NCC200652_NOI Application_20200220

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 2/14/2020 10:09:33 AM (NCG01 NOI Submission)
Approve by Farkas, Jim J 2/18/2020 3:44:34 PM (Review- Construction NOI 21923)
• The task was assigned to Farkas, Jim J by round robin distribution 2/14/2020 10:10 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: February 18, 2020 5:00
PM 2/14/2020 10:10 AM
Submit by McCoy, Suzanne 2/20/2020 11:56:31 AM (Payment Verification for NCC200652)
* State Employee Credit Union
• McCoy, Suzanne assigned the task to McCoy, Suzanne 2/20/2020 11:55 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: March 31, 2020 5:00 PM
2/18/2020 3:44 PM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name * State Employees' Credit Union Wilmington 17th Street Branch
2. County* New Hanover
3. Highway or Street 4355 S 17th Street
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* Wilmington
5. State * NC
6. Zip Code * 28412
7. Latitude * Enter the latitude in decimal degrees
34.1763
8. Longitude* Enter the longitude in decimal degrees (M. ST be negative)
-77.8954
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*
04/01/2020
Estimated Construction Project Start Date
10. Date to End*
04/01 /2021
Estimated Construction Project End Cute
11. SIC (Primary)*
Commercial (1542)
Standard Industrial aassification for Developrrent
12. Acres to be
3.46
disturbed*
(including off -site borrow and waste areas)
13. Total site area
3.97
(acres) *
14. Post-
1.54
construction
(Estimated)
impervious area
(acres) *
NCC Project
NCC-NEW H-2020-State Employees' Credit Union Wilmington 17th
Tracking ID
Street Branch
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 Barnards Creek
Waterbody* Barre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 18-80
Index No.* W-Waterbody Index N.irrber
Stormwater V 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. ^
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 State Employees Credit Union
Name *
2. First Name* Stuart
IF Corporation, enter Pegistered Agent First Barre
3. Last Name* Hudson
If Corporation, enter Faegistered Agent Last %rre
3b. Title Senior Regional Vice President
4. Permitee E-mail Stuart. [e-mail]
Address *
5. Permittee 9107900224
Telephone No.*
6. Permittee Mailing Street Address
Address* 119 North Salisbury Street
Address Line 2
City State / Frovince / Faegion
Raleigh NC
Fbstal / Zip Code Country
27603-1739 US
Check box if the rJ Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
119 North Salisbury Street
Address Line 2
City
State / Frovince / Fbgion
Raleigh
NC
Fbstal / Zip Code
Country
27603-1739
US
8. Type of
Non -Government
Ownership*

C. Site Contact Information
Part C.
^
Roject Site Contact Inforrration
.......................................................................................................................................................................................................................................................................................................................................................................................
1. Primary Site
Mark
Contact - First
Name *
2. Primary Site
Arcuri
Contact - Last
Name *
3. Title
Wilmington Site/Civil Department Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
9102280424
Telephone No.*
6. Organization
SEPI, Inc.
Name
7. Site Contact
Street Address
Mailing Address*
5030 New Centre Drive
Address Line 2
Suite B
City
State / Rovince / Region
Wilmington
NC
Fbstal / Zip Code
Country
28403-1735
us
8. Consultant Name
(Optional)
Krista Duffield
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
5204688992
Telephone No.

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 01/21/2020
Approved *
2. E&SC Plan Project 41-19
Number/ID * Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* New Hanover County
Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a
complete application. For linear projects, please also upload a site map showing the overall extent of the project.
5. E&SC Plan SECU 17th Street Land Disturbing Permit.pdf 237.62KB
Approval Wst be FDFfornat
letter/documentation
Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded documents support
the application.
6. NOI Certification SKM_C364e20021410500.pdf 453.44KB
Form Mist be FDFfon-rat
This is an Express F No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.66 (1) 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 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.
* 17 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
IT 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
:7'M4 5Onf
Type Name* Stuart Hudson
Title Senior Regional Vice President
Organization State Employees' Credit Union
Date * 02/14/2020

F. Tracking and COC Info
NOI Tracking No. 21923
NC Reference No. NCG01-2020-0652
Uses 'count number' variable (incremrented by SP)
Certificate of NCC200652
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 652
Sequential number for submittal that is incremented by Stored Frocedure
COC Year 2020
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)