NCC214145_NOI Application_20210716

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 7/14/2021 3:11:12 PM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 7/15/2021 8:57:06 AM (Review- Construction NOI 59075)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 7/14/2021 3:12 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: July 16, 2021 5:00 PM
7/14/2021 3:12 PM
Submit by McCoy, Suzanne 7/16/2021 7:45:51 AM (Payment Verification for NCC214145)
* Hugh Stephens
• McCoy, Suzanne assigned the task to McCoy, Suzanne 7/16/2021 7:44 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: August 26, 2021 5:00 PM
7/15/2021 8:57 AM

.• SThF� ';
1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting IT No
an NOI that was r Yes
rejected before?
1a. Project Name * Two Hearted Substation
1 b. Specific Lot This field nay be used to list specifc lot nunbers.
Numbers
1 c. Parcel ID List all Rim associated w ith this project.
Number(s) (PIN) 593012869954
2. County* Yadkin
3. Highway or Street Shady Grove Church Rd.
Address* Street name only is acceptable if no address nunber assigned yet
4. City or Township* East Bend
5. State * NC
6. Zip Code* 27018
7. Latitude* Enter the latitude in decinal degrees
36.2354
8. Longitude * Enter the longitude in decinal degrees (MJSTbe negative)
-80.5608
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*
08/01/2021
Estinated Construction Project Start Late
10. Date to End*
02/01/2022
Estinated Construction Project End Date
11. SIC (Primary)*
Commercial (1542)
Standard Industrial aassification for Development
12. Acres to be
5.40
disturbed*
(including off -site borrow and waste areas)

13. Total site area 5.40
(acres) *
14. Post- 1.44
construction (Estimated)
impervious area
(acres) *
Project Tracking ID NCC-YADKI-2021-Two Hearted Substation
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 Hall Creek
Waterbody* Narreof waterbody into which stormwater runoff will discharge
15b. Waterbody 12-74
Index No. * NCWaterbody Index Number
Stormwater V No
discharges will flow r Yes
to additional
wate rs *
16a. Is this project r Yes
subject to the NC r No, not subject to NC SPCA
Sediment Pollution
Control Act?*

B. Permittee Information
Part B. ^
F2rnittee Inforrration - Legally Fbsponsible Entity and Individual
Important: The person who signs the NOI Certification Form and signs the Certification in Section E of this application
form should 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. Organization Legally Pesponsible Entity
Name * Pine Gate Renewables, LLC
It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
Note: The organization name must match the business entity name registered with the NC Secretary of State. You can
verify the registration here.
2. First Name * Adam
If Corporation, enter Faegistered Agent First Wre
3. Last Name* Pinkston
It Corporation, enter F;bgistered Agent Last %rre
3b. Title Project Manager, Construction
4. Permitee E-mail [e-mail]
Address*
5. Permittee 7049751798
Telephone No.*
6. Permittee Mailing Street Address
Address* 130 Roberts Street
Address Line 2
Suite 120
aty
Asheville
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
Fbstal / Zip Code
28801-3129
V Yes
Street Address
130 Roberts Street
Address Line 2
Suite 120
city
Asheville
Fbstal / Zip Code
28801-3129
State / Ffovince / Fbgion
NC
Country
us
State / Ftovince / Faegion
NC
Country
us
8. Type of Ownership is only individual if an individual is naned in B.1. above.
Ownership* Non -Government

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Adam
Contact - First
Name *
2. Primary Site
Pinkston
Contact - Last
Name *
3. Title
Project Manager, Construction
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
7049751798
Telephone No.
6. Organization
Pine Gate Renewables, LLC
Name
7. Site Contact
Street Address
Mailing Address*
130 Roberts Street
Address Line 2
Suite 120
city
Asheville
Postal / Zip Code
28801-3129
8. Consultant Name
(Optional)
Laura Harris
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
919-851-8770
Telephone No.
11. Billing E-mail
(For Annual Fee correspondence)
[e-mail]
Default is legally responsible person e-rrail
12. Billing
(For Annual Fee correspondence)
Telephone
7049751798
Default is legally responsible person telephone
State / Rovince / Region
NC
Country
us

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 06/30/2021
Approved *
2. E&SC Plan Project YADKI-2021-004
Number/ID * Assigned by agency or local program
3. E&SC Plan r State DEQ Office
Approved by* r 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 YADKI-2021-004_20210630_A-M_Express (ID
Approval letter or 5.18MB
103922).pdf
Grading Permit
Mist be FL7Fforrrat
6. Site Location Map Mist be RDFforrret (lint 201VB)
TwoHearted_SoilBoring_2020-10-22.pdf 3.59MB
Rease do not upload entire set of E&SC plans.
7. Notes (Optional) Provide any additional information that night help the reviewer better understand how uploaded docurrents support
the application. Include additional waterbodies if necessary.
8. NOI Certification NCG01-eNO1-Certification-Form-20210514-DEMLR-
Form 1.32MB
SW.pdf
Mast be R7Fformat
This is an Express r No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.66 (1) provides that:
Any person who knowingly makes anyfalse 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 Artcle; 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 Artcle shall be guilty ofa Class 2 misdemeanor which may include a fine not to exceed ten thousand
dollars ($10,000).
Under penalty of law, I certify that:
17 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.
rJ 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.
* 17 I will abide by all conditions of the NCG010000 General Permit and the
approved Erosion and Sediment Control Plan.
* rJ 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:* r The Legally Responsible Person named on this Notice of Intent
r 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 * Adam Pinkston
Title Project Manager, Construction
Organization Legally Plesponsible Entity
Blue Ridge Power
Date * 07/14/2021

F. Tracking and COC Info
NOI Tracking No. 59075
NC Reference No.
NCG01-2021-4145
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC214145
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 4145
Sequential nurrber for subrrittal that is incremented by Stored Frocedure
COC Year 2021
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)
Initial Invoice No. NCC214145-2021
Invoice Due Date 8/14/2021
Initial Fee $ 100.00
Invoice Status OPEN