NCC192757_NOI Application_20191118

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 11/12/2019 12:16:16 PM (NCG01 NOI Submission)
Approve by Garcia, Lauren V 11/13/2019 11:14:22 AM (Review- Construction NOI 18331)
• The task was assigned to Garcia, Lauren V by round robin distribution 11/12/2019 12:16 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: November 14, 2019 5:00
PM 11/12/2019 12:16 PM
Submit by McCoy, Suzanne 11/18/2019 7:38:00 AM (Payment Verification for NCC192757)
* Shawntrelle D Kast
• McCoy, Suzanne assigned the task to McCoy, Suzanne 11/18/2019 7:37 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: December 25, 2019 5:00
PM 11/13/2019 11:14 AM

.• SThF� ';
1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name * Repave Range Road South
2. County* Craven
3. Highway or Street Range Road
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* Cherry Point
5. State * NC
6. Zip Code * 28533-0006
7. Latitude * Enter the latitude in decimal degrees
34.9195
8. Longitude* Enter the longitude in decimal degrees (M. ST be negative)
-76.8772
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*
01/06/2020
Estimated Construction Project Start Cate
10. Date to End*
01 /04/2021
Estimated Construction Project End Cute
11. SIC (Primary)*
Industrial (1541)
Standard Industrial Classification for Developrrent
12. Acres to be
3.93
disturbed*
(including off -site borrow and waste areas)
13. Total site area
3.93
(acres) *
14. Post-
0.35
construction
(Estimated)
impervious area
(acres) *
NCC Project
NCC-CRAVE-2020-Repave Range Road South
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 NEUSE
Wate rbody* arm of waterbody into which storrrwater runoff will discharge
15b. Waterbody 27-(104)
Index No.* NCWaterbody Index Nurrber
Stormwater V No
discharges will flow r Yes
to additional
wate rs *
16a. Is this project F 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 WAS Cherry Point
Name *
2. First Name* Charles
If Corporation, enter Pbegistered Agent First Barre
3. Last Name* Schulz
If Corporation, enter Faegistered Agent Last %rre
3b. Title Deputy Facilities Director
4. Permitee E-mail [e-mail]
Address *
5. Permittee 2524663148
Telephone No.*
6. Permittee Mailing Street Address
Address* P.O. Box8006
Address Line 2
city
Cherry Point
Fbstal / Zip Code
28533-0006
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
r Yes
Street Address
Building 1 C Street
Address Line 2
Cty
Cherry Point
Fbstal / Zip Code
28533-0006
State / Frovince / Faegion
NC
Country
United States
State / Frovince / Fbgion
NC
Country
United States

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
........................................................................................................................................................................................................
1. Type of
Government - Federal
Ownership *
2. Primary Site
Nathan
Contact - First
Name *
3. Primary Site
Arnett
Contact - Last
Name *
4. Title
Environmental Engineer
5. Site Contact E-
[e-mail]
mail Address*
6. Site Contact
2524665271
Telephone No.*
7. Organization
WAS Environmental Affairs Department
Name
8. Site Contact
Street Address
Mailing Address*
Building 4223
Address Line 2
City
Cherry Point
Fbstal / Zip Code
28533-0006
9. Consultant Name
(Optional)
First and Last narre
10. Consultant E-
This person will be copied on all correspondence.
mail
11. Consultant
Telephone No.
State / Rovince / Fbgion
NC
Country
United States

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 09/09/2019
Approved *
2. E&SC Plan Project Crave2020-005
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 * Washington (WaRO)
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 ES Permit Repave Range Road.pdf 191.39KB
Approval Wst be RDFfornat
letter/documentation
6. NOI Certification repave range road south NCG01 signed.pdf 35.27KB
Form Mist be R7Ffon-rat
This is an Express F No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.6E (i) 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 Atide 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 Responsible Person named on this Notice of Intent
f Authorized Responsible Person*
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 *
Charles E. Schulz
Title
Deputy Facilities Director By Direction of the Commanding Officer
Organization
MCAS Cherry Point
Date *
11 /12/2019

F. Tracking and COC Info
NOI Tracking No. 18331
NC Reference No. NCG01-2019-2757
Uses 'count number' variable (incremrented by SP)
Certificate of NCC192757
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 2757
Sequential number for submittal that is incremented by Stored Frocedure
COC Year 2019
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)