NCC201207_NOI Application_20200402

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 3/23/2020 3:09:02 PM (NCG01 NOI Submission)
Approve by McCoy, Suzanne 3/25/2020 8:14:14 AM (Review- Construction NOI 23398)
. The task was assigned to McCoy, Suzanne by round robin distribution 3/23/2020 3:09 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 25, 2020 5:00 PM.
The priority is: High 3/23/2020 3:09 PM
Submit by McCoy, Suzanne 4/2/2020 8:29:05 AM (Payment Verification for NCC201207)
* Wake Forest Hospitality LLC
• McCoy, Suzanne assigned the task to McCoy, Suzanne 4/2/2020 8:28 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: May 6, 2020 5:00 PM. The
priority is: High 3/25/2020 8:14 AM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
la. Project Name * Tru by Hilton Wake Forest
1 b. Specific Lot
This field rray be used to list specifc lot numbers.
Numbers
1831520049
1831511982
1831510935
1831510891
2. County*
Wake
3. Highway or Street Hampton Way Drive
Address* Street narre only is acceptable if no address number assigned yet
4. CityorTownship* Wake Forest
5. State * NC
6. Zip Code* 27587
7. Latitude* Enter the latitude in decimal degrees
35.9801
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-78.5432
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*
03/30/2020
Estimated Construction Project Start Date
10. Date to End*
08/31/2021
Estinated Construction Project End Date
11. SIC (Primary)*
Commercial (1542)
Standard Industrial aassification for teveloprrent
12. Acres to be
2.46
disturbed*
(including off -site borrow and waste areas)
13. Total site area 2.46
(acres)*

14. Post- 1.00
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-WAKE-2020-Tru by Hilton Wake Forest
Tracking ID 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 Richland Creek
Waterbody* Ibrre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 27-21-(1.5)
Index No.* NCWaterbody Index Number
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 Responsible 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 Wake Forest Hospitality, LLC
Name * If pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name* Champaklal
If Corporation, enter Registered Agent First f brre
3. Last Name* Patel
If Corporation, enter Registered Agent Last Wre
3b. Title Managing Member
4. Permitee E-mail [e-mail]
Address *
5. Permittee 2527672545
Telephone No.*
6. Permittee Mailing Street Address
Address* 9800 San Remo Place
Address Line 2
City State / Province / Region
Wake Forest NC
Postal / Zip Code Country
27587-5922 us
Check box if the rJ Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
9800 San Remo Place
Address Line 2
City
State / Province / Region
Wake Forest
NC
Postal / Zip Code
Country
27587-5922
us
8. Type of
Non -Government
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Champaklal
Contact - First
Name *
2. Primary Site
Patel
Contact - Last
Name *
3. Title
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
2527672545
Telephone No.
6. Organization
Milkam Hospitality
Name
7. Site Contact
Street Address
Mailing Address*
9800 San Remo Pl, -
Address Line 2
city
Wake Forest
Postal / Zip Code
27587
8. Consultant Name
(Optional)
First and Last narre
9. Consultant E-mail
This person will be copied on all correspondence.
10. Consultant
Telephone No.
State / Province / Region
North Carolina
Country
USA

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 03/23/2020
Approved *
2. E&SC Plan Project 2018-00002145
Number/ID * Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* Town of Wake Forest
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 TRU Hotel ESC Letter of Approval.pdf 89.36KB
Approval letter or Mast beRDFformat
Grading Permit
Site Map (Optional) Helpful for linear project review
Mast be R7Fform3t
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 NCG01-eNO1-Certification-Form-20190919-DEMLR-
Form 757.03KB
SW-signed.pdf
Wst be RDFfornat
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
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
66ter", C-' rZl t
Type Name* Champaklal Patel
Title Managing Member
Organization Wake Forest Hospitality, LLC
Date * 03/23/2020

F. Tracking and COC Info
NOI Tracking No. 23398
NC Reference No. NCG01-2020-1207
Uses 'count number' variable (incremrented by SP)
Certificate of NCC201207
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 1207
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.)