NCC205018_NOI Application_20201104

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 11/2/2020 3:48:03 PM (NCG01 NOI Submission)
Approve by Gamble, Aana C 11/3/2020 2:53:57 PM (Review- Construction NOI 34731)
• Garcia, Lauren V reassigned the task to Gamble, Aana C 11/3/2020 2:50 PM
* hey there!
• The task was assigned to Garcia, Lauren V by round robin distribution 11/2/2020 3:48 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: November 4, 2020 5:00
PM 11/2/2020 3:48 PM
Submit by Selkane, Aziza 11/4/2020 8:03:54 AM (Payment Verification for NCC205018)
* Town of Youngs0le
• Selkane, Aziza assigned the task to Selkane, Aziza 11/4/2020 8:02 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: December 15, 2020 5:00
PM 11/3/2020 2:54 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 34624
NOI No.
Prior Reviewer Aana Gamble
Name
1a. Project Name * Youngsville Public Works Facility
1 b. Specific Lot This field may be used to list specffc lot numbers.
Numbers
2. County* Franklin
3. Highway or Street 427 South College Street
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* Youngsville
5. State * NC
6. Zip Code * 27596
7. Latitude * Enter the latitude in decirral degrees
36.0190
8. Longitude* Enter the longitude in decir al degrees (M. ST be negative)
-78.4790
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* 11/02/2020
Estimated Construction Project Start Date
10. Date to End* 05/28/2021
Estimated Construction Project End Date
11. SIC (Primary)* Commercial (1542)
Standard Industrial aassification for Developrrent

12. Acres to be 1.22
disturbed* (including off -site borrow and waste areas)
13. Total site area 3.04
(acres) *
14. Post- 0.66
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-F RANK-2020-You ngsvi Ile Public Works Facility
Tracking ID Assignedautonatically
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 Hattles Branch
Wate rbody* %rre of waterbody into which stornwater runoff will discharge
15b. Waterbody 27-21-1
Index No.* NCWaterbody Index Nurrber
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 Legally Pesponsible Entity
Name * Town of Youngsville NC
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 * Phillip
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Cordeiro
It Corporation, enter Registered Agent Last %rre
3b. Title Town Administrator
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-925-3399
Telephone No.*
6. Permittee Mailing Street Address
Address* PO Box 190
Address Line 2
City
Youngsville
Fbstal / Zip Code
27596
Check box if the F Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 134 US 1A South
Address Line 2
State / Frovince / Fbgion
NC
Country
US
aty State / Frovince / Region
Raleigh North Carolina
Fbstal / Zip Code Country
27607 United States
8. Type of Government - Municipal
Ownership *

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Heath
Contact - First
Name *
2. Primary Site
Marks
Contact - Last
Name *
3. Title
Project Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
9194277812
Telephone No.
6. Organization
Bobbitt Construction, Inc.
Name
7. Site Contact
Street Address
Mailing Address*
600 Germantown Rd.
Address Line 2
city
Raleigh
Fbstal / Zip Code
27607
8. Consultant Name
(Optional)
Sam Nye
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
9198354787
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 08/20/2020
Approved *
2. E&SC Plan Project FRANK-2021-002
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 FRANK-2021-002_20200820_LOA.pdf 323.79KB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Helpful for linear project review
(Optional) YPUB_SITE001_ Cover_10052020.pdf 497.6KB
YPUB_SITE302_Erosion Control_10052020.pdf 1.08MB
Mast be R7F format. Rease do not upload entire set of E&SC plans.
7. 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.
8. NOI Certification NCG01-eNO1=Certification-Form Signed.pdf 681.83KB
Form Mast be R7Ffon-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 * Phillip Cordeiro
Title Town Administrator
Organization Legally Responsible Entity
Town of Youngsville NC
Date * 11/02/2020

F. Tracking and COC Info
NOI Tracking No. 34731
NC Reference No.
NCG01-2020-5018
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC205018
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5018
Sequential nurrber for subrrittal 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. NCC205018-2020
Invoice Due Date 12/3/2020
Initial Fee $ 100.00
Invoice Status OPEN