NCC210380_NOI Application_20210125

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/21/2021 6:00:26 PM (NCG01 NOI Submission)
Approve by Garcia, Lauren V 1/22/2021 8:45:32 AM (Review- Construction NOI 41570)
• The task was assigned to Garcia, Lauren V by round robin distribution 1/21/2021 6:01 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 25, 2021 5:00
PM 1/21/2021 6:01 PM
Submit by Selkane, Aziza 1/25/2021 10:56:22 AM (Payment Verification for NCC210380)
* Timothy Carley
• Selkane, Aziza assigned the task to Selkane, Aziza 1/25/2021 10:55 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: March 5, 2021 5:00 PM
1 /22/2021 8:45 AM

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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 41372
NOI No.
Prior Reviewer Lauren Garcia
Name
1a. Project Name * Brentwood Park Phase 1 Renovations
1 b. Specific Lot This field may be used to list specffc lot numbers.
Numbers
1 c. Parcel ID List all R% associated w ith this project.
Number(s) (PIN) 1715-86-9713
2. County* Wake
3. Highway or Street 3315 Vinson Court
Address* Street name only is acceptable if no address number assigned yet
4. CityorTownship* Raleigh
5. State * NC
6. Zip Code* 27604
7. Latitude* Enter the latitude in decimal degrees
35.8280
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-78.6000
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* 01/25/2021
Estimated Construction Project Start Date
10. Date to End* 10/31/2021
Estimated Construction Project End Date

11. SIC (Primary)* Other (9999)
Standard Industrial aasslfication for Development
12. Acres to be 2.14
disturbed* (including off -site borrow and waste areas)
13. Total site area 18.82
(acres) *
14. Post- 0.82
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-WAKE-2021-Brentwood Park Phase 1 Renovations
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 Marsh creek
Waterbody* Name of waterbody into which stormwater runoff will discharge
15b. Waterbody 27-33-20
Index No. * NCWaterbody Index Nurrber
Stormwater V 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. ^
Fternittee 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 * MLB Construction Services, LLC
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 * Timothy
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Carley
It Corporation, enter F;bgistered Agent Last %rre
3b. Title General Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-387-4647
Telephone No.*
6. Permittee Mailing Street Address
Address* 1930 North Salem Street
Address Line 2
Suite 201
Cihj
Apex
Fbstal / Zip Code
27523-8218
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
F Yes
Street Address
1930 North Salem Street
Address Line 2
Suite 201
city
Apex
Fbstal / Zip Code
27523-8218
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* Non -Government

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
...........................................................................................................................................................................................................................................................................
1. Primary Site
Timothy
Contact - First
Name *
2. Primary Site
Carley
Contact - Last
Name *
3. Title
General Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
919-946-7386
Telephone No.*
6. Organization
MLB Construction Services, LLC
Name
7. Site Contact
Street Address
Mailing Address*
1930 North Salem Street
Address Line 2
Suite 201
City
State / Rovince / Region
Apex
NC
Postal / Zip Code
Country
27523-8218
us
8. Consultant Name
(Optional)
N/A
First and Last narre
9. Consultant E-mail
This person will be copied on all correspondence.
10. Consultant
Telephone No.
11. Billing E-mail (For Annual Fee correspondence)
[e-mail]
Default is legally responsible person e-n-ail (older NOts rray not populate)
12. Billing (For Annual Fee correspondence)
Telephone [phone]
Default is legally responsible person telephone (older NOls rray not populate)

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 04/21/2020
Approved *
2. E&SC Plan Project WAKE-2020-067
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. 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 WAKE-2020-67_ 20200421_LOA_MOD.pdf 80.09KB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Mist be RDFfornat (lint 20 NB)
00 - CS Cover Sheet.pdf 772.93KB
0 - SURVEY. pdf 1.79MB
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 if necessary.
8. NOI Certification NCG01-eNO1-Certification-Form-20201222-DEMLR-
Form SW.pdf 756.84KB
Wst be RDFfornat
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
Type Name * Timothy Carley
Title General Manager
Organization Legally Plesponsible Entity
MLB Construction Services, LLC
Date * 01 /21 /2021

F. Tracking and COC Info
NOI Tracking No. 41570
NC Reference No.
NCG01-2021-0380
Uses 'count_nunber' variable (increrrented by SP)
Certificate of
NCC210380
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 380
Sequential nunber for subnittal 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. NCC210380-2021
Invoice Due Date 2/21/2021
Initial Fee $ 100.00
Invoice Status OPEN