NCC200965_NOI Application_20200312

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 3/9/2020 3:30:27 PM (NCG01 NOI Submission)
Approve by Garcia, Lauren V 3/11/2020 1:13:49 PM (Review- Construction NOI 22927)
• Georgoulias, Bethany reassigned the task to Garcia, Lauren V 3/11/2020 12:29 PM
• McCoy, Suzanne reassigned the task to Farkas, Jim J 3/10/2020 7:34 AM
• The task was assigned to Clark, Paul by round robin distribution 3/9/2020 3:30 PM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 11, 2020 5:00
PM 3/9/2020 3:30 PM
Submit by McCoy, Suzanne 3/12/2020 10:38:37 AM (Payment Verification for NCC200965)
p Lawrence K Barthelemy
• McCoy, Suzanne assigned the task to McCoy, Suzanne 3/12/2020 10:37 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: April 22, 2020 5:00 PM
3/11/2020 1:13 PM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
la. Project Name * Phase III Repair/Replace Failing Pavement Claw, Shark and Nose
Docks
1 b. Specific Lot This field rray be used to list specffc lot numbers.
Numbers
2. County* Cumberland
3. Highway or Street Surveyor Street
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* Fort Bragg
5. State * NC
6. Zip Code * 28310
7. Latitude * Enter the latitude in decimal degrees
35.1760
8. Longitude* Enter the longitude in decimal degrees (MIST be negative)
-79.0166
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*
05/01/2020
Fstir ated Construction Project Start Rate
10. Date to End*
04/30/2021
Estimated Construction Project End Date
11. SIC (Primary) *
Other (0000)
Standard Industrial aassification for Ceveloprrent
12. Acres to be
10.00
disturbed*
(including off -site borrow and waste areas)
13. Total site area 12.00
(acres) *
14. Post- 9.00
construction (Estimated)
impervious area
(acres) *

NCC Project NCC-CUMBE-2020-Phase III Repair/Replace Failing Pavement
Tracking ID Claw, Shark and Nose Docks
Assigned autorretically
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 Little River
Wate rbody* Wre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 18-23-(24)
Index No.* NCWaterbody Index Number
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. ^
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 Fort Bragg Directorate of Public Works
Name * If pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name* Monica
It Corporation, enter Fbgistered Agent First Barre
3. Last Name* Stephenson
If Corporation, enter FZegistered Agent Last %rre
3b. Title Director, Fort Bragg Directorate of Public Works
4. Permitee E-mail [e-mail]
Address *
5. Permittee 910-396-4009
Telephone No.*
6. Permittee Mailing Street Address
Address* 2175 Reilly Road Stop A
Address Line 2
city State / Frovince / Region
Fort Bragg NC
Postal / Zip Code Country
28310 us
Check box if the rJ Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
2175 Reilly Road Stop A
Address Line 2
City
State / Ffovince / Plegion
Fort Bragg
NC
Fbstal / Zip Code
Country
28310
us
8. Type of
Government - Federal
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Lee
Contact - First
Name *
2. Primary Site
Ward
Contact - Last
Name *
3. Title
Chief, DPW Water Management Branch
4. Site Contact E-
lee.p.\&[e-mail]
mail Address*
5. Site Contact
910-908-5286
Telephone No.
6. Organization
Fort Bragg Directorate of Public Works
Name
7. Site Contact
Street Address
Mailing Address*
2175 Reilly Road Stop A
Address Line 2
City
Fort Bragg
Postal / Zip Code
28310
8. Consultant Name
(Optional)
Clay Greene, P.E.
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
864-751-9123
Telephone No.
State / Rovince / Region
NC
Country
us

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
............................................................................................................................................................................................................................................................................................................................__
1. Date E&SC Plan 03/02/2020
Approved *
2. E&SC Plan Project CUMBE-2020-111
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 * Fayetteville (FRO)
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 or
include the beginning point and end point coordinates in the "Notes" box below.
5. E&SC Plan Shark Ramp III email ESC Approval Ltr.pdf 75.97KB
Approval letter or Mist beRDFforml
Grading Permit
Site Map (Optional) Helpful for linear project review
Mast be R7Fform3t
Notes (Optional) Provide any additional information that night help the reviewer better understand how uploaded documents support
the application. Include additional waterbodies for linear projects if necessary.
Project was submitted for 10 acres of land disturbing activity ($650
fee). However, the FRO -Land Quality office entered 14 acres on
the attached E&SC Approval Letter.
6. NOI Certification Signed NOI Certification Form.pdf 465.9KB
Form Mast be RDFformat
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 Atide; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case under this Atcle; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring device or method required to be operated or maintained under this Atide or rules of the
Commission implementing this Atcle 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
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
Type Name *
Lee Ward
Title
Chief, DPW Water Management Branch
Organization
Fort Bragg Directorate of Public Works
Date *
03/09/2020

F. Tracking and COC Info
NOI Tracking No. 22927
NC Reference No. NCG01-2020-0965
Uses 'count number' variable (incremrented by SP)
Certificate of NCC200965
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 965
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.)