NCC215038_NOI Application_20210908

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 9/3/2021 5:54:50 PM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 9/7/2021 7:51:41 AM (Review- Construction NOI 64176)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 9/3/2021 5:57 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 7, 2021 5:00
PM 9/3/2021 5:57 PM
Submit by Miller, Ariyelle L 9/8/2021 12:38:20 PM (Payment Verification for NCC215038)
* Charles E Shue
• Miller, Ariyelle L assigned the task to Miller, Ariyelle L 9/8/2021 12:37 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 19, 2021 5:00 PM
9/7/2021 7:52 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 * Little Hope Creek Sanitary Sewer Improvements - Phase 3
1 b. Specific Lot This field rray be used to list specifc lot nunbers.
Numbers
1 c. Parcel ID List all Rios associated w ith this project.
Number(s) (PIN) 17111810
17111808
17111809
17111701
17111721
17111720
17111719
17112164
17112132
17112167
17112127
17112152
17112143
17112146
17111630
17112148
17112128
17112129
17112147
17112149
17112131
17112153
17112151
17112150
17112142
17111715
17112130
17111714
17111804
17111811
17111803
17111812
17111802
17111813

It -I -I -IOU
17109159
17109110
17109160
17109161
17109162
17109105
17109104
17109103
17109102
17108410
17108409
17108408
17108407
17108406
17108405
17108415
17108421
17108422
17108401
17103239
17103240
17103402
14917106
14916320
14917104
14916308
14916307
14916306
14917102
14917109
14917108
14917107
14916107
14916108
14916109
14911526
14911525
14911524
14911523
17102246
17102247
17102249
17102250
17102251
17102252
17102253
17102254
17102255
17102256
17102257
17102217
17102216
17102215
17102214
17102213
17102212
17102211
17102210
17102209
17102208
171nggnF

17102202
17101144
17101145
17101178
17101177
17101176
17101175
17101174
17101123
17101122
17101173
17101172
17101170
17101169
17101168
17101155
17101113
17101112
17105325
17105303
17105304
17105305
17105261
17105259
17105262
17105263
17105264
17105203
2. County* Mecklenburg
3. Highway or Street Seneca PI, Mockingbird Ln, Montford Dr
Address* Street name only is acceptable if no address nunber assigned yet
4. City or Township* Charlotte
5. State *
NC
6. Zip Code*
28209
7. Latitude*
Enter the latitude in decirral degrees
35.1669
8. Longitude *
Enter the longitude in decinal degrees (M-IST be negative)
-80.8550
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*
01/02/2023
Estinated Construction Project Start Date
10. Date to End *
01 /02/2024
Estinated Construction Project End Cate
11. SIC (Primary)*
Other (9999)
Standard Industrial aassification for Development
12. Acres to be
13.00
disturbed*
(including off -site borrow and waste areas)

13. Total site area 13.00
(acres) *
14. Post- 0.00
construction (Estirreted)
impervious area
(acres) *
Project Tracking ID NCC-MECKL-2023-Little Hope Creek Sanitary Sewer Improvements
- Phase 3
Assigned autocratically (not used)
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* f\brre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 11-137-8-3
Index No. * NCWaterbody Index Nurrber
Stormwater P 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
USA
State / Frovince / Region
NC
Country
USA
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
7045108429
Telephone No.
6. Organization
Black & Veatch
Name
7. Site Contact
Street Address
Mailing Address*
10925 David Taylor Drive, Suite 280
Address Line 2
city
Charlotte
Fbstal / Zip Code
28262
8. Consultant Name
(Optional)
Chuck Shue
First and Last narre
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)
[e-mail]
Default is legally responsible person e-rrail
12. Billing
(For Annual Fee correspondence)
Telephone
7045108452
Default is legally responsible person telephone
State / Rovince / Region
NC
Country
United States

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 05/07/2021
Approved *
2. E&SC Plan Project MECKL-2021-063
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 cwilson_5-19-2021_10-20-04_2.pdf 1.48MB
Approval letter or MStbeRDFformat
Grading Permit
6. Site Location Map Wst be RDFforrret (lint 20 NB)
4B - LHC Phase 3_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.
Phases 1 and 2 of this project have been permitted separately.
8. NOI Certification NCG01-eNO1-Little Hope Creek Phase 3.pdf 832.44KB
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 * 09/03/2021

F. Tracking and COC Info
NOI Tracking No. 64176
NC Reference No.
NCG01-2021-5038
Uses 'count_nunber' variable (increrrented by SP)
Certificate of
NCC215038
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5038
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. NCC215038-2021
Invoice Due Date 10/7/2021
Initial Fee $ 100.00
Invoice Status OPEN