NCC202249_NOI Application_20200528

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 5/28/2020 3:12:43 PM (NCG01 NOI Submission)
Approve by Garcia, Lauren V 5/28/2020 3:52:38 PM (Review- Construction NOI 26309)
. The task was assigned to Garcia, Lauren V by round robin distribution 5/28/2020 3:13 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: June 1, 2020 5:00 PM
5/28/2020 3:13 PM
Submit by Garcia, Lauren V 5/28/2020 3:54:07 PM (Payment Verification for NCC202249)
* CJS Conveyance PLLC
• Garcia, Lauren V assigned the task to Garcia, Lauren V 5/28/2020 3:53 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: July 9, 2020 5:00 PM
5/28/2020 3:52 PM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting r No
an NOI that was r Yes
rejected before?
Previous Rejected 26259
NOI No.
Prior Reviewer Lauren Garcia
Name
1a. Project Name * Town of Cary 2020 Water Main Replacements
1 b. Specific Lot This field may be used to list specffc lot numbers.
Numbers
2. County* Wake
3. Highway or Street 316 N. Academy Street
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* Cary
5. State * NC
6. Zip Code * 27513
7. Latitude * Enter the latitude in decimal degrees
35.7902
8. Longitude* Enter the longitude in decimal degrees (M. ST be negative)
-78.7812
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* 05/18/2020
Estimated Construction Project Start Date
10. Date to End* 12/31/2021
Estimated Construction Project End Cute
11. SIC (Primary) * Other (9999)
Standard Industrial Classification for lkveloprrent

12. Acres to be 23.29
disturbed* (including off -site borrow and waste areas)
13. Total site area 23.29
(acres) *
14. Post- 23.29
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-WAKE-2020-Town of Cary 2020 Water Main Replacements
Tracking ID Assigned automatically
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 Lynn Branch
Waterbody * Nacre of waterbody into which stormwater runoff will discharge
15b. Waterbody 27-43-3
Index No.* NC Waterbody Index Nmber
Stormwater r No
discharges will flow Pf Yes
to additional
wate rs *
15c. Additional Walnut Creek
Receiving Waterbody name
Waterbody
15d. Waterbody 27-34-(1)
Index No. NCWaterbody Index Narrber
15e. Additional MacGregor Downs Lake
Receiving Waterbody name
Waterbody
15f. Waterbody 27-43-2.2
Index No. NCWaterbody Index Namber
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. ^
Fbrnittee 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 Legally Responsible Entity
Name * Town of Cary
It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name * Alex
IF Corporation, enter Registered Agent First %rre
3. Last Name* Lopez
It Corporation, enter F;bgistered Agent Last %ne
3b. Title Utility Engineer - Project Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-469-7817
Telephone No.*
6. Permittee Mailing Street Address
Address* 316 North Academy Street
Address Line 2
City State / Rovince / F;bgion
Cary NC
Fbstal / Zip Code Country
27513-4538 us
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
316 North Academy Street
Address Line 2
City
State / Frovince / Region
Cary
NC
Fbstal / Zip Code
Country
27513-4538
us
8. Type of
Government - Municipal
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Alex
Contact - First
Name *
2. Primary Site
Lopez
Contact - Last
Name *
3. Title
Project Manager
4. Site Contact E-
Alex. [e-mail]
mail Address*
5. Site Contact
919-469-7817
Telephone No.
6. Organization
Town of Cary
Name
7. Site Contact
Street Address
Mailing Address*
316 North Academy Street
Address Line 2
Oty
Cary
Fbstal / Zip Code
27513-4538
8. Consultant Name
(Optional)
Alex Biermann
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
919-890-3885
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 11/05/2019
Approved *
2. E&SC Plan Project Wake-2020-027
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 * Raleigh (RRO)
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 WAKE-2020-027 LOA MOD 20191105.pdf 78.24KB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Helpful for linear project review
(Optional) 2020 WMR location map.pdf 312.01KB
Mast be RDFformat. Rease do not upload entire set of E&SCplans.
7. Notes (Optional) Rovide any additional information that night help the reviewer better understand how uploaded docurrents support
the application. Include additional waterbodies for linear projects if necessary.
8. NOI Certification NCG01-eNO1-Certification-Form-20190919-DEMLR-
Form SW.pdf 805.78KB
Mast be FDFformat
This is an Express r 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
twat
Type Name * Robert Hirt, P.E.
Title Utility Engineering Manager
Organization Legally Responsible Entity
Town of Cary
Date * 05/28/2020

F. Tracking and COC Info
NOI Tracking No. 26309
NC Reference No. NCG01-2020-2249
Uses 'count number' variable (incremrented by SP)
Certificate of NCC202249
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 2249
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.)