NCC210174_NOI Application_20210113

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/11/2021 10:11:27 AM (NCG01 NOI Submission)
Approve by Meloy, Michael 1/11/2021 10:54:51 AM (Review- Construction NOI 40816)
• The task was assigned to Meloy, Michael by round robin distribution 1/11/2021 10:13 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 13, 2021 5:00
PM 1/11/2021 10:13 AM
Submit by Selkane, Aziza 1/13/2021 8:05:53 AM (Payment Verification for NCC210174)
* Charles E Shue
• Selkane, Aziza assigned the task to Selkane, Aziza 1/13/2021 8:04 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: February 22, 2021 5:00
PM 1/11/2021 10:55 AM

.• SThF� ';
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 * Little Hope Creek Sanitary Sewer Improvements - Phase 2
1 b. Specific Lot This field may be used to list specifc lot nunbers.
Numbers 17109124
17109120
17109119
17109118
17109117
17109116
17109115
17109114
17109113
17109112
17109159
17108222
17108221
17108220
17108219
17108218
17108217
17108216
17108215
17108214
17108252
17108253
17108201
17104227
17104228
17104229
17104224
17104223
17104222
17104221
17104220
17104236
14920315
14920314
14920313
14920312
14920311

14UZU6]U
14920309
14920308
14920307
14920306
14920305
14920304
14920303
14920302
14920301
14918342
14918329
14918328
14918346
14918347
14918348
14918327
14918326
14918325
14918324
14918323
14918322
14918321
14918320
14918319
14918318
14918317
14918316
14918315
14918313
14918362
14918363
14918364
14918365
14918366
14918367
14921237
14921199
14910615
14910616
14910617
14910618
14910909
14910908
14910907
14910906
14910905
14910904
14910903
14910902
14910901
17109140
17108245
17108246
14918359
14921101
17109127
17109158
14920336
14920371
14920372
1dQ17d7F

14912427
14912428
14912432
14912433
14910619
1 c. Parcel ID List all R% associated w ith this project.
Number(s) (PIN) 17109124
17109120
17109119
17109118
17109117
17109116
17109115
17109114
17109113
17109112
17109159
17108222
17108221
17108220
17108219
17108218
17108217
17108216
17108215
17108214
17108252
17108253
17108201
17104227
17104228
17104229
17104224
17104223
17104222
17104221
17104220
17104236
14920315
14920314
14920313
14920312
14920311
14920310
14920309
14920308
14920307
14920306
14920305
14920304
14920303
14920302
14920301
14918342
14918329
14918328
14918346
14918347
14918348
14918327

14918326
14918325
14918324
14918323
14918322
14918321
14918320
14918319
14918318
14918317
14918316
14918315
14918313
14918362
14918363
14918364
14918365
14918366
14918367
14921237
14921199
14910615
14910616
14910617
14910618
14910909
14910908
14910907
14910906
14910905
14910904
14910903
14910902
14910901
17109140
17108245
17108246
14918359
14921101
17109127
17109158
14920336
14920371
14920372
14912425
14912427
14912428
14912432
14912433
14910619
2. County* Mecklenburg
3. Highway or Street 10925 David Taylor Drive, Suite 280
Address * Street narre only is acceptable if no address nun ber assigned yet
4. City or Township* Charlotte
5. State * NC
6. Zip Code* 28209

7. Latitude* Enter the latitude in decimal degrees
35.1623
8. Longitude * Enter the longitude in decimal degrees (M-ST be negative)
-80.8544
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*
03/15/2021
Estimated Construction Project Start Date
10. Date to End *
03/15/2022
Estimated Construction Project End Cate
11. SIC (Primary)*
Other (9999)
Standard Industrial aassification for Developrnent
12. Acres to be
14.00
disturbed*
(including off -site borrow and waste areas)
13. Total site area 14.00
(acres) *
14. Post- 0.00
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-MECKL-2021-Little Hope Creek Sanitary Sewer Improvements
Tracking ID - Phase 2
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 Little Hope Creek
Wate rbody* %rre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 11-137-8-3
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. ^
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 * City of Charlotte
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 * Joseph
If Corporation, enter Registered Agent First %rre
3. Last Name* Wilson
IF Corporation, enter F;bgistered Agent Last %rre
3b. Title Chief Engineer
4. Permitee E-mail [e-mail]
Address*
5. Permittee 704-336-1083
Telephone No.*
6. Permittee Mailing Street Address
Address* 5100 Brookshire Boulevard
Address Line 2
City
Charlotte
Fbstal / Zip Code
28216-3371
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
5100 Brookshire Boulevard
Address Line 2
city
Charlotte
Fbstal / Zip Code
28216-3371
State / Ffovince / Fbgion
NC
Country
us
State / Frovince / Region
NC
Country
us
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
Grace
Contact - First
Name *
2. Primary Site
Grenfell
Contact - Last
Name *
3. Title
Project Engineer
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
3303229083
Telephone No.
6. Organization
Black & Veatch
Name
7. Site Contact
Street Address
Mailing Address*
10925 David Taylor Drive, Suite 280
Address Line 2
City
State / Rovince / Region
Charlotte
NC
Fbstal / Zip Code
Country
28262
United States
8. Consultant Name
(Optional)
Charles Shue
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
7045108452
Telephone No.
11. Billing E-mail (For Annual Fee correspondence)
Default is legally responsible person e-n-ail (older NOIs rray not populate)
12. Billing (For Annual Fee correspondence)
Telephone Default is legally responsible person telephone (older NOIs rray not populate)

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 07/24/2020
Approved *
2. E&SC Plan Project MECKL-2020-104
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 * Mooresville (MRO)
Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a
complete application. Please also upload a site map showing the overall extent of the project (for linear projects, can
include the beginning point and end point coordinates in the "Notes" box below).
5. E&SC Plan MECKL-2020-104-07232020.pdf 2.09MB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Mist be RDFforrret (lint 20 NB)
4B - LHC Phase 2_Topo Map.pdf 5.7MB
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 if necessary.
Phase 1 and 3 to be permitted separately.
8. NOI Certification NCG01-eNO1-Little Hope Creek Phase 2.pdf 314.25KB
Form Mist be RDFformat
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:* IT 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
psepl if sa
Type Name* Joseph Wilson
Title Chief Engineer
Organization Legally Responsible Entity
City of Charlotte
Date * 01 /11 /2021

F. Tracking and COC Info
NOI Tracking No. 40816
NC Reference No.
NCG01-2021-0174
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC210174
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 174
Sequential nurrber for subrrittal that is incremented by Stored Frocedure
COC Year 2021
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)
Initial Invoice No. NCC210174-2021
Invoice Due Date 2/10/2021
Initial Fee $ 100.00
Invoice Status OPEN