NCC191004_NOI Application_20190717

Action History (UTC-05:00) Eastern Time(US&Canada)
Submit by Anonymous User 7/17/2019 3:07:36 PM(NCG01 NOI Submission)
Approve by Morman,Alaina 7/18/2019 3:47:52 PM(Review-Construction NOI 13580)
• The task was assigned to Morman,Alaina by round robin distribution 7/17/2019 3:07 PM
• The task was assigned to DEMLR NCG01 NOI Review Team.The due date is:July 19,2019 5:00 PM
7/17/2019 3:07 PM
Submit by Morman,Alaina 7/18/2019 4:02:30 PM(Payment Verification-NCG01-2019-1004)
• The task was assigned to Morman,Alaina.The due date is:July 19,2019 5:00 PM 7/18/2019 3:48 PM

1 sees �' � ••. -• i •• i i• i
IY sell
NORTH CAROLINA
Environmental QUII
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name* Wendell Valley Blvd.
2. County* Wake
3. Highway or Street Knightdale Eagle Rock Road
Address* Street narra only is acceptable if no address nurrber assigned yet
4. City or Township* Town of Wendell
5. State* NC
6.Zip Code* 27591
7. Latitude* Enter the latitude in decirral degrees
35.7919
8. Longitude* Enter the longitude in decirral degrees(MIST be negative)
-78.4265
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* 09/02/2019
Estimated Construction Project Start Date
10. Date to End* 09/04/2020
Estimated Construction Project End Date
11. SIC(Primary)* Highway(1611)
Standard Industrial aassification for Developrrent
12.Acres to be 11.73
disturbed* (including off-site borrow and waste areas)
13.Total site area 12.13
(acres)*
14. Post- 5.05
construction (Estimated)
impervious area
(acres)*
NCC Project NCC-WAKE-2019-Wendell Valley Blvd.
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 Marks Creek
Wate rbody* Narre of waterbody into which stormuater runoff will discharge
15b.Waterbody 27-38
Index No.* NCWaterbody Index Nunber
Stormwater rJ 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.
Perrrittee Information-Legally Responsible 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 NASH Wendell Falls, LLC
Name*
2. First Name* Garretson
ff Corporation,enter Registered Agent First l\b e
3. Last Name* Browne
ff Corporation,enter Registered Agent Last Barre
3b.Title Construction Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-819-9427
Telephone No.*
6. Permittee Mailing Street Address
Address* 4020 Westchase Boulevard
Address Line 2
Suite 150
City State/Province/Region
Raleigh NC
Rastal/Zip Code Country
27607 us
Check box if the rJ Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 4020 Westchase Boulevard
Address Line 2
Suite 150
City State/Province/Region
Raleigh NC
Rastal/Zip Code Country
27607 US

C. Site Contact Information
Part C.
Project Site Contact Information
....................................................................................................................
1.Type of Non-Government
Ownership*
2. Primary Site Garretson
Contact-First
Name*
3.Primary Site Browne
Contact-Last
Name*
4.Title Construction Manager
5.Site Contact E- [e-mail]
mail Address*
6.Site Contact 919-819-9427
Telephone No.*
7.Organization NASH Wendell Falls, LLC
Name
8.Site Contact Street Address
Mailing Address* 4020 Westchase Boulevard
Address Line 2
Suite 150
City State/Province/Fbgion
Raleigh NC
Fbstal/Zip Code Country
27607 us

D. E&SC Plan
Part D.
Erosion&Sediment Control(E&SC)Ran Approval Information
....................................................................................................................................................................................................................................... ....................................................................
1. Date E&SC Plan 06/14/2019
Approved*
2. E&SC Plan Project SEC-008941-2018
Number/ID* Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by r Local Program
4. Local Program* Wake 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 Wendell Valley
Approval Blvd_MUNICIPALWatershedManagementApproval_... 320.89KB
letter/documentation
14-19.pdf
Wendell Valley Blvd FRP form.pdf 136.56KB
Wendell Valley Blvd. Erosion Control Plans.pdf 11.1 MB
Mast be RCF format
6. NOI Certification Wendell Valley Blvd_NOI-signed.pdf 277.84KB
Form NLst be PCFfornat
This is an Express r No
Review Project* f 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.
* 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 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*
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
6a/n✓}t.�5a
Type Name* Garretson Browne
Title Construction Manager
Organization Newland
Date* 07/17/2019

F. Tracking and COC Info
NOI Tracking No. 13580
NC Reference No. NCG01-2019-1004
Uses'count number variable(incremented by SP)
Certificate of NCC191004
Coverage (COC) Uses'count number variable(increrrentedbySP)
No.*
Count Number 1004
Sequential nunber for subrrittal that is incremented by Stored Procedure
COC Year 2019
Year of date reviewed(used to assign YY digits after"NGC'in OOCno.)