NCC211959_NOI Application_20210401

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 3/29/2021 3:26:59 PM (NCG01 NOI Submission)
Approve by Clark, Paul 3/31/2021 11:58:15 AM (Review- Construction NOI 48870)
• The task was assigned to Clark, Paul by round robin distribution 3/29/2021 3:27 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 31, 2021 5:00
PM 3/29/2021 3:27 PM
Submit by Selkane, Aziza 4/1/2021 9:34:59 AM (Payment Verification for NCC211959)
* Patricia Creech
• Selkane, Aziza assigned the task to Selkane, Aziza 4/1/2021 9:34 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: May 12, 2021 5:00 PM
3/31 /2021 11:58 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 *
Neuse River East Parallel Interceptor
1 b. Specific Lot
This field rray be used to list specifc lot nunbers.
Numbers

1 c. Parcel ID
List all PINIs associated w ith this project.
Number(s) (PIN)
1742261807
1742027268
1732990791
1732982878
1742328228
1742117604
1742225563
1742406975
1742022603
1742113697
1742118645
1742320667
1732992205
1742016725
1742021862
1742211870
1742210741
1742502056
1742130839
1742110792
1742606427
1742115645
1742506280
1742018713
1742024283
1733650834
1742019754
1742022439
1742112649
1742021283
1742803817
1733903005
1733919712
1743002563
1733737297
2. County*
Wake
3. Highway or Street 6616 Poole Rd
Address * Street narre only is acceptable if no address nun ber assigned yet
4. City or Township* Raleigh
5. State * NC
6. Zip Code* 27610
7. Latitude* Enter the latitude in decinal degrees
35.7405
8. Longitude* Enter the longitude in decinal degrees (N ISTbe negative)
-78.5253
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* 04/13/2021
Estinated Construction Project Start Cate

10. Date to End *
06/12/2023
Estirrated Construction Project End Cate
11. SIC (Primary)*
Residential, Single Family Houses (SFE) (1521)
Standard Industrial aassification for Developrnent
12. Acres to be
115.00
disturbed*
(including off -site borrow and waste areas)
13. Total site area 115.00
(acres) *
14. Post- 3.90
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-WAKE-2021-Neuse River East Parallel Interceptor
Tracking ID Assignedautorraticaly
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 Neuse River
Wate rbody* %rre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 27-(22.5)
Index No.* NCWaterbody Index Nunber
Stormwater rJ 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. ^
Fbrnittee 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 * City of Raleigh
IF 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 * Robert
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Massengill
IF Corporation, enter F;bgistered Agent Last %rre
3b. Title Director - Raleigh Water
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-996-3479
Telephone No.*
6. Permittee Mailing Street Address
Address* 1 Exchange Plaza, Suite 620
Address Line 2
City
Raleigh
Fbstal / Zip Code
27601
Check box if the V Yes
street address the
same as mailing
address
State / Ffovince / Fbgion
NC
Country
United States
7. Permittee Street
Street Address
Address*
1 Exchange Plaza, Suite 620
Address Line 2
city
State / Frovince / Region
Raleigh
NC
Fbstal / Zip Code
Country
27601
United States
8. Type of
Ownership is only individual if an individual is
naned in B. 1. above.
Ownership*
Government- Municipal

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Dennis
Contact - First
Name *
2. Primary Site
Lassiter
Contact - Last
Name *
3. Title
Senior Project Administrator
4. Site Contact E-
Dennis. [e-mail]
mail Address*
5. Site Contact
919-996-3477
Telephone No.
6. Organization
Raleigh Water
Name
7. Site Contact
Street Address
Mailing Address*
1 Exchange Plaza, Suite 620
Address Line 2
city
Raleigh
Postal / Zip Code
27601
8. Consultant Name
(Optional)
Chris Windley
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
919-890-3879
Telephone No.
11. Billing E-mail
(For Annual Fee correspondence)
[e-mail]
Default is legally responsible person a-rmil
12. Billing
(For Annual Fee correspondence)
Telephone
919-996-3479
Default is legally responsible person telephone
State / Rovince / Region
NC
Country
United States

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................................................................................................__
1. Date E&SC Plan 03/06/2021
Approved *
2. E&SC Plan Project WAKE-2020-080
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. 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 WAKE-2020-080_20210306_LOA.pdf 266.5KB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Mist be RDFforrret (lint 20 NB)
3 - Site Map.pdf 617.39KB
Rease do not upload entire set of E&SC plans.
7. Notes (Optional) Rovide any additional information that night help the reviewer better understand how uploaded docurrents support
the application. Include additional waterbodies if necessary.
8. NOI Certification Neuse River East Parallel Interceptor NOI.pdf 54.13KB
Form Wst be RDFforrret
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:* IT The Legally Responsible Person named on this Notice of Intent
f 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 * Robert Massengill
Title Director - Raleigh Water
Organization Legally Responsible Entity
City of Raleigh
Date * 03/29/2021

F. Tracking and COC Info
NOI Tracking No. 48870
NC Reference No.
NCG01-2021-1959
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC211959
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 1959
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. NCC211959-2021
Invoice Due Date 4/30/2021
Initial Fee $ 100.00
Invoice Status OPEN