zip Code* 27819
7. Latitude* Enter the latitude in decimal degrees
35.8840
8. Longitude* Enter the longitude in decimal degrees(MUST be negative)
-77.5346
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* 11/01/2023
Estimated Construction Project Start Date
10. Date to End* 05/31/2025
Estimated Construction Project End Date
11.SIC(Primary)*
Other(9999)
Standard Industrial Classification for Development
12.Acres to be 45.26
disturbed* (including off-site borrow and waste areas)
13.Total site area 174.03
(acres)*
14. Post-construction 13.41
impervious area (Estimated)
(acres)*
Project Tracking ID NCC-EDGEC-2023-Line 105 Tarboro-Parmele Rebuild Phase 1
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 Waterbody*
Hendricks Creek
Name of waterbody into which stormwater runoff will discharge
15b.Waterbody Index No.*
28-81
NC Waterbody Index Number
Stormwater discharges will flow to additional waters*
No
Yes

15c.Additional Receiving Waterbody
Tar River
Waterbody name
15d.Waterbody Index No.
28-(80)
NC Waterbody Index Number
15e.Additional Receiving Waterbody
Cornwell Canal and Connecting Canals
Waterbody name
15f.Waterbody Index No.
28-82
NC Waterbody Index Number
16a.Is this project subject to the NC Sediment Pollution Control Act?
Yes
No, not subject to NC SPCA
17. Is this project funded with ARPA(American Rescue Plan Act)grant funds?
No
Yes
This question was added to the eNO1 on 1/26/2023 and will not be answered in applications submitted prior to that date.

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 NCG010000 General Permit. For more information on signatory requirements,see Part IV,Section B,
Item(6)of that permit.
1. Permittee*
Legally Responsible Entity
Virginia Electric&Power Company d/b/a Dominion Energy North Carolina
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 INC 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* Kevin
If Corporation,enter Registered Agent First Name
3. Last Name* Fields
If Corporation,enter Registered Agent Last Name
3b.Title Authorized Representative
4. Permitee E-mail Address*
[e-mail]
5. Permittee Telephone No.*
[phone]
6. Permittee Mailing Address*
Street Address
5000 Dominion Boulevard
Address Line 2
City State/Province/Region
Glen Allen VA
Postal/Zip Code Country
23060 us
Check box if the street address the same as mailing address
Yes
7. Permittee Street Address*
Street Address
5000 Dominion Boulevard
Address Line 2
City State/Province/Region
Glen Allen VA
Postal/Zip Code Country
23060 us

B.Type of Ownership*
Ownership is only individual if an individual is named in B.1.above.
Non-Government

C. Site Contact Information
Part C.
Project Site Contact Information
................................................................................................................................................................................................................................................................................................................................................................................................
1. Primary Site Contact-First Name*
Charles
2. Primary Site Contact-Last Name*
Schleicher
3.Title
Construction Superintendent
4.Site Contact E-mail Address*
[e-mail]
5.Site Contact Telephone No.*
[phone]
6.Organization Name
Dominion Energy North Carolina
7.Site Contact Mailing Address*
Street Address
5000 Dominion Boulevard
Address Line 2
City State/Province/Region
Glen Allen VA
Postal/Zip Code Country
23060 us
8.Consultant Name
(Optional)
C2
First and Last name
9.Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10.Consultant Telephone No.
[phone]
11. Billing E-mail
(For Annual Fee correspondence)
[e-mail]
Default is legally responsible person e-mail
12. Billing Telephone
(For Annual Fee correspondence)
[phone]
Default is legally responsible person telephone

D. E&SC Plan
Part D.
Erosion&Sediment Control(E&SC)Plan Approval Information
......................................................................................................................................................................
1. Date E&SC Plan 12/16/2022
Approved*
2. E&SC Plan Project EDGEC-2023-004
Number/ID* Assigned by agency or local program
3. E&SC Plan State DEQ Office
Approved by* Local Program
4.State DEQ Office* Raleigh (RRO)
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 prm_deq_p1_edgec_2023-004_LOA.pdf 245.62KB
Approval letter or Must be PDF format
Grading Permit
6.Signed FRO Financial Responsibility/Ownership Form
FRO_P1 signed.pdf 988.11 KB
Must be PDF format
7.Site Location Map Must be PDF format(limit 20 MB)
0166_location_deq_p 1.pdf 939.43KB
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.
Complete List of Receiving Waters, Classification,and Index:
Hendricks Creek(C;NSW 28-81),
Tar River(C;NSW 28-(80)),
Cromwell Canal and Connecting Canals(C;NSW 28-82),
Knight Canal(C;NSW 28-87-3-1),
Mitchell Swamp Canal(C;NSW 28-87-3),
Ballahack Canal(C;NSW 28-87-1.2),
Conetoe Creek(C;NSW 28-87-(0.5))
9. NOI Certification Signed NOI.pdf 75.93KB
Form Must be PDF format
This is an Express No
Review Project* Yes

E. Certification
North Carolina General Statute 143-215.613(1)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
G)16�;W q"11
Type Name* Kevin Fields
Title Authorized Representative, Director-ET Project Management
Organization
Organization Legally Responsible Entity
Virginia Electric&Power Company d/b/a Dominion Energy North
Carolina
Date* 08/31/2023

F. Tracking and COC Info
NOI Tracking No. 158070
NC Reference No. NCG01-2023-2655
Indicates NCG01 or NCG25.Uses NOI number until approved,then uses NUMBER incremented by SP(passed
from workflow if eNOI approved)
Certificate of NCC232655
Coverage(COC)No.* Uses NOI number until approved,then uses NUMBER incremented by SP(formatted and passed from workflow if
eNOI approved)
Initial Invoice No. NCC232655-2023
Invoice Due Date 10/1/2023
Initial Fee $ 100.00
Invoice Status OPEN