NCC204871_NOI Application_20201215

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/26/2020 10:41:28 AM (NCG01 NOI Submission)
Approve by Garcia, Lauren V 10/28/2020 10:21:52 AM (Review- Construction NOI 33976)
• The task was assigned to Garcia, Lauren V by round robin distribution 10/26/2020 10:41 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 28, 2020 5:00
PM 10/26/2020 10:41 AM
Submit by Selkane, Aziza 12/15/2020 12:23:44 PM (Payment Verification for NCC204871)
* Stephen Miller
• Selkane, Aziza assigned the task to Selkane, Aziza 12/15/2020 12:22 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: December 9, 2020 5:00
PM 10/28/2020 10:22 AM

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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 * Smithfield Way West Gravity Sewer Extension
1 b. Specific Lot This field may be used to list specifc lot numbers.
Numbers PIN Numbers:
359502766695
359502863864
359502867032
450501056447
1 c. Parcel ID List all Rim associated w ith this project.
Number(s) (PIN)
2. County* Lenoir
3. Highway or Street 1447 Enterprise Blvd.
Address* Street name only is acceptable if no address number assigned yet
4. City or Township* Kinston
5. State * NC
6. Zip Code* 28504
7. Latitude* Enter the latitude in decimal degrees
35.2708
8. Longitude * Enter the longitude in decimal degrees (MBTbe negative)
-77.6694
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* 12/01/2020
Estimated Construction Project Start Date
10. Date to End* 07/01/2021
Estimated Construction Project End Date
11. SIC (Primary) * Other (9999)
Standard Industrial C]assification for Development

12. Acres to be 1.58
disturbed* (including off -site borrow and waste areas)
13. Total site area 1.58
(acres) *
14. Post- 0.00
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-LENOI-2020-Smithfield Way West Gravity Sewer Extension
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 Falling Creek
Wate rbody* %rre of waterbody into which stormwater runoff will discharge
15b. Waterbody 27-77
Index No.* NCWaterbody Index Number
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. ^
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 * City of Kinston
IF 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 * Tony
IF Corporation, enter Faegistered Agent First %rre
3. Last Name* Sears
IF Corporation, enter F;bgistered Agent Last %rre
3b. Title Kinston City Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 252-939-3111
Telephone No.*
6. Permittee Mailing Street Address
Address* PO Box339
Address Line 2
aty
Kinston
Fbstal / Zip Code
28502
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
F Yes
Street Address
207 E King Street
Address Line 2
city
Kinston
Fbstal / Zip Code
28501
State / Ffovince / Fbgion
NC
Country
Lenoir
State / Frovince / Region
NC
Country
united states
8. Type of Ownership is only individual if an individual is naned in B.1. above.
Ownership* Government- Municipal

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Steve
Contact - First
Name *
2. Primary Site
Miller
Contact - Last
Name *
3. Title
Public Services Director
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
252-939-3237
Telephone No.
6. Organization
City of Kinston
Name
7. Site Contact
Street Address
Mailing Address*
PO Box339
Address Line 2
city
Kinston
Fbstal / Zip Code
28502
8. Consultant Name
(Optional)
WithersRavenel
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
336-605-3009
Telephone No.
State / Rovince / Region
NC
Country
Lenoir

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 10/08/2020
Approved *
2. E&SC Plan Project Lenoi-2020-006
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 * Washington (WaRO)
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
Lenoi-2020-006 Smithfield Way West Gravity Sewer
Approval letter or
816.05KB
Extension (REV) - 10082.... pdf
Grading Permit
Mist be FDFfon-rat
6. Site Location Map
Mist be RDFforrret (lint 201VB)
2019.12.30 - Aerial.pdf 2.6MB
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 docurrents support
the application. Include additional waterbodies for linear projects if necessary.
See the attached approval letter issued by Mr. Samir Dumpor and
Mr. Randall Jones of the NCDEQ Washington regional office. Note
that after the first application submittal for this project, a letter of
disapproval was issued due to unpermitted impacts to jurisdictional
ditches requiring 404/401 permitting. Since then, 404/401
permitting was received from USACE and NCDEQ DWR, after which
the letter of approval was issued.
Also see the attached aerial map showing the project site in
Kinston, NC and e-NOI certification form executed by the City of
Kinston.
8. NOI Certification NCG01-eNO1-Certification-Form-20190915-DEMLR-
Form 1.83MB
SW - Executed.pdf
Mast be FCFfon-rat
This is an Express r 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 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 Legally Responsible Person named on this Notice of Intent
f Authorized Responsible Person* (signing on behalf of Legally Responsible
Person named in Part B)
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
f�6��tt��/Tfvf
Type Name* Tony Sears
Title City Manager
Organization Legally Responsible Entity
City of Kinston
Date * 10/26/2020

F. Tracking and COC Info
NOI Tracking No. 33976
NC Reference No. NCG01-2020-4871
Uses 'count_nunber' variable (increrrented by SP)
Certificate of NCC204871
Coverage (COC) Uses 'count nurrber' variable (increrrented by SP)
No.*
Count Number 4871
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. NCC204871-2020
Invoice Due Date 11/27/2020
Initial Fee $ 100.00
Invoice Status OPEN