NCC213129_NOI Application_20210601

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 5/20/2021 3:17:34 PM (NCG01 NOI Submission)
Approve by Garcia, Lauren V 5/24/2021 4:58:49 PM (Review- Construction NOI 53283)
. The task was assigned to Garcia, Lauren V by round robin distribution 5/20/2021 3:18 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: May 24, 2021 5:00 PM
5/20/2021 3:18 PM
Submit by Selkane, Aziza 6/1/2021 12:26:54 PM (Payment Verification for NCC213129)
* Chandra Farmer
• Selkane, Aziza assigned the task to Selkane, Aziza 6/1/2021 12:26 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: July 5, 2021 5:00 PM
5/24/2021 4:59 PM

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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 *
Pine Level Sewer Force Main Replacement
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)
262415-53-532, 262414-33-7734, 262415-54-5743, 262400-36-1249, 262414-33-
1316, 262414-23-9465, 262414-23-8043, 262414-23-6066, 262413-23-4088,
262414-23-5593, 262413-23-2163, 262413-23-2784, 262413-13-8973, 262413-
23-1442, 262413-13-9108, 262413-13-4175, 262413-03-9941, 262413-13-0024,
261411-65-5210, 261415-54-1575, 261414-44-1722, 261413-03-6895, 261415-
52-4656, 261414-23-6588, 261413-13-5516, 261413-23-2529, 261413-13-5996,
261413-13-4068, 261413-04-1261, 260416-94-4538, and 260416-94-6909
2. County*
Johnston
3. Highway or Street Pine Level - Micro Road
Address* Street name only is acceptable if no address number assigned yet
4. City or Township* Pine Level/Selma
5. State * NC
6. Zip Code* 27568
7. Latitude* Enter the latitude in decimal degrees
35.5153
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-78.2422
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* 09/01/2021
Estimated Construction Project Start Date
10. Date to End* 03/31/2022
Estinated Construction Project End Date

11. SIC (Primary)* Other (9999)
Standard Industrial aasslfication for Development
12. Acres to be 13.32
disturbed* (including off -site borrow and waste areas)
13. Total site area 13.32
(acres) *
14. Post- 0.00
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-JOHNS-2021-Pine Level Sewer Force Main Replacement
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 Moccasin Creek
Waterbody* %rreof waterbody into which stormwater runoff will discharge
15b. Waterbody 24-53-(0.5)
Index No. * NCWaterbody Index Nurrber
Stormwater F No
discharges will flow 17 Yes
to additional
wate rs *
15c. Additional Bawdy Swamp
Receiving Waterbody narre
Waterbody
15d. Waterbody 27-50-1
Index No. NCWaterbody Index Nunber
15e. Additional Neuse River
Receiving Waterbody narre
Waterbody
15f. Waterbody 27-(50.375)
Index No. NCWaterbody Index Number
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. ^
Fternittee Inforrration - Legally Fa sponsible 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 Pesponsible Entity
Name * Johnston County
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 * Chandra
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Farmer
IF Corporation, enter Pegistered Agent Last %rre
3b. Title Public Utilities Department Director
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-989-5075
Telephone No.*
6. Permittee Mailing Street Address
Address* PO Box2263
Address Line 2
City
State / Ffovince / Fbgion
Smithfield
North Carolina
Fbstal / Zip Code
Country
27577
United States
Check box if the F Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
Land Use Center
Address Line 2
309 E. Market Street
City
State / F rovince / Region
Smithfield
North Carolina
Fbstal / Zip Code
Country
27577
Untied States
8. Type of
ONnership is only individual if an individual is naned in B.1. above.
Ownership*
Government -County

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Chandra
Contact - First
Name *
2. Primary Site
Farmer
Contact - Last
Name *
3. Title
Public Utilities Department Director
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
919-989-5075
Telephone No.
6. Organization
Johnston County
Name
7. Site Contact
Street Address
Mailing Address*
PO Box2263
Address Line 2
city
Smithfield
Fbstal / Zip Code
27577
8. Consultant Name
(Optional)
First and Last narre
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 e-rrail
12. Billing
(For Annual Fee correspondence)
Telephone
919-989-5075
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 05/04/2021
Approved *
2. E&SC Plan Project JOHNS-2021-024
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 JOHNS-2021-024_20210504_LOA.pdf 226.2KB
Approval letter or Mist beRDFforml
Grading Permit
6. Site Location Map Mist be RDFfornat (lint 20 NB)
F-1 USGS Quad Map.pdf 446.93KB
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 PL.NCG01.05.20.21.pdf 847.17KB
Form Wst be RDFfornat
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 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:* 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 * Chandra C. Farmer
Title Public Utilities Department Director
Organization Legally Plesponsible Entity
Johnston County
Date * 05/20/2021

F. Tracking and COC Info
NOI Tracking No. 53283
NC Reference No.
NCG01-2021-3129
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC213129
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 3129
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. NCC213129-2021
Invoice Due Date 6/23/2021
Initial Fee $ 100.00
Invoice Status OPEN