NCC200829_NOI Application_20200316

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 2/26/2020 10:30:06 AM (NCG01 NOI Submission)
Approve by Farkas, Jim J 2/28/2020 3:28:43 PM (Review- Construction NOI 22454)
• The task was assigned to Farkas, Jim J by round robin distribution 2/26/2020 10:30 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: February 28, 2020 5:00
PM 2/26/2020 10:30 AM
Submit by Garcia, Lauren V 3/16/2020 9:10:05 AM (Payment Verification for NCC200829)
* Fayetteville Public Works Commission
• Garcia, Lauren V assigned the task to Garcia, Lauren V 3/16/2020 9:08 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: April 10, 2020 5:00 PM
2/28/2020 3:28 PM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
la. Project Name * Maiden Lane Phase 2 Sanitary Sewer and Water Relocation
1 b. Specific Lot This field may be used to list specifc lot numbers.
Numbers
2. County* Cumberland
3. Highway or Street Maiden Lane
Address* Street name only is acceptable if no address number assigned yet
4. CityorTownship* Fayetteville
5. State * NC
6. Zip Code* 28301
7. Latitude* Enter the latitude in decimal degrees
35.0550
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-78.8800
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
Estimated Construction Project Start Date
10. Date to End*
11/30/2020
Estinated Construction Project End Date
11. SIC (Primary) *
Other (0000)
Standard Industrial C]assification for Development
12. Acres to be
2.17
disturbed*
(including off -site borrow and waste areas)
13. Total site area 4.00
(acres)*
14. Post- 0.70
construction (Estimated)
impervious area
(acres) *

NCC Project NCC-CUMBE-2020-Maiden Lane Phase 2 Sanitary Sewer and
Tracking ID Water Relocation
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 Cross Creek
Waterbody* Narreof waterbody into which storrrwater runoff will discharge
15b. Waterbody 18-27-(3)
Index No. * NCWaterbody Index Nurrber
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 Fayetteville Public Works Commision
Name * If perrrittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name* Joseph
IF Corporation, enter Fbgistered Agent First Barre
3. Last Name * Glass
IF Corporation, enter Pegistered Agent Last %rre
3b. Title Engineering Manager
4. Permitee E-mail [e-mail]
Address *
5. Permittee 9102234730
Telephone No.*
6. Permittee Mailing Street Address
Address* P.O. Box 1089
Address Line 2
city State / Ftovince / Faegion
Fayetteville NC
Festal / Zip Code Country
28302 United States
Check box if the r Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
955 Old Wilmington Rd
Address Line 2
City
State / Ffovince / Pegion
Fayetteville
NC
Fbstal / Zip Code
Country
28301
United States
8. Type of
Government - Municipal
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Sam
Contact - First
Name *
2. Primary Site
Powers
Contact - Last
Name *
3. Title
Project Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
910-223-4370
Telephone No.
6. Organization
Fayetteville Public Works Commission
Name
7. Site Contact
Street Address
Mailing Address*
P.O. Box 1089
Address Line 2
city
Fayetteville
Fbstal / Zip Code
28302
8. Consultant Name
(Optional)
John Prevette
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
910-223-4409
Telephone No.
State / Rovince / Region
NC
Country
United States

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 02/15/2020
Approved *
2. E&SC Plan Project CUMBE-2020-097
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
Approval letter or
Grading Permit
Site Map (Optional)
cu mbe-2020-097. pdf
Mast be FDFfornat
Helpful for linear project review
Mast be FDFform3t
85.75KB
Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded documents support
the application. Include additional w aterbodies for linear projects if necessary.
6. NOI Certification 20200226101856134.pdf 835.25KB
Form Mast be FDFfon-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
Type Name * Joseph E. Glass, P.E.
Title Water Resources Engineering Department Manager
Organization Fayetteville Public Works Commision
Date * 02/26/2020

F. Tracking and COC Info
NOI Tracking No. 22454
NC Reference No. NCG01-2020-0829
Uses 'count number' variable (incremrented by SP)
Certificate of NCC200829
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 829
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.)