NCC191652_NOI Application_20190903

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/28/2019 10:16:31 AM (NCG01 NOI Submission)
Approve by Farkas, Jim J 8/29/2019 9:23:42 AM (Review- Construction NOI 15360)
• The task was assigned to Farkas, Jim J by round robin distribution 8/28/2019 10:16 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 30, 2019 5:00
PM 8/28/2019 10:16 AM
Submit by McCoy, Suzanne 9/3/2019 1:57:33 PM (Payment Verification for NCC191652)
* City of Hickory.
• McCoy, Suzanne assigned the task to McCoy, Suzanne 9/3/2019 1:57 PM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: September 12, 2019 5:00
PM 8/29/2019 9:23 AM

STME
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name * City Contract City of Hickory Riverwalk
2. County* Burke
3. Highway or Street 2035 12th Street Drive NW
Address * Street name only is acceptable if no address number assigned yet
4. City or Township* Hickory
5. State * NC
117-8) sT.:2,G) M F1Ii (-_TiI a 10141
6. Zip Code* 28601
7. Latitude * Enter the latitude in decimal degrees
35.7654
8. Longitude * Enter the longitude in decimal degrees (MIST be negative)
-81.3686
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* 10/15/2019
Estimated Construction Project Start Date
10. Date to End* 10/30/2020
Estimated Construction Project End Date
11. SIC (Primary)* Commercial (1542)
Standard Industrial aassification for Development
12. Acres to be 2.87
disturbed* (including off -site borrow and waste areas)
13. Total site area
100.80
(acres)*
14. Post-
18.13
construction
(Estimated)
impervious area
(acres) *
NCC Project
NCC-BURKE-2019-City Contract City of Hickory Riverwalk
Tracking ID
Assigned automatically

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 Catawba River
Wate rbody* Nacre of waterbody into which stormuater runoff will discharge
15b. Waterbody 11-(53)
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.
Perrrittee 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 City of Hickory
Name *
2. First Name* Warren
ff Corporation, enter Registered Agent First l\b e
3. Last Name * Wood
ff Corporation, enter Registered Agent Last Barre
3b. Title City Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 828-323-7412
Telephone No.*
6. Permittee Mailing Street Address
Address* PO Box398
Address Line 2
City
Hickory
Postal / Zip Code
28603
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
fJ Yes
Street Address
76 North Center Street
Address Line 2
City
Hickory
Postal / Zip Code
28601
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 - Municipal
Ownership*
2. Primary Site Kevin
Contact - First
Name *
3. Primary Site Greer
Contact - Last
Name *
4. Title Public Services Director
5. Site Contact E-
[e-mail]
mail Address*
6. Site Contact
828-323-7427
Telephone No.*
7. Organization
City of Hickory
Name
8. Site Contact
Street Address
Mailing Address*
1441 9th Avenue
Address Line 2
City
Hickory
Pbstal/ Zip Code
28601
9. Consultant Name (optional)
First and Last narre
10. Consultant E- This person will be copied on all correspondence.
mail
11. Consultant
Telephone No.
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 05/14/2019
Approved *
2. E&SC Plan Project BURKE-2019-017
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 * Asheville (ARO)
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 Riverwalk City Contract EC Letter of Approval_5-14-
Approval 19.pdf 117.11 KB
letter/documentation
Mist be RDF format
6. NOI Certification City Contract COH Riverwalk NCG01 Notice of Intent
Form 435.83KB
Certification Form 082819.pdf
Wst be RJF format
This is an Express F No
Review Project* r Yes
h

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
V'Uw't'-'Y f -"h-w
Type Name *
Warren Wood
Title
City Manager
Organization
City of Hickory
Date *
08/28/2019

F. Tracking and COC Info
NOI Tracking No. 15360
NC Reference No. NCG01-2019-1652
Uses 'count number variable (incremrented by SP)
Certificate of NCC191652
Coverage (COC) Uses 'count _nunber'variable (increrrented bySP)
No. *
Count Number 1652
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.)