NCC211420_NOI Application_20210311

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 3/8/2021 11:46:37 AM (NCG01 NOI Submission)
Approve by Meloy, Michael 3/10/2021 8:18:55 AM (Review- Construction NOI 47387)
• The task was assigned to Meloy, Michael by round robin distribution 3/8/2021 11:47 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 10, 2021 5:00
PM 3/8/2021 11:47 AM
Submit by Selkane, Aziza 3/11/2021 10:31:32 AM (Payment Verification for NCC211420)
* Roy Lynch
• Selkane, Aziza assigned the task to Selkane, Aziza 3/11/2021 10:30 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: April 21, 2021 5:00 PM
3/10/2021 8:19 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 *
Siler City Municipal Airport -Obstruction Clearing
1 b. Specific Lot
This field rray be used to list specffc lot numbers.
Numbers
1 c. Parcel ID List all Rios associated w ith this project.
Number(s) (PIN) 0067144, 0013352, 0013353, 0089249, 0089248, 0013354
2. County* Chatham
3. Highway or Street Aviation Drive
Address* Street name only is acceptable if no address number assigned yet
4. City or Township* Siler City
5. State * NC
6. Zip Code* 27344
7. Latitude* Enter the latitude in decimal degrees
35.6963
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-79.5107
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 Rate
10. Date to End *
04/30/2021
Estinated Construction Project End Date
11. SIC (Primary)*
Commercial (1542)
Standard Industrial aassification for Development
12. Acres to be
5.50
disturbed*
(including off -site borrow and waste areas)

13. Total site area 5.50
(acres) *
14. Post- 0.00
construction (Estinated)
impervious area
(acres) *
NCC Project NCC-CHATH-2021-Siler City Municipal Airport -Obstruction Clearing
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 Little Brush Creek
Waterbody* Narreof waterbody into which stornwater runoff will discharge
15b. Waterbody 17-23-2
Index No. * NCWaterbody Index Nunber
Stormwater F No
discharges will flow 17 Yes
to additional
wate rs *
15c. Additional Blood Run Creek
Receiving Waterbody narre
Waterbody
15d. Waterbody 17-23-1
Index No. NC Waterbody Index Nmber
15e. Additional Waterbody name
Receiving
Waterbody
15f. Waterbody NCWaterbody Index Narrber
Index No.
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.
R;rmttee Inforrration - Legally Fbsponsible Entity and Individual
...........................................................................................................................................................
Important: The person vvho 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 ovvns 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 PesponsibleEntity
Name * Town of Siler City
If pernittee is an individual (i.e., organization does not apply), enter first and last nave 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 * Roy
If Corporation, enter Faegistered Agent First None
3. Last Name* Lynch
If Corporation, enter Fbgistered Agent Last I\bne
3b. Title Town Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-742-4731
Telephone No.*
6. Permittee Mailing Street Address
Address* P. O. Box769
Address Line 2
311 N. Second Avenue
City
Siler City
Fbstal / Zip Code
27344
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address *
R Yes
Street Address
P. O. Box 769
Address Line 2
311 N. Second Avenue
city
Siler City
Postal / Zip Code
27344
State / Province / Fbgion
NC
Country
us
State / Province / Faegion
NC
Country
us
8. Type of Ojvnership is only individual if an individual is named in B.1. above.
Ownership* Government -Municipal

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Roy
Contact - First
Name *
2. Primary Site
Lynch
Contact - Last
Name *
3. Title
Town Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
9197424731
Telephone No.
6. Organization
Town of Siler City
Name
7. Site Contact
Street Address
Mailing Address*
P. O. Box769
Address Line 2
311 N. Second Avenue
City
Siler City
Postal / Zip Code
27344
8. Consultant Name
(Optional)
Benjamin Bothell
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
7249192683
Telephone No.
11. Billing E-mail
(For Annual Fee correspondence)
[e-mail]
Default is legally responsible person e-rrail
12. Billing
(For Annual Fee correspondence)
Telephone
919-742-4731
Default is legally responsible person telephone
State / Rovince / Region
North Carolina
Country
United States

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................................................................................................__
1. Date E&SC Plan 03/05/2021
Approved *
2. E&SC Plan Project CHATF-1-2021-010
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 CHATH-2021-010_20210305_LOA.pdf 266.46KB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Mist be RDFformat (lint 20 NB)
2 USGS MAP.pdf 10.45MB
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.
8. NOI Certification NCG01 NOI Notice of Intent for Obstruction Clearing
Form 794.04KB
- Town of Siler City.pdf
Mast be FDFfon-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:* 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 * Roy Lynch
Title Town Manager
Organization Legally Plesponsible Entity
Town of Siler City
Date * 03/08/2021

F. Tracking and COC Info
NOI Tracking No. 47387
NC Reference No.
NCG01-2021-1420
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC211420
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 1420
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. NCC211420-2021
Invoice Due Date 4/9/2021
Initial Fee $ 100.00
Invoice Status OPEN