NCC192841_NOI Application_20191122

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 11/18/2019 1:21:23 PM (NCG01 NOI Submission)
Approve by Farkas, Jim J 11/19/2019 2:33:20 PM (Review- Construction NOI 18580)
• The task was assigned to Farkas, Jim J by round robin distribution 11/18/2019 1:21 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: November 20, 2019 5:00
PM 11/18/2019 1:21 PM
Submit by McCoy, Suzanne 11/22/2019 2:39:02 PM (Payment Verification for NCC192841)
* McKim & Creed
• McCoy, Suzanne assigned the task to McCoy, Suzanne 11/22/2019 2:38 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: December 31, 2019 5:00
PM 11/19/2019 2:33 PM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name * West New Bern - ESI Phase 1
2. County* Craven
3. Highway or Street US HWY 70/NC HWY 43
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* New Bern
5. State * NC
6. Zip Code * 28562
7. Latitude * Enter the latitude in decimal degrees
35.1322
8. Longitude* Enter the longitude in decimal degrees (M. ST be negative)
-77.1274
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*
12/01/2019
Estimated Construction Project Start Date
10. Date to End*
06/01 /2020
Estimated Construction Project End Cute
11. SIC (Primary) *
Residential, Single
Family Houses (SFE)
(1521)
Standard Industrial aassification for Developrrent
12. Acres to be
59.20
disturbed*
(including off -site borrow and waste areas)
13. Total site area 499.30
(acres) *
14. Post- 10.00
construction (Estimated)
impervious area
(acres)*

NCC Project NCC-CRAVE-2019-West New Bern - ESI Phase 1
Tracking ID Assignedautonatically
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 Caswell Branch
Wate rbody* Nacre of waterbody into which storrrwater runoff w ill discharge
15b. Waterbody 27-98-2.6
Index No. * NC Waterbody Index Minter
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. ^
F2rnittee Inforrration - Legally Fbsponsible 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 Weyerhaeuser NR Company
Name *
2. First Name* Todd
IF Corporation, enter Pbegistered Agent First Barre
3. Last Name* Powell
IF Corporation, enter Faegistered Agent Last %rre
3b. Title Vice President
4. Permitee E-mail [e-mail]
Address *
5. Permittee 352-415-4520
Telephone No.*
6. Permittee Mailing Street Address
Address* 13005 Southwest 1st Road
Address Line 2
Suite 241
city
Newberry
Fbstal / Zip Code
32669
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
13005 Southwest 1st Road
Address Line 2
Suite 241
Cty
Newberry
Fbstal / Zip Code
32669
State / Frovince / Faegion
FL
Country
us
State / Frovince / ilegion
FL
Country
us

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Type of
Non -Government
Ownership *
2. Primary Site
Tim
Contact - First
Name *
3. Primary Site
Jackson
Contact - Last
Name *
4. Title
Development Director
5. Site Contact E-
[e-mail]
mail Address*
6. Site Contact
407-808-5655
Telephone No.*
7. Organization
Weyerhaeuser NR Company
Name
8. Site Contact
Street Address
Mailing Address*
13005 Southwest 1st Road
Address Line 2
Suite 241
Cty
Newberry
Fbstal / Zip Code
32669
9. Consultant Name
(Optional)
Richard A. Moore, PE
First and Last narre
10. Consultant E-
[e-mail]
mail
This person will be copied on all correspondence.
11. Consultant
910-343-1048
Telephone No.
State / Rovince / Fegion
FL
Country
us

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 09/24/2019
Approved *
2. E&SC Plan Project Crave-2019-033
Number/ID * Assigned by agency or local program
3. E&SC Plan r State DEQ Office
Approved by* r Local Program
4. State DEQ Office * Washington (WaRO)
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 Crave-2019-033 West New Bern - ESI Phase 1
Approval 1.25MB
(REV).pdf
letter/documentation
Mast be R7Ffon-rat
6. NOI Certification NCG01-NOI Certification_signed.pdf 85.81KB
Form Mist be PDFfon-rat
This is an Express F No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.6E (i) provides that:
Any person who knowingly makes anyfalse statement, representation, or certification in any application, record, report, plan, or other
document filed or required to be maintained under this Article or a rule implementing this Article; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case under this Artcle; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
Commission implementing this Artcle shall be guilty ofa Class 2 misdemeanor which may include a fine not to exceed ten thousand
dollars ($10,000).
Under penalty of law, I certify that:
17 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.
* 17 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
f 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
Wll
Type Name * Todd Powell
Title Vice President
Organization Weyerhaeuser NR Company
Date * 11 /18/2019

F. Tracking and COC Info
NOI Tracking No. 18580
NC Reference No. NCG01-2019-2841
Uses 'count number' variable (incremrented by SP)
Certificate of NCC192841
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 2841
Sequential number for submittal that is incremented by Stored Frocedure
COC Year 2019
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)