NCC215105_NOI Application_20210910

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 9/9/2021 10:25:22 AM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 9/9/2021 10:30:02 AM (Review- Construction NOI 64460)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 9/9/2021 10:25 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 13, 2021 5:00
PM 9/9/2021 10:25 AM
Submit by Selkane, Aziza 9/10/2021 10:35:52 AM (Payment Verification for NCC215105)
* Robert M. Green
• Selkane, Aziza assigned the task to Selkane, Aziza 9/10/2021 10:34 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 21, 2021 5:00 PM
9/9/2021 10:30 AM

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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 * CDIA- Ta)away F Ext, South Crossfield Ta)away, Yorkmont Realign - Pkg 3
1 b. Specific Lot This field rray be used to list specffc lot numbers.
Numbers
1 c. Parcel ID List all Rios associated w ith this project.
Number(s) (PIN) 11521103A, 14119204, 14119203, 14119202, 11521109, 11521105, 14119206,
14119103, 14119101, 14102318
2. County* Mecklenburg
3. Highway or Street Yorkmont Road
Address* Street name only is acceptable if no address nunber assigned yet
4.CityorTownship* Charlotte
5. State * NC
6. Zip Code* 28202
7. Latitude* Enter the latitude in decimal degrees
35.2040
8. Longitude * Enter the longitude in decinal degrees (MJST be negative)
-80.9470
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*
11/01/2021
Estirrated Construction Project Start Date
10. Date to End*
10/31/2023
Estinated Construction Project End Date
11. SIC (Primary) *
Other (9999)
Standard Industrial C]assification for Developrrent
12. Acres to be
43.00
d istu rbe d *
(including off -site borrow and waste areas)

13. Total site area 43.00
(acres) *
14. Post- 40.00
construction (Estimated)
impervious area
(acres) *
Project Tracking ID NCC-MECKL-2021-CDIA - Taxiway F Ext, South Crossfield Taxiway,
Yorkmont Realign - Pkg 3
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 Coffey Creek
Waterbody* Name of waterbody into which stormwater runoff will discharge
15b. Waterbody 11-137-4
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.
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 must 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. Permittee * Legally Pesponsible Entity
City of Charlotte - Aviation
IF pernittee is an individual, enter first and last narre in this field. otherwise, enter organization/business narre.
Note: If the permittee is a business, the business must be registered with the NC Secretary of State. You can verify the
registration here.
2. First Name * Jeff
IF Corporation, enter Faegistered Agent First %rre
3. Last Name* McSwain
IF Corporation, enter F;bgistered Agent Last %rre
3b. Title Airport Development Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 704-564-7919
Telephone No.*
6. Permittee Mailing Street Address
Address* 600 East 4th Street
Address Line 2
City
Charlotte
Fbstal / Zip Code
28202-2816
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
600 East 4th Street
Address Line 2
City
Charlotte
Fbstal / Zip Code
28202-2816
State / Ffovince / Pegion
NC
Country
us
State / Ftovince / Region
NC
Country
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
Leslie Jo
Contact - First
Name *
2. Primary Site
Hurwitz
Contact - Last
Name *
3. Title
Engineering Project Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
704-564-7919
Telephone No.
6. Organization
City of Charlotte - Aviation
Name
7. Site Contact
Street Address
Mailing Address*
600 East 4th Street
Address Line 2
City
Charlotte
Fbstal / Zip Code
28202-2816
8. Consultant Name
(Optional)
Rob Green
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
980-365-2322
Telephone No.
11. Billing E-mail
(For Annual Fee correspondence)
leslie.hur\&[e-mail]
Default is legally responsible person e-rrail
12. Billing
(For Annual Fee correspondence)
Telephone
704-564-7919
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 06/09/2021
Approved *
2. E&SC Plan Project MECKL-2021-073
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 * Mooresville (MRO)
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 MECKL-2021-073 CDIA-06092021.pdf 1.6MB
Approval letter or Mast beRDFformal
Grading Permit
6. Signed FRO Financial Pesponsibility/Ownership Form
Mast be FDFfornat
7. Site Location Map Wst be RDFforrret (lint 201VB)
SurfacewaterMap(V1.1).pdf 432.08KB
Rease do not upload entire set of E&SC plans.
8. Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded docurrents support
the application. Include additional waterbodies if necessary.
9. NOI Certification CamScanner 08-24-2021 13.58_1.pdf 785.11KB
Form Mist 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 * Jeff McSwain
Title Airport Development Manager
Organization Legally Responsible Entity
City of Charlotte - Aviation
Date * 09/09/2021

F. Tracking and COC Info
NOI Tracking No. 64460
NC Reference No.
NCG01-2021-5105
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC215105
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5105
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. NCC215105-2021
Invoice Due Date 10/9/2021
Initial Fee $ 100.00
Invoice Status OPEN