NCC212937_NOI Application_20210513

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 5/11/2021 3:50:30 PM (NCG01 NOI Submission)
Approve by Garcia, Lauren V 5/12/2021 3:21:01 PM (Review- Construction NOI 52606)
• The task was assigned to Garcia, Lauren V by round robin distribution 5/11/2021 3:52 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: May 13, 2021 5:00 PM
5/11/2021 3:52 PM
Submit by McCoy, Suzanne 5/13/2021 8:05:04 AM (Payment Verification for NCC212937)
* Henry Louis Duffie
• McCoy, Suzanne assigned the task to McCoy, Suzanne 5/13/2021 8:04 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: June 23, 2021 5:00 PM
5/12/2021 3:22 PM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting r No
an NOI that was r Yes
rejected before?
Previous Rejected 52159
NOI No.
Prior Reviewer Lauren Garcia
Name
1a. Project Name * Town of Clayton Neuse River WRF - Transmission Infrastructure
1 b. Specific Lot This field any be used to list specifc lot nunbers.
Numbers N/A

1 c. Parcel ID
List all PINS associated w ith this project.
Number(s) (PIN)
165808-98-5881
166805-08-5538
166805-08-7403
166805-19-3475
166805-19-6874
166805-29-2511
166805-29-450
166805-29-4520
166806-29-5684
166806-29-6742
166806-29-9612
166806-29-9607
166818-38-9809
166818-39-3796
166818-39-6977
166918-40-3804
166918-41-1304
166918-41-0740
166918-32-8244
166918-42-1327
166918-41-7775
166914-42-4864
166915-52-5804
166915-53-7027
166915-63-1193
166915-64-1095
166915-63-8630
166915-74-0667
166900-74-2974
166900-76-7638
166900-96-3988
2. County*
Johnston
3. Highway or Street 1000 Durham Street
Address * Street narre only is acceptable if no address nun ber assigned yet
4. City or Township* Clayton
5. State * NC
6. Zip Code* 27520
7. Latitude* Enter the latitude in decimal degrees
35.6412
8. Longitude* Enter the longitude in decimal degrees (N ISTbe negative)
-78.4632
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* 10/01/2021
Estimated Construction Project Start Date
10. Date to End* 02/01/2023
Estimated Construction Project End Date
11. SIC (Primary)* Other (9999)
Standard Industrial aassification for Leveloprrent

12. Acres to be 22.00
disturbed* (including off -site borrow and waste areas)
13. Total site area 22.00
(acres) *
14. Post- 0.50
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-JOHNS-2021-Town of Clayton Neuse River WRF -
Tracking ID Transmission Infrastructure
Assigned autorratically
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 Little Creek
Waterbody * N larre of waterbody into which stormwater runoff will discharge
15b. Waterbody 27-43-12
Index No.* NCWaterbody Index Number
Stormwater r No
discharges will flow pr Yes
to additional
wate rs *
15c. Additional Neuse River
Receiving Waterbody narre
Waterbody
15d. Waterbody 27-(38.5)
Index No. NCWaterbody Index Number
15e. Additional Waterbody narre
Receiving
Waterbody
15f. Waterbody NCWaterbody Index Number
Index No.
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 * Town of Clayton
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 *
Richard
If Corporation, enter Faegistered Agent First %rre
3. Last Name*
Cappola
It Corporation, enter Pbegistered Agent Last %rre
3b. Title
Deputy Town Manager / Public Services Director
4. Permitee E-mail
[e-mail]
Address*
5. Permittee 919-553-1530
Telephone No.*
6. Permittee Mailing Street Address
Address* PO Box879
Address Line 2
Clayton
Fbstal / Zip Code
27520
Check box if the F Yes
street address the
same as mailing
address
State / Ffovince / Fbgion
NC
Country
United States
7. Permittee Street
Street Address
Address*
111 East 2nd Street
Address Line 2
city
State / Frovince / Region
Clayton
NC
Fbstal / Zip Code
Country
27520
US
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 Richard
Contact - First
Name *
2. Primary Site Cappola
Contact - Last
Name *
3. Title
Deputy Town Manager / Public Services
Director
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
919-553-1530
Telephone No.*
6. Organization
Town of Clayton
Name
7. Site Contact
Street Address
Mailing Address*
PO Box879
Address Line 2
Cty
Clayton
Fbstal / Zip Code
27520
8. Consultant Name
(Optional)
WithersRavenel
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
919-535-5185
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
919-553-1530
Default is legally responsible person telephone
State / Rovince / Fbgion
NC
Country
United States

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................................................................................................__
1. Date E&SC Plan 04/09/2021
Approved *
2. E&SC Plan Project JOHNS-2021-025
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 6) 2021-04-09 NCDEMLR Approval Johns-2021-
Approval letter or 025.pdf 339.27KB
Grading Permit
Mast be RDFforrrat
6. Site Location Map Mist be FDFfornat (lint 201VB)
2020.11.18 - Aerial Map - FM.pdf 6.39MB
2020.11.19 - Aerial Map - GS.pdf 7.72MB
Rease do not upload entire set of E&SC plans.
7. Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded documents support
the application. Include additional w aterbodies if necessary.
Resubmitting based on comments received 5/7/2021. See attached
aerial site maps, letter of approval, and executed NOI Certification
Form.
8. NOI Certification TOC Signature.pdf 94.78KB
Form Mast be FDFformat
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 Atide; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case under this Atcle; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring device or method required to be operated or maintained under this Atide or rules of the
Commission implementing this Atcle 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* Richard D Cappola Jr
Title Interim Town Manager
Organization Legally Plesponsible Entity
Town of Clayton
Date * 05/11 /2021

F. Tracking and COC Info
NOI Tracking No. 52606
NC Reference No.
NCG01-2021-2937
Uses 'count_nurber' variable (increrrented by SP)
Certificate of
NCC212937
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 2937
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. NCC212937-2021
Invoice Due Date 6/11/2021
Initial Fee $ 100.00
Invoice Status OPEN