NCC204072_NOI Application_20200918

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 9/14/2020 1:42:09 PM (NCG01 NOI Submission)
Approve by Gwinn, Matt 9/17/2020 12:10:50 PM (Review- Construction NOI 31395)
• The task was assigned to Gwinn, Matt by round robin distribution 9/14/2020 1:43 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 16, 2020 5:00
PM 9/14/2020 1:43 PM
Submit by McCoy, Suzanne 9/18/2020 8:24:07 AM (Payment Verification for NCC204072)
* Lisa Levin
• McCoy, Suzanne assigned the task to McCoy, Suzanne 9/18/2020 8:23 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 29, 2020 5:00 PM
9/17/2020 12:10 PM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting IT No
an NOI that was r Yes
rejected before?
1a. Project Name * Fuller Elementary School
1 b. Specific Lot This field nay be used to list specifc lot nunbers.
Numbers
2. County* Wake
3. Highway or Street 806 Calloway Drive
Address* Street narre only is acceptable if no address number assigned yet
4. City or Township* Raleigh
5. State * NC
6. Zip Code * 27610
7. Latitude* Enter the latitude in decinal degrees
35.7500
8. Longitude* Enter the longitude in decir al degrees (M.JST be negative)
-78.6200
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*
02/01/2021
Estimated Construction Project Start Date
10. Date to End *
06/02/2022
Estinated Construction Project End Date
11. SIC (Primary) *
Other (9999)
Standard Industrial aassification for Leveloprrent
12. Acres to be
13.00
disturbed*
(including off -site borrow and waste areas)
13. Total site area 14.64
(acres) *

14. Post- 5.69
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-WAKE-2021-Fuller Elementary School
Tracking ID Assigned &Aonaticaly
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 Gatling Branch
Waterbody* %rm of waterbody into which storrrwater runoff will discharge
15b. Waterbody 27-34-9
Index No.* NCWaterbody Index Nunber
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. ^
Fl rnittee 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 Pesponsible Entity
Name * Wake County Board of Education
It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
Note: The organization name must match the business entity name registered with the NC Secretary of State. You can
verify the registration here.
2. First Name * William
IF Corporation, enter Faegistered Agent First %rre
3. Last Name* Hartley
It Corporation, enter F;bgistered Agent Last %rre
3b. Title Director, Project Management, WCPSS
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-588-3577
Telephone No.*
6. Permittee Mailing Street Address
Address* 5625 Dillard Drive
Address Line 2
Crossroads Building 1
City State / Frovince / Fbgion
Cary NC
Fbstal / Zip Code Country
27518-9226 us
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
5625 Dillard Drive
Address Line 2
Crossroads Building 1
City
State / Frovince / Faegion
Cary
NC
Fbstal / Zip Code
Country
27518-9226
us
8. Type of
Government - County
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Jason
Contact - First
Name *
2. Primary Site
Reynolds
Contact - Last
Name *
3. Title
Senior Project Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
919-588-3581
Telephone No.
6. Organization
WCPSS FD&C
Name
7. Site Contact
Street Address
Mailing Address*
111 Corning Road
Address Line 2
Suite 190
city
Cary
Fbstal / Zip Code
27518
8. Consultant Name
(Optional)
Keith Downing
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
919-319-6716
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 09/04/2020
Approved *
2. E&SC Plan Project WAKE-2021-012
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-2021-012_20200904_LOA.pdf 66.01KB
Approval letter or
Mast beRDFformat
Grading Permit
6. Site Location Map
Helpful for linear project review
(Optional)
Mast be FCFfornat. Rease do not upload entire set of E&SCplans.
7. Notes (Optional)
Frovide 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
17-142 NCG01-eNO1-Certification-Form-20190919-
Form
242.18KB
DEMLR-SW SIGNED.pdf
Mast be FCFformat
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 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 Amide 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
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 * William Hartley
Title Director, Project Management, WCPSS, for and on behalf of the
Wake County Board of Education pursuant to duly delegated
authority
Organization Legally Pesponsible Entity
Wake County Board of Education
Date * 09/14/2020

F. Tracking and COC Info
NOI Tracking No. 31395
NC Reference No.
NCG01-2020-4072
Uses 'count_nunber' variable (increrrented by SP)
Certificate of
NCC204072
Coverage (COC)
Uses 'count nurrber' variable (increrrented by SP)
No.*
Count Number 4072
Sequential nunber for subnittal that is incremented by Stored Frocedure
COC Year 2020
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)
Initial Invoice No. NCC204072-2020
Invoice Due Date 10/17/2020
Initial Fee $ 100.00
Invoice Status OPEN