NCC193357_NOI Application_20200102

Action History (UTC-05:00)Eastern Time(US&Canada)
Subrrit by Anonymous User 12/30/2019 8:18:13 PM(NCG01 NOI Submission)
Approve by Clark, Paul 12/31/2019 9:18:42 AM(Review-Construction NOI 20038)
• Morman,Alaina reassigned the task to Clark, Paul 12/31/2019 8:50 AM
• The task was assigned to Farkas,Jim J by round robin distribution 12/30/2019 8:18 PM
• The task was assigned to DEMLR NCG01 NOI Review Team.The due date is:January 1,2020 5:00
PM 12/30/2019 8:18 PM
Submit by McCoy, Suzanne 1/2/2020 7:08:45 AM(Payment Verification for NCC193357)
* Vu Xuan Bui
• McCoy,Suzanne assigned the task to McCoy, Suzanne 1/2/2020 7:08 AM
• The task was assigned to DEMLR NCG01 Payment Team.The due date is: February 11, 2020 5:00
PM 12/31/2019 9:18 AM

�ThF1
1Construction Stormwater: Notice of Intent (NOI)
National Pollutant Discharge Elimination System 'D application for•• - .•-under NorthCarolina's
General Permit 1 1111:STORIVWATER DISCHARGES associated with construction activities(or
NORTH CAROLINA
Enrlrnnmenfu�Qr�arlry
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name* Beaman Single Family
2.County* Mecklenburg
3. Highway or Street 3204 Beaman Avenue
Address* Street nacre only is acceptable if no address number assigned yet
4. City or Township* Charlotte
5.State* NC
6.Zip Code* 28273
7. Latitude* Enter the latitude in decimal degrees
35.1641
8. Longitude* Enter the longitude in decimal degrees(M.ST be negative)
-80.9412
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* 01/20/2020
Estimated Construction Project Start Date
10. Date to End* 06/15/2020
Estimated Construction Project End Cute
11.SIC(Primary)* Residential, Single
Family Houses(SFE)
(1521)
Standard Industrial aassification for Development
12.Acres to be 1.43
disturbed* (including off-site borrow and waste areas)
13.Total site area 2.17
(acres)*
14. Post- 0.67
construction (Estimated)
impervious area
(acres)*

NCC Project NCC-MECKL-2020-Beaman Single Family
Tracking ID Assignedautorratically
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 Coffey Creek
Wate rbody* Nacre of waterbody into which storrrwater runoff will discharge
15b.Waterbody 11-137-4
Index No.* NCWaterbody Index IALrrber
Stormwater V No
discharges will flow r Yes
to additional
wate rs*
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 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 Vu Bui
Name*
2. First Name* Vu
ff Corporation,enter Fbgistered Agent First Barre
3. Last Name* Bui
ff Corporation,enter Faegistered Agent Last%rre
3b.Title Land Owner
4. Permitee E-mail [e-mail]
Address*
5. Permittee 404-542-1828
Telephone No.*
6. Permittee Mailing Street Address
Address* 323 Village Loop Drive
Address Line 2
City State/Frovince/Region
Rock Hill South Carolina
Fostal/Zip Code Country
29732 USA
Check box if the rJ Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 323 Village Loop Drive
Address Line 2
City State/Frovince/Fbgion
Rock Hill South Carolina
Fbstal/Zip Code Country
29732 USA

C. Site Contact Information
Part C. ^
Roject Site Contact Inforrration
.......................................................................................................................................................................................................................................................................................................................................................................................
1.Type of Individual
Ownership*
2. Primary Site Scott
Contact-First
Name*
3. Primary Site Knight
Contact-Last
Name*
4.Title Owner
5.Site Contact E- [e-mail]
mail Address*
6.Site Contact 803-320-9576
Telephone No.*
7.Organization 4K Land Clearing
Name
8.Site Contact Street Address
Mailing Address* 2309 Burning Bush Lane
Address Line 2
City State/Rovince/Fbgion
Lancaster South Carolina
Fbstal/Zip Code Country
29720 USA
9. Consultant Name (Optional)
First and Last narre
10. Consultant E- This person will be copied on all correspondence.
mail
11. Consultant
Telephone No.

D. E&SC Plan
Part D. ^
Erosion&Sediment Control(E&SC)Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 10/15/2019
Approved*
2. E&SC Plan Project LDGP-2019-00216
Number/ID* Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* City of Charlotte
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 modified April 2019-Beaman
Approval 29.68KB
Single Family.pdf
letter/documentation
Mist be R7Fforrrat
6. NOI Certification Signed ENOI.pdf 239.96KB
Form Mist be FDFforrrat
This is an Express F 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* Vu Bui
Title Owner
Organization Vu Bui
Date* 12/30/2019

F. Tracking and COC Info
NOI Tracking No. 20038
NC Reference No. NCG01-2019-3357
Uses'count_nurrber'variable(increrrented by SP)
Certificate of NCC193357
Coverage (COC) Uses'count number'variable(increrrented by SP)
No.*
Count Number 3357
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.)