NCC191732_NOI Application_20190912

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/5/2019 9:56:51 AM (NCG01 NOI Submission)
Approve by Garcia, Lauren V 9/5/2019 11:14:11 AM (Review- Construction NOI 15583)
• The task was assigned to Garcia, Lauren V by round robin distribution 9/5/2019 9:57 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 9, 2019 5:00
PM 9/5/2019 9:57 AM
Submit by McCoy, Suzanne 9/12/2019 11:27:29 AM (Payment Verification for NCC191732)
* Margo Tauzel
• McCoy, Suzanne assigned the task to McCoy, Suzanne 9/12/2019 11:26 AM
• Georgoulias, Bethany changed the task's due date to October 5, 2019 5:00 PM 9/5/2019 12:56 PM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 17, 2019 5:00 PM
9/5/2019 11:14 AM

STME
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1. Project Name * Gastonia FUSE Complex
2. County* Gaston
3. Highway or Street Franklin Blvd.
Address * Street name only is acceptable if no address nurrtrer assigned yet
4. City or Township* Gastonia
5. State * NC
1r-i)iTII1T7i1)MFill f_TiIa10141
6. Zip Code* 28053
7. Latitude * Enter the latitude in decirral degrees
35.2635
8. Longitude * Enter the longitude in decirral degrees (MIST be negative)
-81.1940
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* 09/23/2019
Estimated Construction Project Start Date
10. Date to End* 03/31 /2021
Estimated Construction Project End Date
11. SIC (Primary)* Commercial (1542)
Standard Industrial aassification for Development
12. Acres to be 10.10
disturbed* (including off -site borrow and waste areas)
13. Total site area
10.10
(acres)*
14. Post-
5.55
construction
(Estimated)
impervious area
(acres) *
NCC Project
NCC-GASTO-2019-Gastonia FUSE Complex
Tracking ID
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. You may
enter up to 3 waterbodies.
15a. Receiving Catawba Creek
Waterbody * Nacre of waterbody into which stormuater runoff will discharge
15b. Waterbody 11-130
Index No. * NCWaterbody Index Nunber
Stormwater r No
discharges will flow rj Yes
to additional
wate rs *
15c. Additional Catawba River / Lake Wylie
Receiving Waterbody nacre
Waterbody
15d. Waterbody 00-(123.5)
Index No. NCWaterbody Index Ninber
15e. Additional Waterbody narre
Receiving
Waterbody
15f. Waterbody NCWaterbody Index Nunter
Index No.
16a. Is this project r Yes
subject to the NC f No, not subject to NC SPCA
Sediment Pollution
Control Act?*

B. Permittee Information
Part B.
Perrrittee Information - Legally Responsible Entity and Individual
.....................................................................................................................................................................
h
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 City of Gastonia
Name *
2. First Name* V. Todd
ff Corporation, enter Registered Agent First l\b e
3. Last Name * Carpenter
ff Corporation, enter Registered Agent Last Barre
3b. Title Deputy City Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 704-866-6719
Telephone No.*
6. Permittee Mailing Street Address
Address * Post Office Box 1748
Address Line 2
City
Gastonia
Postal / Zip Code
28053
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
r Yes
Street Address
186 W. Franklin Blvd.
Address Line 2
City
Gastonia
Fbstal / Zip Code
28052
State / Province / Region
NC
Country
USA
State / Province / Region
NC
Country
USA

C. Site Contact Information
Part C.
Proiect Site Contact hforrration
1. Type of Government - Municipal
Ownership*
2. Primary Site Philip
Contact - First
Name *
3. Primary Site Bombardier
Contact - Last
Name *
4. Title Special Projects Advisor
5. Site Contact E-
[e-mail]
mail Address*
6. Site Contact
704-214-9137
Telephone No.*
7. Organization
City of Gastonia
Name
8. Site Contact
Street Address
Mailing Address*
Post Office Box 1748
Address Line 2
City
Gastonia
Pbstal / Zip Code
28053
9. Consultant Name (optional)
Jonathan Cole
First and Last narre
10. Consultant E- [e-mail]
mail This person will be copied on all correspondence.
11.Consultant 816-335-3030
Telephone No.
State / Province / Region
NC
Country
USA

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 05/23/2019
Approved *
2. E&SC Plan Project GASTO-2019-018
Number/ID* Assigned by agency or local program
3. E&SC Plan f• 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.
5. E&SC Plan FUSE S and EC App LETTER 9 5 19.pdf 496.12KB
Approval Mist be FDFfornat
letter/documentation
6. NOI Certification NOI Cert Form FUSE 9 5 19.pdf 288.15KB
Form Mist be RDFformat
This is an Express f• No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.613 (1) provides that:
Anyperson who knowinglymakes any false statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained under this Article or a rule implementing this Article; or who knowinglymakes a false statement
of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring deice or method required to be operated or maintained under this Article or rules of the
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine not to exceed ten thousand
dollars ($10,000).
Under penalty of law, I certify that:
rJ 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.
* I7 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 Responsible Person named on this Notice of Intent
r Authorized Responsible Person*
Important: The person who signs this Certification above and signs the NOI Certification Form should be the same
person (or authorized responsible person within the same organization) as listed in Section B (Permittee Information)
of this form. *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 *
V. Todd Carpenter
Title
Deputy City Manager
Organization
City of Gastonia
Date *
09/05/2019

F. Tracking and COC Info
NOI Tracking No. 15583
NC Reference No. NCG01-2019-1732
Uses 'count number variable (incremrented by SP)
Certificate of NCC191732
Coverage (COC) Uses'count_nunber'variable (incremrented by SF)
No. *
Count Number 1732
Sequential nunber for subrrittal that is incremented by Stored Procedure
COC Year 2019
Year of date reviewed (used to assign YY digits after "NGC' in OOCno.)