NCC191459_NOI Signed Certification_20190819

NCG01 Notice of Intent (NOI) Certification Form
Directions:
Print this form, complete, scan and upload to the electronic NOL
Then, mail the original form tothe NC DEMLR Stormwater Program (with $100 check if paying by check) at.
Division of Energy, Mineral & Land Resources Stormwater Program
512 N. Salisbury Street, 6t" Floor
1612 Mail Service Center
Raleigh, NC 27699-1612
Per NC General Statute 143-215.6E (i), any person who knowingly makes any false 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 ... shall be guilty of a Class 2 misdemeanor which may
include a fine not to exceed ten thousand dollars ($10,000).
Under enalty of law, I certify that (check all boxes to indicate your agreement):
l 1 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.
al/ 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
E�3/directly responsible for gathering the information.
I will abide by all conditions of the NCGO10000 General Permit and the approved Erosion and
Sediment Control Plan.
if the approved Erosion and Sediment Control Plan is not compliant with Part II (Stormwater Pollution
Prevention Plan) of the NCG010000 General Permit, I will nonetheless ensure that all conditions of
Part II of the permit are met on the project at all times.
I hereby request coverage under the NCGO10000 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.
Name of Project: 19 1,VT/r &�Ia i K
Legally Responsible Organizational Entity:
* Legally Responsible Person:
Title of Legally Responsible Person:
Signature: \, J, ]
Date: T
* IMPORTANT NOTE. This form must be signed by a responsible corporate officer that 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 1V, Section B, Item (6) of the NCGO10000 permit.
For more information on signatory requirements, see Part iV, Section B, Item (6) of the NCGO10000 permit.

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S, DANIEL SMITH
Interim Director
NORTH CAROL.INA
Environmental Quality
14 May 2019
LETTER OF APPROVAL WITH MODIFICATIONS
City of Hickory
ATTN: Mr. Warren Wood
P.O. Box 398
Hickory, N.C. 28603
RE: Project Name: City Contract Riverwalk
Acres Approved: 2.87
Project ID: BURKE-2019-017
County: Burke
City: Hickory
Address: 12'th St Dr. NW
River Basin: Catawba
Stream Classification: Lalce Hickory, WSAV, CA
Submitted By: Ms. Christine Brown, CPSWQ CPESC
Date Received by LQS: 6 May 2019
Plan Type: Recreational
Dear Mr. Wood,
This office has reviewed the subject erosion and sedimentation control plan. We find the plan to
be acceptable and hereby issue this Letter of Approval with Modifications. The Modification
required for plan approval are attached. The enclosed Certificate of Approval must be posted at
the job site. This plan shall expire three (3) years following the date of approval, if no land
disturbing activity has been undertaken, as is required by Title 15A NCAC 4B .0129.
As of April 1, 2019, all new construction activities are required to complete and submit an
electronic Notice of Intent (NOI) form requesting a Certificate of Coverage (COC) under the
NCG010000 Construction Stormwater General Permit. This form MUST be submitted prior to the
commencement of any land disturbing activity on the above named project. The NOI form may
be accessed at deq.nc.gov/NCG01. Please direct questions about the NOI form to Annette Lucas
at [e-mail] or Paul Clark at [e-mail]. After you submit a
complete and correct N0I Form, a COC will be emailed to you within three business days. Initially,
DEMLR will not charge a fee for coverage under the NCG01 permit. However, on or after May 1,
2019, a $100 fee will be charged annually. This fee is to be sent to the DEMLR Stormwater Central
Office staff in Raleigh.
North Carolina Department of Environmental Quallty I Division of Energy, Mineral and Land Resoarces
Asheville Regional Office 12090 U.S. Highway 70 I Swannanoa, North Carolina 28778
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Letter of Approval with Modifications
Mr. Warren Wood
14 May 2019
Page 2 of 3
Title 15A NCAC 4B .0118(a) and the NCG01 permit require that the following documentation be
kept on file at the job site:
1. The approved E&SC plan as well as any approved deviation.
2. The NCG01 permit and the COC, once it is received.
3. Records of inspections made during the previous 30 days. Please note that these records
shall be maintained until permanent groundcover has been established as required by the
G.S. 113A-54.1}.
Also, this letter gives the notice required by G.S.113A-61.1(a) of our right of periodic inspection
to insure compliance with the approved plan.
North Carolina's Sedimentation Pollution Control Act is performance -oriented, requiring
protection of existing natural resources and adjoining properties. If, following the
commencement of this project, the erosion and sedimentation control plan is inadequate to meet
the requirements of the Sedimentation Pollution Control Act of 1973 (North Carolina General
Statute 113A-51 through 66), this office may require revisions to the plan and implementation of
the revisions to insure compliance with the Act.
Acceptance and approval of this plan is conditioned upon your compliance with Federal and State
water quality laws, regulations, and rules. In addition, local city or county ordinances or rules may
also apply to this land -disturbing activity. This approval does not supersede any other permit or
approval.
Please note that this approval is based in part on the accuracy of the information provided in the
Financial Responsibility Form, which.you provided. You are requested to file an amended form if
there is any change in the information included on the form. In addition, it would be helpful if you
notify this office of the proposed starting date for this project. Please notify us if you plan to have
a preconstruction conference.
Your cooperation is appreciated.
Sincerely,
Mil ael Smith
Assistant Regional Engineer
Land Quality Section
Enclosures: Certificate of Approval
NCG01 Fact Sheet
ec: Ms. Christine Brown, CPSWQ, CPESC chris.brown me illassocia e

Letter of Approval with Modifications
Mr. Warren Wood
14 May 2019
Page 3 of 3
MODIFICATIONS REQUIRED FOR APPROVAL,
Project Name: City Contract Riverwalk
Project ID: BURKE-2019-017
County: Burke
1. Please check the copy of the deed included in the submittal package. The copy the deed
does not seem to match the area delineated in the plan sheets. {G.S.113A-54 (1)1.
2. Please provide an updated original, signed and notarized FRO showing the correct
Latitude and Longitude for this site. {GS.113A-57 (3)}.
3. For clarity on the erosion and sediment control plan sheets, please call out on the plans
the number and method of stabilization of each of the swales that were detailed in the
Erosion Control Calculations Package. {G.S.113A-57 (3)1.
4. if any soil stockpiles are to be used on the site, please the show the locations on the plans
and surround the area with sedimentation fence, leaving an access for ingress/egress. {G.S.
113A-57 (3)}.

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