NCC191710_NOI Application_20190917

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/30/2019 1:24:20 PM (NCG01 NOI Submission)
Approve by Farkas, Jim J 9/4/2019 10:06:34 AM (Review- Construction NOI 15470)
• The task was assigned to Farkas, Jim J by round robin distribution 8/30/2019 1:24 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 3, 2019 5:00
PM 8/30/2019 1:24 PM
Submit by McCoy, Suzanne 9/17/2019 12:50:41 PM (Payment Verification for NCC191710)
• McCoy, Suzanne assigned the task to McCoy, Suzanne 9/17/2019 12:47 PM
• Georgoulias, Bethany changed the task's due date to October 4, 2019 5:00 PM 9/5/2019 12:56 PM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 16, 2019 5:00 PM
9/4/2019 10:06 AM

117-8) &T:M'G) M F1Ii f_TiI a 10141
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1. Project Name * Charlotte Inland Terminal Pavement Replacement
2. County* Mecklenburg
3. Highway or Street 1301 Exchange Street
Address * Street name only is acceptable if no address nurrtrer assigned yet
4. City or Township* Charlotte
5. State * NC
6. Zip Code* 28208
7. Latitude * Enter the latitude in decirral degrees
35.2721
8. Longitude * Enter the longitude in decirral degrees (WISTbe negative)
-80.9101
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* 09/09/2019
Estimated Construction Project Start Date
10. Date to End* 12/31 /2019
Estimated Construction Project End Date
11. SIC (Primary)* Industrial (1541)
Standard Industrial aassification for Development
12. Acres to be 5.15
disturbed* (including off -site borrow and waste areas)
13. Total site area
18.85
(acres)*
14. Post-
5.15
construction
(Estimated)
impervious area
(acres) *
NCC Project
NCC-MECKL-2019-Charlotte Inland Terminal Pavement
Tracking ID
Replacement
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. 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 Paw Creek
Waterbody* Nbrre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 11-124
Index No. * NCWaterbody Index Pbnber
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.
P rrrittee 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
North Carolina State Ports Authority
Name *
2. First Name*
Mark
ff Corporation, enter Registered Agent First Nacre
3. Last Name *
Blake
ff Corporation, enter Registered Agent Last Nbrre
3b. Title
Vice President, Engineering and Maintenance
4. Permitee E-mail [e-mail]
Address*
5. Permittee 910-251-5674
Telephone No.*
6. Permittee Mailing Street Address
Address* 2202 Burnett Blvd
Address Line 2
City State / Province / Region
Wilmington NC
Postal / Zip Code Country
28401 us
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 2202 Burnett Blvd
Address Line 2
City
State / Province / Region
Wilmington
NC
Postal / Zip Code
Country
28401
us

C. Site Contact Information
Part C.
Roiect Site Contact Information
1. Type of Government - State
Ownership*
2. Primary Site Jeffrey
Contact - First
Name *
3. Primary Site White
Contact - Last
Name *
4. Title Chief Clerk
5. Site Contact E- [e-mail]
mail Address*
6. Site Contact 704-398-2076
Telephone No.*
7. Organization
North Carolina State Ports Authority
Name
8. Site Contact
Street Address
Mailing Address*
1301 Exchange Street
Address Line 2
aty
Charlotte
Fbstal / Zip Code
28208-1225
9. Consultant Name (optional)
First and Last nacre
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 08/19/2019
Approved *
2. E&SC Plan Project MECKL-2020-011
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 * Mooresville (MRO)
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 jm1-08192019.pdf 1.5MB
Approval Mist be FDFforrrat
letter/documentation
6. NOI Certification NOI signed.pdf 121.36KB
Form Mist be RDFforrret
This is an Express f• 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 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
( At'6 0 16r19A-'
Type Name * Mark A Blake
Title Vice President, Engineering and Maintenace
Organization NC State Ports Authority
Date * 08/30/2019

F. Tracking and COC Info
NOI Tracking No. 15470
NC Reference No. NCG01-2019-1710
Uses 'count_nunber variable (increrrented by SP)
Certificate of NCC191710
Coverage (COC) Uses'count_nunber'variable (incremented by SF)
No. *
Count Number 1710
Sequential nunber for subrrittal that is increrrented by Stored Procedure
COC Year 2019
Year of date reviewed (used to assign YY digits after "NGC' in OOCno.)