NCC193229_NOI Application_20191227

Action History (UTC-05:00) Eastern Time(US&Canada)
Submit by Anonymous User 12/16/2019 11:18:28 AM(NCG01 NOI Submission)
Approve by Morman,Alaina 12/17/2019 12:53:11 PM(Review-Construction NOI 19585)
p Applicant entered December 3, 2019 instead of December 6, 2019 as the E&SC plan approval date.
The letter from Durham County is unclear as to what the December 3rd date represents, so reviewer is
accepting the December 3rd date.
• The task was assigned to Morman,Alaina by round robin distribution 12/16/2019 11:18 AM
• The task was assigned to DEMLR NCG01 NOI Review Team.The due date is: December 18, 2019 5:00
PM 12/16/2019 11:18 AM
Submit by McCoy, Suzanne 12/27/2019 2:43:22 PM(Payment Verification for NCC193229)
* McAdams
• McCoy, Suzanne assigned the task to McCoy, Suzanne 12/27/2019 2:43 PM
• The task was assigned to DEMLR NCG01 Payment Team.The due date is:January 28, 2020 5:00 PM
12/17/2019 12:53 PM

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1Construction Stormwater: Notice of Intent (NOI)
National Pollutant Discharge Elimination System 'D application for•• - .•-under NorthCarolina's
General Permit 1 1111:STORIMATER DISCHARGES associated with construction activities(or
NORTH CAROLINA
Enrlrnnmenfu�Qr�arlry
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name* Genesis Waterline
2.County* Durham
3. Highway or Street 3029 East Cornwallis Road
Address* Street nacre only is acceptable if no address number assigned yet
4. City or Township* Durham
5.State* NC
6.Zip Code* 27709
7. Latitude* Enter the latitude in decimal degrees
35.9148
8. Longitude* Enter the longitude in decimal degrees(M.ST be negative)
-78.8679
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* 12/16/2019
Estinated Construction Project Start Date
10. Date to End* 12/06/2021
Estimated Construction Project End Cute
11.SIC(Primary)* Other(0000)
Standard Industrial Classification for Ceveloprrent
12.Acres to be 2.42
disturbed* (including off-site borrow and waste areas)
13.Total site area 2.42
(acres)*
14. Post- 0.25
construction (Estimated)
impervious area
(acres)*
NCC Project NCC-DURHA-2019-Genesis Waterline
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 Northeast Creek
Waterbody* %rre of waterbody into which storrrwater runoff will discharge
15b.Waterbody 16-41-1-17-(0.3)
Index No.* NCWaterbody Index N nber
Stormwater r No
discharges will flow Pf Yes
to additional
wate rs*
15c.Additional Burdens Creek
Receiving Waterbody narre
Waterbody
15d.Waterbody 16-41-1-17-1-(0.3)
Index No. NCWaterbody Index Nurrber
15e.Additional Waterbody narre
Receiving
Waterbody
15f.Waterbody NCWaterbody Index Nirrber
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. ^
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 TKC-3029 Holdings, LLC
Name*
2. First Name* Kenneth
ff Corporation,enter Pegistered Agent First Barre
3. Last Name* Beuley
ff Corporation,enter Faegistered Agent Last%rre
3b.Title Managing Member
4. Permitee E-mail [e-mail]
Address*
5. Permittee 704-365-5000
Telephone No.*
6. Permittee Mailing Street Address
Address* 4500 Cameron Valley Parkway
Address Line 2
Suite 400
City State/Frovince/Region
Charlotte NC
Fbstal/Zip Code Country
28211 us
Check box if the rJ Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 4500 Cameron Valley Parkway
Address Line 2
Suite 400
City State/Frovince/Fbgion
Charlotte NC
Fbstal/Zip Code Country
28211 us

C. Site Contact Information
Part C. ^
Roject Site Contact Inforrration
.......................................................................................................................................................................................................................................................................................................................................................................................
1.Type of Non-Government
Ownership*
2. Primary Site Preston
Contact-First
Name*
3. Primary Site Sloan
Contact-Last
Name*
4.Title Project Manager
5.Site Contact E- [e-mail]
mail Address*
6.Site Contact 919-719-4703
Telephone No.*
7.Organization Choate Construction Company
Name
8.Site Contact Street Address
Mailing Address* 5440 Wade Park Boulevard
Address Line 2
Suite 220
C7ty State/Rovince/Fbgion
Raleigh NC
Fbstal/Zip Code Country
27607-6068 us
9. Consultant Name (Optional)
Z. Nathan Bales
First and Last narre
10. Consultant E- [e-mail]
mail This person will be copied on all correspondence.
11. Consultant 919-361-5000
Telephone No.

D. E&SC Plan
Part D. ^
Erosion&Sediment Control(E&SC)Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 12/03/2019
Approved*
2. E&SC Plan Project 6089-11
Number/ID* Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* Durham City/County
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 Letter of Approval-Genesis Waterline JCN#6089-
Approval 11.pdf 252.28KB
letter/documentation
Mist be R7Fforrrat
6. NOI Certification Genesis Waterline NOI Certification Form-
Form 83.85KB
Signed.pdf
Mist be RDFforrrat
This is an Express r No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.66(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 knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case underthis 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 guiltyofa Class 2 misdemeanor which mayinclude 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 If the Erosion and Sediment Control Plan approved by the delegated program 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.
* 17 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* Kenneth Beuley
Title Managing Member
Organization TKC-3029 Holdings Inc.
Date* 12/16/2019

F. Tracking and COC Info
NOI Tracking No. 19585
NC Reference No. NCG01-2019-3229
Uses'count_nurrber'variable(increrrented by SP)
Certificate of NCC193229
Coverage (COC) Uses'count number'variable(increrrented by SP)
No.*
Count Number 3229
Sequential nurrber for subrrittal that is incremented by Stored Frocedure
COC Year 2019
Year of date reviewed(used to assign YY digits after"NOC'in COCno.)