NCC215575_NOI Application_20211012

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/6/2021 8:56:55 AM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 10/6/2021 9:14:57 AM (Review- Construction NOI 68007)
. The task was assigned to Broussard, Brooklyn C by round robin distribution 10/6/2021 8:58 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 8, 2021 5:00
PM 10/6/2021 8:58 AM
Submit by Evans, Shaundra M 10/12/2021 12:30:50 PM (Payment Verification for NCC215575)
* Town of Enfield
• Evans, Shaundra M assigned the task to Evans, Shaundra M 10/12/2021 12:30 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 17, 2021 5:00
PM 10/6/2021 9:15 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 *
Town of Enfield - Phase 5 Water System Improvements
1 b. Specific Lot
This field may be used to list specifc lot numbers.
Numbers
N/A
1 c. Parcel ID List all RED associated w ith this project.
Number(s) (PIN) N/A
2. County* Halifax
3. Highway or Street 121 SE Railroad Street
Address* Street name only is acceptable if no address number assigned yet
4. City or Township* Enfield
5. State * NC
6. Zip Code* 27823
7. Latitude* Enter the latitude in decimal degrees
36.1797
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-77.6642
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*
03/01/2022
Estimated Construction Project Start Rate
10. Date to End*
07/01/2022
Estinated Construction Project End Cate
11. SIC (Primary)*
Residential, Single Family Houses (SFE) (1521)
Standard Industrial Oassification for Development
12. Acres to be
1.50
disturbed*
(including off -site borrow and waste areas)

13. Total site area 1.50
(acres) *
14. Post- 1.50
construction (Estimated)
impervious area
(acres) *
Project Tracking ID NCC-HALIF-2022-Town of Enfield - Phase 5 Water System
Improvements
Assigned automatically (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 Fishing Creek
Waterbody* %rreof waterbody into which stormwater runoff will discharge
15b. Waterbody 28-79-(29)
Index No. * NCWaterbody Index Number
Stormwater r- No
discharges will flow 17 Yes
to additional
wate rs *
15c. Additional Beech Swamp
Receiving Waterbody narre
Waterbody
15d. Waterbody 28-79-30
Index No. NCWaterbody Index Number
15e. Additional Waterbody name
Receiving
Waterbody
15f. Waterbody NCWaterbody Index Number
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.
F2rnittee 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 must 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. Permittee * Legally Pesponsible Entity
Town of Enfield
IF pernittee is an individual, enter first and last narre in this field. otherwise, enter organization/business narre.
Note: If the permittee is a business, the business must be registered with the NC Secretary of State. You can verify the
registration here.
2. First Name * Wayne
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Anderson
IF Corporation, enter F;bgistered Agent Last %rre
3b. Title Mayor
4. Permitee E-mail [e-mail]
Address*
5. Permittee 2524453146
Telephone No.*
6. Permittee Mailing Street Address
Address* 121 Southeast Railroad Street
Address Line 2
City
Enfield
Fbstal / Zip Code
27823
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
121 Southeast Railroad Street
Address Line 2
City
Enfield
Fbstal / Zip Code
27823
State / Ffovince / i egion
NC
Country
us
State / Frovince / Region
NC
Country
us
8. Type of Ojvnership 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
Wayne
Contact - First
Name *
2. Primary Site
Anderson
Contact - Last
Name *
3. Title
Mayor
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
2524453146
Telephone No.
6. Organization
Town of Enfield
Name
7. Site Contact
Street Address
Mailing Address*
121 Southeast Railroad Street
Address Line 2
City
Enfield
Fbstal / Zip Code
27823-0699
8. Consultant Name
(Optional)
Todd Steele (Engineering Services, P.A.)
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
9196627272
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
2524453146
Default is legally responsible person telephone
State / Rovince / Region
NC
Country
us

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 10/03/2021
Approved *
2. E&SC Plan Project HALIF-2022-001
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 20211005102408.pdf 213.71KB
Approval letter or Mast beRDFforml
Grading Permit
6. Signed FRO Financial Pesponsibility/Ojvnership Form
20211005092908. pdf 128.07KB
Mist be RDFfornal
7. Site Location Map Mast be RDFforrrat (lirrit 20IVB)
20211005092934. pdf 271.44KB
Rease do not upload entire set of E&SC plans.
8. Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded documents support
the application. Include additional w aterbodies if necessary.
9. NOI Certification 20211006075541.pdf 85.53KB
Form Mast be R7Ffon-rat
This is an Express F 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 * Wayne Anderson
Title Mayor
Organization Legally Responsible Entity
Town of Enfield
Date * 10/06/2021

F. Tracking and COC Info
NOI Tracking No. 68007
NC Reference No.
NCG01-2021-5575
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC215575
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5575
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. NCC215575-2021
Invoice Due Date 11/5/2021
Initial Fee $ 100.00
Invoice Status OPEN