NCC240095_Modification Review_20240813

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 8/8/2024 9:51:29 PM(ADD TO FILE Submittal)
Approve by bethany.georgoulias 8/13/2024 11:05:14 AM (Construction COC ADD TO FILE Review-NCC240095)
• The task was assigned to bethany.georgoulias.The due date is:August 13,2024 5:00 PM
8/8/2024 9:51:30 PM

Ago Permit for DEQMODIFICATION
Construction0i00
0000
Certificate of NCC240095
Coverage(COC)No.* Enter the Certificate of Coverage Number(Use capital letters)
2020 Annual Fee Status 2021 Annual Fee Status 2022 Annual Fee Status
May be blank if N/A May be blank if N/A May be blank if N/A
2023 Annual Fee Status 2024 Annual Fee Status
May be blank if N/A May be blank if N/A
Information associated with this permit:
Project Name Line 105 Tarboro-Parmele Rebuild Phase 2
Address 4879 Parmele Rd, Bethel, NC
County Pitt
Latitude 35.8068
Longitude -77.3180
Permittee Listed Virginia Electric&Power Company d/b/a Dominion Energy North Carolina
Legally Responsible Kevin Fields
Individual At the time of Modification Request(not looked up again at review)
NC Reference No. NCG01-2024-0095
E&SC Plan ID Pitt-2023-021
Original NOI Tracking 177396
No.*
Date COC Issued* Effective Date at Submittal
04/01/2024
Prior Rescission Date This field will populate only if COC has already been rescinded.
Modification Information:
Reason for Modification*
Closed-Out Lots/Outparcels in E&SC Plan
Additional Lots/Outparcels Approved-E&SC Revised
Other Revision(s)to E&SC Plan
Legally Responsible Individual and/or Site Contact Has Changed
Multiple Reasons(List)

Addional Explanation
More information(e.g.,new Site Contact details).If lots are being added,please include specific lot numbers.
Upon issuance of the original plan approval,the project was registered for coverage under the Construction
General Permit(NCG01)and construction commenced. Since that time, Dominion has identified several needs
that warrant a revision to the approved plans.The first change was the removal of a construction entrance and
access route and addition of a workpad,for which our coordination with NCDEQ determined that no modification
was needed. Dominion has now identified the need to add mat access around an existing cemetery near Price
Road/Route 1430 in Pitt County.The proposed matting would provide access for forestry crews to remove
danger trees without disrupting the cemetery plat(Sheet 20 Area B).
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 Documentation
Upload Supporting Documentation(Revised E&SC Approval,Close-Out Doc,etc.)
CoC Request for Cemetery Mod TL 105 Ph2.pdf 20.49MB
Must be PDF format
Is this project funded with ARPA(American Rescue Plan Act)grant funds?
No
Yes
This question was added to the eNOI on 2/3/2023 and will not be answered in applications submitted prior to that date.
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).
* 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:* The Legally Responsible Individual
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 NCG010000 General Permit. For more information on signatory requirements,see Part IV,Section B, Item
(6)of that permit.
Signature
�ir l�f/l�J
Type Name* Kevin Fields
Title* Authorized Representative, Director-ET Project Management
Organization
Organization* Dominion Energy North Carolina
Date* 08/08/2024
Email Address* [e-mail]
Email for confirmation

Telephone Number* 4349810483
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 email for confirmation
Original Permittee [e-mail]
Email
Original Site Contact [e-mail]
Email
Review Date 08/13/2024
Rescinded Since
Submitted?
Current Effective Date Current Expiration Date Permit Version
4/1/2024 3/31/2029 2.00