NCC193070_NOI Application_20191209

Action History (UTC-05:00)Eastern Time(US&Canada)
Subrrit by Anonymous User 12/5/2019 3:41:00 PM(NCG01 NOI Submission)
Approve by Clark, Paul 12/6/2019 8:27:34 AM(Review-Construction NOI 19177)
• Morman,Alaina reassigned the task to Clark, Paul 12/6/2019 7:48 AM
• The task was assigned to Farkas,Jim J by round robin distribution 12/5/2019 3:41 PM
• The task was assigned to DEMLR NCG01 NOI Review Team.The due date is: December 9,2019 5:00
PM 12/5/2019 3:41 PM
Submit by Lucas,Annette 12/9/2019 12:15:45 PM(Payment Verification for NCC193070)
* Rod Miller
• Lucas,Annette assigned the task to Lucas,Annette 12/9/2019 12:14 PM
• The task was assigned to DEMLR NCG01 Payment Team.The due date is:January 17, 2020 5:00 PM
12/6/2019 8:27 AM

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1Construction Stormwater: Notice of Intent (NOI)
National Pollutant Discharge Elimination System 'D application for•• - .•-under NorthCarolina's
General Permit 1 1111:STORIVWATER DISCHARGES associated with construction activities(or
NORTH CAROLINA
Enrlrnnmenfu�Qr�arlry
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name* East College Park-Evergreen-All SF Lots
2.County* Wake
3. Highway or Street Maple St, Hill St, N Carver St, N Fisher St, Pender St, Boyer St
Address* Street narre only is acceptable if no address number assigned yet
4. City or Township* Raleigh
5.State* NC
6.Zip Code* 27610
7. Latitude* Enter the latitude in decimal degrees
35.7824
8. Longitude* Enter the longitude in decimal degrees(M.ST be negative)
-78.6157
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* 12/05/2019
Estinated Construction Project Start Date
10. Date to End* 12/05/2022
Estimated Construction Project End Cute
11.SIC(Primary)* Residential, Single
Family Houses(SFE)
(1521)
Standard Industrial aassification for Development
12.Acres to be 3.30
disturbed* (including off-site borrow and waste areas)
13.Total site area 13.30
(acres)*
14. Post- 2.11
construction (Estimated)
impervious area
(acres)*

NCC Project NCC-WAKE-2019-East College Park-Evergreen-All SF Lots
Tracking ID Assignedautorratically
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 Longview Branch
Wate rbody* Nine of waterbody into which storrrwater runoff will discharge
15b.Waterbody 27-33-21
Index No.* NC Waterbody Index I Lrrber
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 Evergreen Construction Co, Inc
Name*
2. First Name* Timothy
If Corporation,enter Registered Agent First f brre
3. Last Name* Morgan
If Corporation,enter Faegistered Agent Last%rre
3b.Title Vice President
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-848-2041
Telephone No.*
6. Permittee Mailing Street Address
Address* 7706 Six Forks Road
Address Line 2
City State/Province/Fegion
Raleigh NC
Postal/Zip Code Country
27615-5067 us
Check box if the rJ Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 7706 Six Forks Road
Address Line 2
City State/Rovince/Region
Raleigh NC
Fbstal/Zip Code Country
27615-5067 us

C. Site Contact Information
Part C. ^
Roject Site Contact Inforrration
.......................................................................................................................................................................................................................................................................................................................................................................................
1.Type of Non-Government
Ownership*
2. Primary Site Rod
Contact-First
Name*
3. Primary Site Miller
Contact-Last
Name*
4.Title Project Manager
5.Site Contact E- [e-mail]
mail Address*
6.Site Contact 919-427-4010
Telephone No.*
7.Organization Evergreen Construction Co, Inc
Name
8.Site Contact Street Address
Mailing Address* 7706 Six Forks Road
Address Line 2
City State/Rovince/Fbgion
Raleigh NC
Fbstal/Zip Code Country
27615-5067 us
9. Consultant Name (Optional)
Caitlin Shields
First and Last narre
10. Consultant E- [e-mail]
mail This person will be copied on all correspondence.
11. Consultant 919-828-4428
Telephone No.

D. E&SC Plan
Part D. ^
Erosion&Sediment Control(E&SC)Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 10/11/2017
Approved*
2. E&SC Plan Project Wake-2018-027
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* Raleigh(RRO)
Documentation of E&SC Plan approval and the signed Notice of Intent(NOI)Certification Form is required for a
complete application.
5. E&SC Plan NCDENR-Erosion Approval Letter Full-WAKE-
Approval 659.55KB
2018-027 LOA EX20171011.pdf
letter/documentation
Mist be R7Fforrrat
6. NOI Certification Evergreen-NOI Certification.pdf 405.37KB
Form Mist be Ft7Fforrrat
This is an Express F No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.6E(i) 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 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 guiltyofa Class 2 misdemeanor which mayinclude 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 Responsible Person named on this Notice of Intent
f Authorized Responsible Person*
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* Timothy Morgan
Title Vice President
Organization Evergreen Construction Co.
Date* 12/05/2019

F. Tracking and COC Info
NOI Tracking No. 19177
NC Reference No. NCG01-2019-3070
Uses'count_nurrber'variable(increrrented by SP)
Certificate of NCC193070
Coverage (COC) Uses'count number'variable(increrrented by SP)
No.*
Count Number 3070
Sequential nurrber for subrrittal that is incremented by Stored Frocedure
COC Year 2019
Year of date reviewed(used to assign YY digits after"NOC'in COCno.)