NCC210291_NOI Application_20210209

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/15/2021 8:45:20 AM (NCG01 NOI Submission)
Approve by Garcia, Lauren V 1/15/2021 5:00:32 PM (Review- Construction NOI 41148)
• The task was assigned to Garcia, Lauren V by round robin distribution 1/15/2021 8:46 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 19, 2021 5:00
PM 1/15/2021 8:46 AM
Submit by Selkane, Aziza 2/9/2021 8:49:23 AM (Payment Verification for NCC210291)
* Jeremy Gupton
• Selkane, Aziza assigned the task to Selkane, Aziza 2/9/2021 8:48 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: February 26, 2021 5:00
PM 1/15/2021 5:01 PM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting
F No
an NOI that was
r Yes
rejected before?
1a. Project Name *
Fiesta -Featherstone -Whittier Sidewalk Improvement Project
1 b. Specific Lot
This field rray be used to list specifc lot numbers.
Numbers

1 c. Parcel ID List all RIBS associated w ith this project.
Number(s) (PIN) Featherstone
1707492629
1707493638
1707495689
1707495700
1707496665
1707497598
1707497632
1707498564
1707499439
1707585861
1707588524
1707589480
1707590296
1707590365
1707590424
1707592057
1707680326
1707681209
Whittier
1706597114
1706598300
1706599308
1706599399
1706690379
1706691460
1706692446
1706693601
1706693712
Fiesta Way
1717189968
1717189983
1717192923
1717193891
1717193920
1717194675
1717195465
1717195514
1717196315
1717197231
1717198124
1717198180
1717199036
1718102037
1718102125
1718102226
2. County* Wake
3. Highway or Street Fiesta Way, Featherstone Drive, and Whittier Drive
Address *
Street narre only is acceptable if no address nun ber assigned yet
4. City or Township*
Raleigh
5. State *
NC
6. Zip Code*
27509

7. Latitude * Enter the latitude in decimal degrees
35.8638
8. Longitude* Enter the longitude in decimal degrees (MJSTbe negative)
-78.6425
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*
03/01/2021
Estimated Construction Project Start Date
10. Date to End*
01/01/2022
Estimated Construction Project End Date
11. SIC (Primary)*
Other (9999)
Standard Industrial aassification for Ceveloprrent
12. Acres to be
2.14
disturbed*
(including off -site borrow and waste areas)
13. Total site area 6.40
(acres) *
14. Post- 4.56
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-WAKE-2021-Fiesta-Featherstone-Whittier Sidewalk
Tracking ID Improvement Project
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 Mine Creek
Waterbody* Narreof waterbody into which stormwater runoff will discharge
15b. Waterbody 27-33-14
Index No. * NCWaterbody Index Number
Stormwater F No
discharges will flow 17 Yes
to additional
wate rs *
15c. Additional Crabtree Creek
Receiving Waterbody narre
Waterbody
15d. Waterbody 27-33-(10)
Index No. NCWaterbody Index Number
15e. Additional Perry Creek
Receiving Waterbody narre
Waterbody

15f. Waterbody
Index No.
27-25-(1)
NC Waterbody Index Narrber
16a. Is this project
subject to the NC
Sediment Pollution
Control Act?*
r Yes
r No, not subject to NC SPCA

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 Responsible Entity
Name * City of Raleigh - Engineering Services, Roadway Design and
Construction Division
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 * Benjamin
IF Corporation, enter Registered Agent First %rre
3. Last Name* Possiel
IF Corporation, enter F;bgistered Agent Last %ne
3b. Title Senior Engineer
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-996-4057
Telephone No.*
6. Permittee Mailing Street Address
Address* 222 West Hargett Street
Address Line 2
City
Raleigh
Fbstal / Zip Code
27601
Check box if the V Yes
street address the
same as mailing
address
State / Ffovince / Fbgion
NC
Country
us
7. Permittee Street
Street Address
Address*
222 West Hargett Street
Address Line 2
City
State / Ftovince / Region
Raleigh
NC
Fbstal / Zip Code
Country
27601
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
Brian
Contact - First
Name *
2. Primary Site
Roth-Roffy
Contact - Last
Name *
3. Title
Senior Engineer
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
314-596-7360
Telephone No.
6. Organization
City of Raleigh
Name
7. Site Contact
Street Address
Mailing Address*
222 West Hargett Street
Address Line 2
city
Raleigh
Fbstal / Zip Code
27601
8. Consultant Name
(Optional)
First and Last nacre
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 a-rrail
12. Billing
(For Annual Fee correspondence)
Telephone
919-996-4057
Default is legally responsible person telephone
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 10/09/2020
Approved *
2. E&SC Plan Project WAKE-2020-055
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-2020-055_20201009_LOA.pdf 258.15KB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Wst be RDFforrret (lint 20 NB)
Vicinity Map For COC.pdf 1.3MB
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.
This project is a combination of 3 sidewalk street projects on Fiesta
Way, Featherstone Drive, and Whittier Drive.
8. NOI Certification NOI - Fiesta Featherstone Whittier.pdf 49.33KB
Form Mist be RFformat
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 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 Legally Responsible Person named on this Notice of Intent
r 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* Richard Kelly
Title Engineering Services Director
Organization Legally Responsible Entity
City of Raleigh
Date * 01/15/2021

F. Tracking and COC Info
NOI Tracking No. 41148
NC Reference No. NCG01-2021-0291
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of NCC210291
Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 291
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. NCC210291-2021
Invoice Due Date 2/14/2021
Initial Fee $ 100.00
Invoice Status OPEN