NCC215188_NOI Application (Recovered)_20210914

Construction Stormwater: Notice of Intent (NOI)
National Pollutant Discharge Elimination System (NPDES) application for coverage under North Carolina's
General Permit NCG010000: STORMWATER DISCHARGES associated with construction activities (or
NCG250000)
A. Proj ect Information
Are you submitting
an NOI that was
re je cte d be fore ?
1a. Proje ct Name *
1b. Spe cific Lot
Numbe rs
1c. Parce l ID
Numbe r(s) (PIN)*
2. County *
3. Highway or Stre e t
Addre ss *
4. City or Township *
5. State *
6. Zip Code *
7. Latitude *
8. Longitude *
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 le ft corne r.
9. Date to Be gin *
10. Date to End *
11. SIC (Primary)*
12. Acre s to be
disturbe d *
Part A.
Project Location and Waterbody Information
No
Yes
Holt Farms
This f ield may be used to list specif c lot numbers.
1-24
List all PINs associated w ith this project.
129675
Alamance
4601 Mt Hermon Rock Creek Road
Street name only is acceptable if no address number assigned yet
Snow Camp
NC
27349
Enter the latitude in decimal degrees
35.9787
Enter the longitude in decimal degrees (MUST be negative)
-79.4228
10/11/2021
Estimated Construction Project Start Date
05/01/2023
Estimated Construction Project End Date
Residential, Single Family Houses (SFE) (1521)
Standard Industrial Classification for Development
6.00
(including of f -site borrow and w aste areas)
13. Total site are a
(acre s)*
14. Post-
construction
impe rv ious are a
(acre s)*
Below you must enter wate rbody information for surface wate rs affe cte d by this proje ct. Please consult
DWR's Surface Water Classifications Map Viewer to find waterbody name and corresponding index number. Please
enter only imme diate receiving waterbodies - not waters downstream of those unless the project extends there. You
may enter up to 3 waterbodies if needed.
15a. Re ce iv ing
Wate rbody *
15b. Wate rbody
Inde x No.*
Stormwate r
discharge s will flow
to additional
wate rs *
15c. Additional
Re ce iv ing
Wate rbody
15d. Wate rbody
Inde x No.
15e . Additional
Re ce iv ing
Wate rbody
15f. Wate rbody
Inde x No.
16a. Is this proje ct
subje ct to the NC
Se dime nt Pollution
Control Act?*
Note : Stormwater discharges from construction activ itie s associate d with oil and gas e xploration, production,
proce ssing, tre atme nt, or transmission facilitie s are eligible for the exemption from NPDES permit coverage except
in very limited instances. Do not proceed with this application before consulting this EPA fact sheet and verifying a
permit applies.
23.49
0.77
(Estimated)
Varnals Creek
Name of w aterbody into w hich stormw ater runof f w ill discharge
16-21
NC Waterbody Index Number
No
Yes
Rock Creek
Waterbody name
16-19-8-3
NC Waterbody Index Number
Waterbody name
allison@c3designeng.
com
NC Waterbody Index Number
Yes
No, not subject to NC SPCA
B. Permittee Information
Important: The person who signs the NOI Certification Form and signs the Certification in Section E of this application
form must be the same person as liste d 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 re quire me nts, se e Part
IV, Se ction B, Ite m (6) of that pe rmit.
1. Pe rmitte e *
Note: If the permittee is a business, the business must be registered with the NC Secretary of State. You can verify the
registration here.
2. First Name *
3. Last Name *
3b. Title *
4. Pe rmite e E-mail
Addre ss *
5. Pe rmitte e
Te le phone No.*
6. Pe rmitte e M ailing
Addre ss *
Che ck box if the
stre e t addre ss the
same as mailing
addre ss
7. Pe rmitte e Stre e t
Addre ss *
8. Type of
Owne rship *
Part B.
Permittee Information - Legally Responsible Entity and Individual
Legally Responsible Entity
Cimland, LLC
If permittee is an individual, enter first and last name in this f ield. Otherw ise, enter organization/business name.
Craig
If Corporation, enter Registered Agent First Name
Morrison
If Corporation, enter Registered Agent Last Name
Member/Manager
[e-mail]
919-880-6297
City
Durham
State / Province / Region
NC
Postal / Zip Code
27705
Country
USA
Street Address
2330 Operations Dr
Address Line 2
Yes
City
Durham
State / Province / Region
NC
Postal / Zip Code
27705
Country
USA
Street Address
2330 Operations Dr
Address Line 2
Ow nership is only individual if an individual is named in B.1. above.
Non-Government
C. Site Contact in formation
1. Primary Site
Contact - First
Name *
2. Primary Site
Contact - Last
Name *
3. Title
4. Site Contact E-
mail Addre ss *
5. Site Contact
Te le phone No.*
6. Organization
Name
7. Site Contact
M ailing Addre ss *
8. Consultant Name
9. Consultant E-mail
10. Consultant
Te le phone No.
11. Billing E-mail *
12. Billing
Te le phone *
Part C.
Project Site Contact Information
Chad
Abbott
Principal Engineer
[e-mail]
This person w ill be copied on all correspondence.
919-230-0996
C3 Design & Engineering, PLLC
City
Creedmoor
State / Province / Region
NC
Postal / Zip Code
27522
Country
USA
Street Address
PO Box 361
Address Line 2
(Optional)
Chad Abbott
First and Last name
[e-mail]
This person w ill be copied on all correspondence.
919-230-0996
(For Annual Fee correspondence)
[e-mail]
Def ault is legally responsible person e-mail
(For Annual Fee correspondence)
919-880-6297
Def ault is legally responsible person telephone
D. E&SC Plan
1. Date E&SC Plan
Approv e d *
2. E&SC Plan Proje ct
Numbe r/ID *
3. E&SC Plan
Approv e d by *
4. State DEQ Office *
Docume ntation of E&SC Plan approv al 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
Approv al le tte r or
Grading Pe rmit *
6. Signe d FRO *
7. Site Location
M ap *
8. Note s (Optional)
9. NOI Ce rtification
Form *
YOU MUST MAIL THE ORIGINAL SIGNED NOI CERTIFICATION FORM (click on this link) to The Stormwater Program
at the address on the form for the application to fulfill federal application requirements. The Certification Form must be
signed by the person listed in Section B (Permittee Information) or by an authorized responsible person within the same
organization. NOTE: The pe rson who signs the pape r form must be the same pe rson to e le ctronically ce rtify
and sign the e NOI.
This is an Expre ss
Re v ie w Proje ct *
Part D.
Erosion & Sediment Control (E&SC) Plan Approval Information
08/31/2021
ALAMA-2021-064
Assigned by agency or local program
State DEQ Office
Local Program
Winston-Salem Regional Office (WSRO)
Approval documentation only! DO NOT upload entire set(s) of E&SC Plans
5 - LoA-M ALAMA-2021-064.pdf 216.71KB
Must be PDF f ormat
Financial Responsibility/Ow nership Form
6 - FRO.pdf 1.22MB
Must be PDF f ormat
Must be PDF f ormat (limit 20 MB)
7 - Preliminary Plat.pdf 977.95KB
Please do not upload entire set of E&SC plans.
Provide any additional information that might help the review er better understand how uploaded documents support
the application. Include additional w aterbodies if necessary.
9 - NOI Certification Form.pdf 730.96KB
Must be PDF f ormat
No
Yes
E. Certification
North Carolina Ge ne ral Statute 143-215.6B (i) prov ide s that:
Any person who knowingly makes any false 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 Article; 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 Article shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed ten thousand
dollars ($10,000).
Under penalty of law, I certify that:
*
*
*
*
Spe cify if you are :*
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 re quire me nts, se e Part IV, Se ction B, Ite m (6) of that pe rmit.
Signature *
Type Name *
Title *
Organization *
Date *
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.
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.
I will abide by all conditions of the NCG010000 General Permit and the
approved Erosion and Sediment Control Plan.
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.
The Legally Responsible Person named on this Notice of Intent
Authorized Responsible Person* (signing on behalf of Legally Responsible
Person named in Part B)
Craig Morrison
Member/Manager
Legally Responsible Entity
Cimland, LLC
09/14/2021