NCC210235_NOI Application_20210126

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/12/2021 1:35:54 PM (NCG01 NOI Submission)
Approve by Clark, Paul 1/13/2021 12:47:01 PM (Review- Construction NOI 40937)
• The task was assigned to Clark, Paul by round robin distribution 1/12/2021 1:36 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 14, 2021 5:00
PM 1/12/2021 1:36 PM
Submit by McCoy, Suzanne 1/26/2021 3:50:58 PM (Payment Verification for NCC210235)
* Stillwell Engineering PA
• McCoy, Suzanne assigned the task to McCoy, Suzanne 1/26/2021 3:50 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: February 24, 2021 5:00
PM 1/13/2021 12:47 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 * Cow Mountain Road
1 b. Specific Lot This field nay be used to list specifc lot nunbers.
Numbers
1 c. Parcel ID List all Rus associated w ith this project.
Number(s) (PIN) 7584-32-2402, 7584-54-3308
2. County* Jackson
3. Highway or Street Roaming Road
Address* Street name only is acceptable if no address nunber assigned yet
4.CityorTownship* Cashiers
5. State * NC
6. Zip Code* 28717
7. Latitude* Enter the latitude in decinal degrees
35.1760
8. Longitude * Enter the longitude in decinal degrees (MJSTbe negative)
-83.0700
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*
01/19/2021
Estinated Construction Project Start Rate
10. Date to End *
10/29/2021
Estirrated Construction Project End Cate
11. SIC (Primary)*
Residential, Single Family Houses (SFE) (1521)
Standard Industrial aassification for Development
12. Acres to be
13.99
disturbed*
(including off -site borrow and waste areas)

13. Total site area 13.99
(acres) *
14. Post- 4.70
construction (Estinated)
impervious area
(acres) *
NCC Project NCC-JACKS-2021-Cow Mountain Road
Tracking ID Assignedautonatically
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 Cow Mountain Branch
Waterbody* Narreof waterbody into which stornwater runoff will discharge
15b. Waterbody 2-79-13-2-2
Index No. * NCWaterbody Index Nunber
Stormwater F No
discharges will flow 17 Yes
to additional
wate rs *
15c. Additional Robinson Creek
Receiving Waterbody narre
Waterbody
15d. Waterbody 2-79-13
Index No. NC Waterbody Index Nmber
15e. Additional Waterbody name
Receiving
Waterbody
15f. Waterbody NCWaterbody Index Narrber
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 Legally Pesponsible Entity
Name * Chinquapin, LLC
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 * William
IF Corporation, enter Faegistered Agent First %rre
3. Last Name* Adkins
IF Corporation, enter F;bgistered Agent Last %rre
3b. Title Managing Member
4. Permitee E-mail [e-mail]
Address*
5. Permittee 704.896.5880
Telephone No.*
6. Permittee Mailing Street Address
Address* 19421 Liverpool Parkway
Address Line 2
City
Cornelius
Fbstal / Zip Code
28031
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
19421 Liverpool Parkway
Address Line 2
city
Cornelius
Fbstal / Zip Code
28031
State / Frovince / Fbgion
NC
Country
us
State / Frovince / Faegion
NC
Country
us
8. Type of Ojvnership 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
Lucas
Contact - First
Name *
2. Primary Site
Murdock
Contact - Last
Name *
3. Title
Facilities Director
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
828.577.4591
Telephone No.
6. Organization
Name
7. Site Contact
Street Address
Mailing Address*
1351 Breedlove Road
Address Line 2
City
State / Rovince / Region
Glenville
NC
Postal / Zip Code
Country
28736-6379
us
8. Consultant Name
(Optional)
William Stillwell
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
828.586.6066
Telephone No.
11. Billing E-mail
(For Annual Fee correspondence)
[e-mail]
Default is legally responsible person a-rrail (older NOIs rray not populate)
12. Billing
(For Annual Fee correspondence)
Telephone
704.896.5880
Default is legally responsible person telephone (older NOLs rray not populate)

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 01/07/2021
Approved *
2. E&SC Plan Project 20-121
Number/ID * Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* Jackson 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 COW MOUNTAIN ROAD 20-121 01.07.21.pdf 105.62KB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Mist be RDFforrret (lint 201VB)
CM 12_4_20-COVER.pdf 116.7KB
Rease do not upload entire set of E&SC plans.
7. Notes (Optional) Rovide any additional information that night help the reviewer better understand how uploaded docurrents support
the application. Include additional waterbodies if necessary.
8. NOI Certification DEMLR NOI 1_12_21.pdf 648.03KB
Form Wst be RDF format
This is an Express r 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
f 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
Type Name* William Adkins
Title Managing Member
Organization Legally Ibsponsible Entity
Chinquapin, LLC
Date * 01 /12/2021

F. Tracking and COC Info
NOI Tracking No. 40937
NC Reference No.
NCG01-2021-0235
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC210235
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 235
Sequential nurrber for subrrittal that is incremented by Stored Frocedure
COC Year 2021
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)
Initial Invoice No. NCC210235-2021
Invoice Due Date 2/12/2021
Initial Fee $ 100.00
Invoice Status OPEN