NCC190153_NOI Application_20190501

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 5/1/2019 3:23:05 PM (NCG01 NOI Submission)
Approve by Lucas, Annette 5/1/2019 4:29:06 PM (Review- Construction NOI 10570)
• The task was assigned to Lucas, Annette by round robin distribution 5/1/2019 3:23 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: May 3, 2019 5:00 PM.
The priority is: High 5/1/2019 3:23 PM
Submit by Lucas, Annette 5/1/2019 4:31:14 PM (Payment Verification - NCG01-2019-0153)
• The task was assigned to Lucas, Annette. The due date is: May 2, 2019 5:00 PM. The priority is: High
5/1/2019 4:29 PM

STME
NORTH CAROLINA
Errvlronmenfal qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1 r-G) &T:M'i) M 1i1 (-:TiI a 1010
1. Project Name * UNCW — Temporary Modular Buildings (Dobo Hall Phase 2) —
[EXPRESS]
2. County* New Hanover
3. Highway or Street Price Drive
Address* Street narre only is acceptable if no address nun-ber assigned yet
4. City or Township* Wilmington
5. State * NC
6. Zip Code * 28403
7. Latitude* Enter the latitude in decimal degrees
34.2251
8. Longitude * Enter the longitude in decirral degrees (MJST be negative)
-77.8695
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. Date to End*
11. SIC (Primary)*
12. Acres to be
disturbed *
13. Total site area
(acres) *
14. Post -
construction
impervious area
(acres)*
04/25/2019
Estirrated Construction Project Start Date
10/15/2019
Estirrated Construction Project End Date
Other(0000)
Standard Industrial Classification for Developrrent
1.30
(including off -site borrow and waste areas)
1.30
0.59

NCC Project NCC-NEW H-2019-UNCW — Temporary Modular Buildings (Dobo
Tracking ID Hall Phase 2) — [EXPRESS]
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 White Oak Branch
Wate rbody* Narre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 27-52-5-2
Index No. * NC Waterbody Index Narrber
Stormwater PF No
discharges will flow r Yes
to additional
wate rs *
16a. Is this project F Yes
subject to the NC r No, not subject to NC SPCA
Sediment Pollution
Control Act?*

B. Permittee Information
Part B.
Pbrrrittee Information - Legally Responsible Entity and Individual
.....................................................................................................................................................................
h
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 University of North Carolina at Wilmington
Name *
2. First Name*
Mark
ff Corporation, enter Registered Agent First l\b e
3. Last Name *
Morgan
ff Corporation, enter Registered Agent Last Barre
4. Permitee E-mail
[e-mail]
Address*
5. Permittee 910-962-7743
Telephone No.*
6. Permittee Mailing Street Address
Address* 601 South College Road
Address Line 2
City
Wilmington
Fbstal / Zip Code
28403
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
601 South College Road
Address Line 2
City
Wilmington
Pbstal / Zip Code
28403
State / Province / Region
NC
Country
US
State / Province / Region
NC
Country
US

C. Site Contact Information
Part C.
Roiect Site Contact Information
1. Type of Government - State
Ownership*
2. Primary Site Mark
Contact - First
Name *
3. Primary Site Morgan
Contact - Last
Name *
4. Title Assoc. Vice Chancellor Business Affairs -
Facilities
5. Site Contact E- [e-mail]
mail Address*
6. Site Contact 910-962-7743
Telephone No.*
7. Organization
University of North Carolina Wilmington
Name
8. Site Contact
Street Address
Mailing Address*
601 South College Road
Address Line 2
City
Wilmington
Fbstal / Zip Code
28403
State / Rovince / iegion
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 NEWHA-2019-019
Number/ID* Assigned by agency or local program
3. E&SC Plan f• State DEQ Office
Approved by r Local Program
4. State DEQ Office * Wilmington (WiRO)
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 NEWHA-2019-019 Approval 4-4-2019.pdf 348.27KB
Approval Mist be RDFforrrat
letter/documentation
6. NOI Certification NOI - SW.pdf 65.44KB
Form Mist be R7Fformat
This is an Express r No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.613 (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.
* 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.
* I7 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:* r The Responsible Person named on this Notice of Intent
r Authorized Responsible Person*
Important: The person who signs this Certification above and signs the NOI Certification Form should be the same
person (or authorized responsible person within the same organization) as listed in Section B (Permittee Information)
of this form. *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 * Mark Morgan
Date * 05/01 /2019

F. Tracking and COC Info
NOI Tracking No. 10570
NC Reference No. NCG01-2019-0153
Uses 'count_nunber variable (increrrented by SP)
Certificate of NCC190153
Coverage (COC) Uses 'count _nunber'variable (increrrented bySP)
No. *
Count Number 153
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.)