NCC215583_NOI Application_20211012

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/6/2021 11:12:24 AM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 10/7/2021 7:00:10 AM (Review- Construction NOI 68028)
• The task was assigned to EADS\bcbroussard by round robin distribution 10/6/2021 11:13 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 8, 2021 5:00
PM 10/6/2021 11:13 AM
Submit by Evans, Shaundra M 10/12/2021 8:33:55 AM (Payment Verification for NCC215583)
* M Prather Foster
• Evans, Shaundra M assigned the task to Evans, Shaundra M 10/12/2021 8:33 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 18, 2021 5:00
PM 10/7/2021 7:00 AM

.• SThF� ';
1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting f• No
an NOI that was r Yes
rejected before?
1a. Project Name * Hinsdale Tinkerbell Storm Drainage Improvement Project
1 b. Specific Lot This field rrey be used to list specifc lot numbers.
Numbers 2
4
5
8
17
19
20
21
22
23
24
25
26
27
28
29
30
31
33
34
35
36
37
38
41
42
43
48
49
54
55
61
62
63
64
65
66

b/
68
69
72
73
76
77
78
79
80
81
89
90
92
110
116
145
149
150
176
177
179
180
193
194
195
196
197
211
212
213
227
228
229
242
243
244
245
246
247
248
249
250
252
253
254
256
257
262
263
265
266
267
272
273
277
278
292
293
294
295
,im

1 c. Parcel ID List all Rim associated w ith this project.
Number(s) (PIN) 179-054-15
179-054-13
179-075-52
179-075-49
209-073-02
209-073-06
209-073-07
209-073-08
209-073-11
209-073-10
209-073-09
209-071-09
209-071-10
209-071-11
209-071-12
209-071-13
209-071-14
209-071-15
209-071-03
209-071-04
209-071-05
209-071-06
209-071-07
209-071-08
209-073-14
209-073-15
209-073-16
209-072-22
209-072-21
209-072-03
209-072-04
209-091-06
209-091-05
209-091-04
209-091-03
209-091-02
209-091-01
209-104-26
209-104-25
209-104-24
209-104-21
209-104-29
209-104-20
209-104-19
209-104-18
209-104-17
209-104-16
209-104-15
209-104-07
209-104-06
209-104-04
209-091-13
209-105-23
209-103-06
209-103-40
209-103-11
209-103-25
209-103-24
209-103-22

209-103-21
209-122-09
209-122-11
209-103-18
209-103-17
209-103-16
209-123-02
209-123-01
209-123-03
209-112-59
209-112-60
209-112-61
209-124-46
209-124-24
209-124-23
209-124-22
209-124-21
209-124-20
209-124-19
209-124-18
209-124-17
209-121-10
209-121-11
209-121-12
209-121-14
209-121-15
209-121-03
209-121-04
209-121-06
209-121-07
209-121-09
209-124-06
209-124-07
209-124-11
209-124-12
209-124-30
209-124-31
209-124-32
209-124-33
209-122-10
2. County* Mecklenburg
3. Highway or Street Intersection of Hinsdale St & Tinkerbell Ln
Address * Street narre only is acceptable if no address nun ber assigned yet
4. City or Township* Charlotte
5. State * NC
6. Zip Code* 28210
7. Latitude* Enter the latitude in decimal degrees
35.1330
8. Longitude* Enter the longitude in decirral degrees (NL1STbe negative)
-80.8280
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*
05/10/2021
Estirrated Construction Project Start Date
10. Date to End*
05/10/2023
Estirrated Construction Project End Date
11. SIC (Primary)*
Other (9999)
Standard Industrial aassification for Leveloprrent
12. Acres to be
9.86
disturbed*
(including off -site borrow and waste areas)
13. Total site area 258.00
(acres) *
14. Post- 0.00
construction (Estirrated)
impervious area
(acres) *
Project Tracking ID NCC-MECKL-2021-Hinsdale Tinkerbell Storm Drainage
Improvement Project
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 McMullen Creek
Waterbody* Narreof waterbody into which storrrwater runoff will discharge
15b. Waterbody 11-137-9-5
Index No. * NCWaterbody Index Nurrber
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
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 * John
IF Corporation, enter Faegistered Agent First %rre
3. Last Name* Keene
IF Corporation, enter F;bgistered Agent Last %rre
3b. Title Project Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 980-293-2086
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 / Frovince / 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
Keith
Contact - First
Name *
2. Primary Site
Greene
Contact - Last
Name *
3. Title
Inspector
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
980-240-7469
Telephone No.
6. Organization
City of Charlotte
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)
Armstrong Glen, PC
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
704-529-0345
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
980-293-2086
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 05/05/2020
Approved *
2. E&SC Plan Project MECKL-2020-06
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 KECKL-2020-061 HINSDALE-05052020.pdf 242.98KB
Approval letter or Mast beRDFformat
Grading Permit
6. Signed FRO Financial Pesponsibility/Ojvnership Form
Hinsdale Tinkerbell Signed FRO.PDF 206.37KB
Mast be RDFfornat
7. Site Location Map Mast be RDFforrrat (lirrit 20IVB)
eNOI Site Location Map.pdf 622.94KB
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 documents support
the application. Include additional w aterbodies if necessary.
Project is only for construction of storm drainage improvements.
The project will not create any new impervious area.
9. NOI Certification NCG01-eNOI-Certification-Form-20210514-DEMLR-
Form SW.pdf 908.68KB
Mast be FDFfornat
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 * John Keene
Title Project Manager
Organization Legally Responsible Entity
City of Charlotte
Date * 10/06/2021

F. Tracking and COC Info
NOI Tracking No. 68028
NC Reference No.
NCG01-2021-5583
Uses 'count_nunber' variable (increrrented by SP)
Certificate of
NCC215583
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5583
Sequential nunber for subnittal 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. NCC215583-2021
Invoice Due Date 11/6/2021
Initial Fee $ 100.00
Invoice Status OPEN