NCC205282_NOI Application_20201208

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 11/17/2020 9:02:20 AM (NCG01 NOI Submission)
Approve by Garcia, Lauren V 11/17/2020 4:00:25 PM (Review- Construction NOI 36347)
• The task was assigned to Garcia, Lauren V by round robin distribution 11/17/2020 9:02 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: November 19, 2020 5:00
PM. The priority is: High 11/17/2020 9:02 AM
Submit by McCoy, Suzanne 12/8/2020 2:38:30 PM (Payment Verification for NCC205282)
* Wynnefield Properties inc
• McCoy, Suzanne assigned the task to McCoy, Suzanne 12/8/2020 2:37 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: December 29, 2020 5:00
PM. The priority is: High 11/17/2020 4:01 PM

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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 * Aspen Point
1 b. Specific Lot This field nay be used to list specifc lot nunbers.
Numbers
2. County* Forsyth
3. Highway or Street Stavvord Place Cir.
Address* Street narre only is acceptable if no address number assigned yet
4. City or Township* Winston Salem
5. State * NC
6. Zip Code * 27127
7. Latitude* Enter the latitude in decinal degrees
36.0290
8. Longitude* Enter the longitude in decir al degrees (M.JST be negative)
-80.2658
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*
11/20/2020
Estinated Construction Project Start Date
10. Date to End*
12/31/2021
Estirrated Construction Project End Date
11. SIC (Primary)*
Residential, Other than SFE (1522)
Standard Industrial aassification for Developrrent
12. Acres to be
6.72
disturbed*
(including off -site borrow and waste areas)
13. Total site area 11.00
(acres) *

14. Post- 2.42
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-FORSY-2020-Aspen Point
Tracking ID Assigned autorratically
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 Sides Branch
Waterbody* %rm of waterbody into which stornwater runoff will discharge
15b. Waterbody 12-94-13-6
Index No.* NCWaterbody Index Nunber
Stormwater V No
discharges will flow r Yes
to additional
wate rs *
16a. Is this project F 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 Legally Pesponsible Entity
Name * Wynnefield Construction, LLC
It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
Note: The organization name must match the business entity name registered with the NC Secretary of State. You can
verify the registration here.
2. First Name * Craig
IF Corporation, enter Faegistered Agent First Wre
3. Last Name* Stone
It Corporation, enter Pbegistered Agent Last %rre
3b. Title Member
4. Permitee E-mail [e-mail]
Address*
5. Permittee 336-880-3300
Telephone No.*
6. Permittee Mailing Street Address
Address* PO Box395
Address Line 2
City
State / Rovince / Fbgion
Jamestown
NC
Fbstal / Zip Code
Country
27282
United States
Check box if the F Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
5614 Riverdale Dr.
Address Line 2
City
State / Frovince / Region
Jamestown
NC
Fbstal / Zip Code
Country
27282
United States
8. Type of
Non -Government
Ownership

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Matt
Contact - First
Name *
2. Primary Site
Raab
Contact - Last
Name *
3. Title
Construction Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
3368803300
Telephone No.
6. Organization
Wynnefield Properties
Name
7. Site Contact
Street Address
Mailing Address*
PO Box395
Address Line 2
Street Address 2
city
Jamestown
Fbstal / Zip Code
27282
8. Consultant Name
(Optional)
First and Last narre
9. Consultant E-mail
This person will be copied on all correspondence.
10. Consultant
Telephone No.
State / Rovince / Region
NC
Country
United States

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 10/30/2020
Approved *
2. E&SC Plan Project EN2000142
Number/ID * Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* Winston-Salem/Forsyth County
Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a
complete application. For linear projects, please also upload a site map showing the overall extent of the project or
include the beginning point and end point coordinates in the "Notes" box below.
5. E&SC Plan Aspen Pointe - WS EC Approval.pdf 432.75KB
Approval letter or Mast beRDFformal
Grading Permit
6. Site Location Map Mist be RDFforrrat (lint 20 NB)
Aspen - Site Map.pdf 995.95KB
Rease do not upload entire set of E&SC plans.
7. Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded documents support
the application. Include additional waterbodies for linear projects if necessary.
8. NOI Certification Aspen Pointe - NCG01 Certification. pdf 551.7KB
Form Wst be RDFforrrat
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 Atide; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case under this Atcle; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring device or method required to be operated or maintained under this Atide or rules of the
Commission implementing this Atcle 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 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
c. c C-5'mw
Type Name* C. Craig Stone
Title Member
Organization Legally Iesponsible Entity
Wynnefield Construction
Date * 11 /17/2020

F. Tracking and COC Info
NOI Tracking No. 36347
NC Reference No.
NCG01-2020-5282
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC205282
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5282
Sequential nurrber for subrrittal that is incremented by Stored Frocedure
COC Year 2020
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)
Initial Invoice No. NCC205282-2020
Invoice Due Date 12/17/2020
Initial Fee $ 100.00
Invoice Status OPEN