NCC192937_Modification Review_20200522

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 5/22/2020 11:19:32 AM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 5/22/2020 11:58:11 AM (Construction COC ADD TO FILE Review- NCC192937)
• The task was assigned to Georgoulias, Bethany. The due date is: May 27, 2020 5:00 PM
5/22/2020 11:19 AM

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NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of NCC192937
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
Information associated with this permit
Project Name
Duke Cedar Cliff IDF and Spillway Upgrade
Address
Canada Road, Tuckasegee, NC
County
Jackson
Latitude
35.2570
Longitude
-83.1050
Permittee Listed
Duke Energy Carolinas, LLC
Legally Responsible
Jon Wise
Individual
NC Reference No.
NCG01-2019-2937
E&SC Plan ID
JACKS 2020-003
Original NOI
18816
Tracking No.*
Date COC Issued*
12/03/2019
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This field will populate only if COChas already been rescinded.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 * r Additional Lots/Outparcels Approved - E&SC Revised
F Other Revision(s) to E&SC Plan
r Legally Responsible Individual Has Changed
r Multiple Reasons (List)
Addional We infornation if necessary
Explanation Expanded disturbed area (1.99 acres)
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 (%vised E&SCApproval, (lose -Out Doc, etc.)
Documentation LOAwMPR revision 5-22-2020.docx.pdf 1.15MB
Mast be FDFformat
North Carolina General Statute 143-215.66 (1) provides that:
Anyperson who knowinglymakes any false 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 knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case underthis 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 guiltyofa Class 2 misdemeanor which mayinclude a fine not to 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 NCG010000 General Permit. For more information on signatory requirements, see Part IV, Section B,
Item (6) of that permit.
Signature
j
Type Name* Ken Karably
Title * Project Manager
Organization* Duke Energy
Date * 05/22/2020
Email Address* [e-mail]
Errail for confirmation
Telephone Number* 980-373-6623
Contact nurrber 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 confirmation
Original Permittee [e-mail]
Email
Original Site Contact [e-mail]
Email
Review Date 05/22/2020
Request Date 20200522
Formatted

Review Date 20200522
Formatted