NCC190021_NOI Application_20190408

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 4/8/2019 1:42:56 PM (NCG01 NOI Submission)
Approve by Lucas, Annette 4/8/2019 4:07:31 PM (Review- Construction NOI 9965)
• The task was assigned to Lucas, Annette by round robin distribution 4/8/2019 1:43 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: April 10, 2019 5:00 PM
4/8/2019 1:43 PM
Submit by Lucas, Annette 4/8/2019 4:43:35 PM (Payment Verification - NCG01-2019-0021)
• The task was assigned to Lucas, Annette. The due date is: April 9, 2019 5:00 PM 4/8/2019 4:07 PM

STME
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1. Project Name* PublixAt Flowers Plantation
2. County* Johnston
3. Highway or Street Publix Drive
Address * Street name only is acceptable if no address nurrtrer assigned yet
4. City or Township* Clayton
5. State * NC
117-8) TiT 2,G) M 111 f_TiI a 10141
6. Zip Code* 27520
7. Latitude * Enter the latitude in decirral degrees
35.6523
8. Longitude * Enter the longitude in decirral degrees (WISTbe negative)
-78.3519
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* 04/12/2019
Estimated Construction Project Start Date
10. Date to End* 04/02/2021
Estimated Construction Project End Date
11. SIC (Primary)* Commercial (1542)
Standard Industrial aassification for Development
12. Acres to be 19.05
disturbed* (including off -site borrow and waste areas)
13. Total site area
54.82
(acres)*
14. Post-
11.50
construction
impervious area
(acres) *
NCC Project
NCC-JOHNS-2019-PublixAt Flowers Plantation
Tracking ID
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. You may
enter up to 3 waterbodies.
15a. Receiving Neuse
Wate rbody* Nacre of waterbody into which stormuater runoff will discharge
15b. Waterbody 27-(38.5)
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.
Ferrrittee Information - Legally Responsible Entity and Individual
.........................................................................................................................................................................
1. Organization Rebecca Flowers
Name *
2. First Name*
Rebecca
ff Corporation, enter Registered Agent First l\bre
3. Last Name *
Flowers
ff Corporation, enter Registered Agent Last f brre
4. Permitee E-mail
[e-mail]
Address*
5. Permittee 800-343-0659
Telephone No.*
6. Permittee Mailing Street Address
Address* 4880 NC-42 East
Address Line 2
City
State / Province / Region
Clayton
NC
Fbstal / Zip Code
Country
27527-8870
us
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 4880 NC-42 East
Address Line 2
City
State / Province / Region
Clayton
NC
Postal / Zip Code
Country
27527-8870
us
h

C. Site Contact Information
Part C.
Roiect Site Contact hforrration
1. Type of Individual
Ownership*
2. Primary Site Kevin
Contact - First
Name *
3. Primary Site Varnell
Contact - Last
Name *
4. Title Project Engineer
5. Site Contact E- [e-mail]
mail Address*
6. Site Contact 252-459-8196
Telephone No.*
7. Organization Stocks Engineering
Name
8. Site Contact Street Address
Mailing Address* PO Box 1108
Address Line 2
city
Nashville
Fbstal / Zip Code
27856
State / Province / Region
NC
Country
us

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 04/04/2019
Approved *
2. E&SC Plan Project JC# 19-015-P
Number/ID* Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by r Local Program
4. Local Program* Johnston County
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 19-015 Publix at Flowers_ESCApproval_4.4.19.pdf 128.08KB
Approval Mist be RDFfornat
letter/documentation
6. NOI Certification NCGO1 NOI Certification Form - Signed.pdf 68.77KB
Form Mist be R7Ffornat
This is an Express r No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.6B (1) 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 knowinglymakes a false statement
of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring deice or method required to be operated or maintained under this Article or rules of the
Commission implementing this Article 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:
rJ 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.
* V 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.
* I7 I will abide by all conditions of the NCG010000 General Permit and the
approved Erosion and Sediment Control Plan.
* V If the Erosion and Sediment Control Plan approved by the delegated program is
not compliant with Part II (Stormwater Pollution Prevention Plan) of the
NCG010000 General Permit, I will nonetheless ensure that all conditions of Part
II of the permit are met on the project at all times.
* I7 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
r Authorized Responsible Person'
"This form must be signed by a responsible corporate officer that 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* Rebecca Flowers
Date * 04/08/2019

F. Tracking and COC Info
NOI Tracking No. 9965
NC Reference No. NCG01-2019-0021
Uses 'count_nunber variable (increrrented by SP)
Certificate of NCC190021
Coverage (COC) Uses 'count _nunber'variable (increrrented bySP)
No. *
Count Number 21
Sequential nunber for subrrittal that is increrrented by Stored Procedure
COC Year 2019
Year of date reviewed, used to assign YY digits after "NOC' in OOC no.)