NCC200345_NOI Application_20200130

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/27/2020 2:42:30 PM (NCG01 NOI Submission)
Approve by Clark, Paul 1/27/2020 4:09:51 PM (Review - Construction NOI 21181)
• The task was assigned to Clark, Paul by round robin distribution 1/27/2020 2:43 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 29, 2020 5:00
PM 1/27/2020 2:43 PM
Submit by McCoy, Suzanne 1/30/2020 7:11:58 AM (Payment Verification for NCC200345)
* Matthew Vranjes
• McCoy, Suzanne assigned the task to McCoy, Suzanne 1/30/2020 7:11 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: March 9, 2020 5:00 PM
1/27/2020 4:09 PM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name * Cross Creek Mall - Sears Redevelopment
2. County* Cumberland
3. Highway or Street Skibo Rd
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* Fayetteville
5. State * NC
6. Zip Code * 28303
7. Latitude * Enter the latitude in decimal degrees
35.0722
8. Longitude* Enter the longitude in decimal degrees (M. ST be negative)
-78.9623
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*
02/03/2020
Estimated Construction Project Start Date
10. Date to End*
11/30/2020
Estimated Construction Project End Cute
11. SIC (Primary)*
Commercial (1542)
Standard Industrial aassification for Developrrent
12. Acres to be
20.38
disturbed*
(including off -site borrow and waste areas)
13. Total site area
20.38
(acres) *
14. Post-
18.40
construction
(Estimated)
impervious area
(acres) *
NCC Project
NCC-CUMBE-2020-Cross Creek Mall - Sears Redevelopment
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 Beaver Creek
Waterbody * %rre of waterbody into which stornwater runoff will discharge
15b. Waterbody 18-31-24-5
Index No.* NCWaterbody Index N nber
Stormwater r No
discharges will flow Pf Yes
to additional
wate rs *
15c. Additional Buckhead Creek
Receiving Waterbody narre
Waterbody
15d. Waterbody 18-31-24-6
Index No. NCWaterbody Index Nunber
15e. Additional Waterbody narre
Receiving
Waterbody
15f. Waterbody NCWaterbody Index Nunber
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 Cross Creek Anchor S.L.P.
Name *
2. First Name* Curt
If Corporation, enter Pegistered Agent First Barre
3. Last Name* Hammontree
If Corporation, enter Faegistered Agent Last %rre
3b. Title VP Development
4. Permitee E-mail [e-mail]
Address *
5. Permittee 423-855-0001
Telephone No.*
6. Permittee Mailing Street Address
Address* 419 Cross Creek Mall
Address Line 2
City
Fayetteville
Fbstal / Zip Code
28303
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
419 Cross Creek Mall
Address Line 2
City
Fayetteville
Fbstal / Zip Code
28303
State / Frovince / Faegion
NC
Country
us
State / Frovince / Plegion
NC
Country
us

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Type of
Non -Government
Ownership *
2. Primary Site
Jeff
Contact - First
Name *
3. Primary Site
Allen
Contact - Last
Name *
4. Title
Director - Development
5. Site Contact E-
[e-mail]
mail Address*
6. Site Contact
423-490-8826
Telephone No.*
7. Organization
CBL Properties
Name
8. Site Contact
Street Address
Mailing Address*
2030 Hamilton Place Boulevard
Address Line 2
CBL Center, Suite 500
aty
Chattanooga
Fbstal / Zip Code
37421-6000
9. Consultant Name
(Optional)
Civil & Environmental Consultants, Inc.
First and Last narre
10. Consultant E-
[e-mail]
mail
This person will be copied on all correspondence.
11.Consultant
980-260-2108
Telephone No.
State / Rovince / Fbgion
TN
Country
us

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 01/06/2020
Approved *
2. E&SC Plan Project CUMBE-2019-115
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 * Fayetteville (FRO)
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 1.6.2020 Approval Letter - Erosion Control.pdf 2.21 MB
Approval Wst be FDFfornat
letter/documentation
Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded documents support
the application.
6. NOI Certification CBL Properties_20200123_165050.pdf 763.48KB
Form Mast be FDFforrrat
This is an Express F No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.6E (i) 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:* 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 * Curt Hammontree
Title VP - Development
Organization CBL Properties.
Date * 01 /27/2020

F. Tracking and COC Info
NOI Tracking No. 21181
NC Reference No. NCG01-2020-0345
Uses 'count number' variable (incremrented by SP)
Certificate of NCC200345
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 345
Sequential number for submittal that is incremented by Stored Frocedure
COC Year 2020
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)