NCC205394_NOI Application_20210111

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 11/20/2020 10:52:05 AM (NCG01 NOI Submission)
Approve by Morman, Alaina 11/20/2020 11:42:24 PM (Review- Construction NOI 36734)
• Morman, Alaina reassigned the task to Morman, Alaina 11/20/2020 11:03 AM
• The task was assigned to Meloy, Michael by round robin distribution 11/20/2020 10:52 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: November 24, 2020 5:00
PM 11/20/2020 10:52 AM
Submit by Selkane, Aziza 1/11/2021 11:08:28 AM (Payment Verification for NCC205394)
* John D. Cox
• Selkane, Aziza assigned the task to Selkane, Aziza 1/11/2021 11:07 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: January 1, 2021 5:00 PM
11/20/2020 11:42 PM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting r No
an NOI that was r Yes
rejected before?
Previous Rejected 36384
NOI No.
Prior Reviewer Alaina Morman
Name
1a. Project Name * Ingles Distribution Center - Main Driveway Reconfiguration
1 b. Specific Lot This field may be used to list specffc lot numbers.
Numbers
1 c. Parcel ID List all PIS associated w ith this project.
Number(s) (PIN)
2. County* Buncombe
3. Highway or Street 2913 Hwy 70 West
Address* Street name only is acceptable if no address number assigned yet
4. City or Township* Black Mountain
5. State * NC
6. Zip Code* 28711
7. Latitude* Enter the latitude in decimal degrees
35.6047
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-82.3600
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* 03/03/2021
Estimated Construction Project Start late
10. Date to End * 08/27/2021
Estimated Construction Project End late

11. SIC (Primary)* Commercial (1542)
Standard Industrial Classification for Development
12. Acres to be 2.30
disturbed* (including off -site borrow and waste areas)
13. Total site area 119.45
(acres) *
14. Post- 1.65
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-BUNCO-2021-Ingles Distribution Center - Main Driveway
Tracking ID Reconfiguration
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 Swannanoa River
Waterbody* Name of waterbody into which stormwater runoff will discharge
15b. Waterbody 6-78
Index No. * NCWaterbody Index Nurrber
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. ^
Fbrnittee 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 * Ingles Markets, Inc.
IF 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 * Preston
If Corporation, enter Faegistered Agent First Wre
3. Last Name* Kendall
IF Corporation, enter F;bgistered Agent Last %rre
3b. Title Construction Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 828-669-2941
Telephone No.*
6. Permittee Mailing Street Address
Address* P.O. Box6676
Address Line 2
aty
Asheville
Fbstal / Zip Code
28816
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
F Yes
Street Address
2913 U.S. 70
Address Line 2
city
Black Mountain
Fbstal / Zip Code
28711-9103
State / Frovince / Fbgion
NC
Country
US
State / Frovince / Faegion
NC
Country
US
8. Type of Ownership is only individual if an individual is naned in B.1. above.
Ownership* Non -Government

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
...........................................................................................................................................................................................................................................................................
1. Primary Site
Preston
Contact - First
Name *
2. Primary Site
Kendall
Contact - Last
Name *
3. Title
Construction Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
828-669-2941
Telephone No.*
6. Organization
Ingles Markets, Inc.
Name
7. Site Contact
Street Address
Mailing Address*
P.O. Box6676
Address Line 2
city
State / Rovince / Region
Asheville
NC
Fbstal / Zip Code
Country
28816
us
8. Consultant Name
(Optional)
First and Last narre
9. Consultant E-mail
This person will be copied on all correspondence.
10. Consultant
Telephone No.
11. Billing E-mail (For Annual Fee correspondence)
Default is legally responsible person e-n-ail (older NOts rray not populate)
12. Billing (For Annual Fee correspondence)
Telephone Default is legally responsible person telephone (older NOIs rray not populate)

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 11/06/2020
Approved *
2. E&SC Plan Project ERO2020-00045
Number/ID * Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* Buncombe County
Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a
complete application. Please also upload a site map showing the overall extent of the project (for linear projects, can
include the beginning point and end point coordinates in the "Notes" box below).
5. E&SC Plan LOA_11062020.pdf 641.68KB
Approval letter or LD Permit_11062020.pdf 606.54KB
Grading Permit
Mist be RDFfon-rat
6. Site Location Map Mist be FDFfornat (lint 201VB)
2913 Old US Hwy 70 - Google Maps.pdf 2.61 MB
C-104 SITE PLAN.pdf 626.78KB
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 w aterbodies if necessary.
8. NOI Certification DC signed NOI 11-16-2020.pdf 83.23KB
Form Mast be FDFfon-rat
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 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 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 Legally Responsible Person named on this Notice of Intent
r Authorized Responsible Person' (signing on behalf of Legally Responsible
Person named in Part B)
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
P�esla� .�e�c��lf
Type Name* Preston Kendall
ale Construction Manager
Organization Legally Ibsponsible Entity
Ingles Markets, Inc.
11 /20/2020

F. Tracking and COC Info
NOI Tracking No. 36734
NC Reference No.
NCG01-2020-5394
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC205394
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5394
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. NCC205394-2020
Invoice Due Date 12/20/2020
Initial Fee $ 100.00
Invoice Status OPEN