NCC191090_NOI Application_20190726

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 7/26/2019 3:21:44 PM (NCG01 NOI Submission)
Approve by Lucas, Annette 7/26/2019 4:48:37 PM (Review- Construction NOI 14037)
• The task was assigned to Lucas, Annette by round robin distribution 7/26/2019 3:21 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: July 30, 2019 5:00 PM
7/26/2019 3:21 PM
Submit by Lucas, Annette 7/26/2019 5:29:57 PM (Payment Verification - NCG01-2019-1090)
• The task was assigned to Lucas, Annette. The due date is: July 29, 2019 5:00 PM 7/26/2019 4:48 PM

STME
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
1re) frIT7i)Mfi1i(-_ToIa1010
Part A.
Project Location and Waterbody Information
1. Project Name * North Carolina School of Science and Math - Western Campus
2. County* Burke
3. Highway or Street 509 W Fleming Dr.
Address * Street name only is acceptable if no address number assigned yet
4. City or Township* MORGANTON
5. State * NC
6. Zip Code* 28655
7. Latitude * Enter the latitude in decimal degrees
35.7317
8. Longitude * Enter the longitude in decimal degrees (MIST be negative)
-81.6858
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*
07/03/2019
Estimated Construction Project Start Date
10. Date to End*
08/12/2021
Estimated Construction Project End Date
11. SIC (Primary)*
Other (0000)
Standard Industrial aassification for Development
12. Acres to be
21.08
disturbed*
(including off -site borrow and waste areas)
13. Total site area
62.73
(acres)*
14. Post-
6.83
construction
(Estimated)
impervious area
(acres) *
NCC Project
NCC-BURKE-2019-North Carolina School of Science and Math -
Tracking ID
Western Campus
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. You may
enter up to 3 waterbodies.
15a. Receiving Hunting Creek
Waterbody* %rre of waterbody into which stormuater runoff will discharge
15b. Waterbody 11-36-(0.7)
Index No.* NC Waterbody Index Nunter
Stormwater V No
discharges will flow r- Yes
to additional
wate rs *
16a. Is this project r Yes
subject to the NC f No, not subject to NC SPCA
Sediment Pollution
Control Act?*

B. Permittee Information
Part B.
Perrrittee Information - Legally Responsible Entity and Individual
.....................................................................................................................................................................
h
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 NHM Constructors, LLC
Name *
2. First Name* Adam
ff Corporation, enter Registered Agent First Nacre
3. Last Name * Rice
ff Corporation, enter Registered Agent Last Nbrre
3b. Title Member/Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 8287770609
Telephone No.*
6. Permittee Mailing Street Address
Address* PO Box6385
Address Line 2
City
Asheville
Postal / Zip Code
28816
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
r Yes
Street Address
1121 Brevard Road
Address Line 2
City
Asheville
Fbstal / Zip Code
28806-9555
State / Province / Region
NC
Country
United States
State / Province / Region
NC
Country
US

C. Site Contact Information
Part C.
Roiect Site Contact Information
1. Type of Government - State
Ownership*
2. Primary Site Chad
Contact - First
Name *
3. Primary Site Barrow
Contact - Last
Name *
4. Title Project Engineer
5. Site Contact E- CBARROW@BARNHILLCONT RACT ING. CO
mail Address* M
6. Site Contact 7046199979
Telephone No.*
7. Organization Barnhill Contracting Company
Name
8. Site Contact Street Address
Mailing Address* 5701 Westpark Dr
Address Line 2
aty
State / Rovince / Region
Charlotte
North Carolina
Fbstal / Zip Code
Country
28217
United States

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 04/17/2019
Approved *
2. E&SC Plan Project BURKE-2019-013
Number/ID* Assigned by agency or local program
3. E&SC Plan f• State DEQ Office
Approved by r Local Program
4. State DEQ Office * Asheville (ARO)
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 LOA COPA 4-17-19.pdf
Approval Mast be FDF format
letter/documentation
6. NOI Certification NCG01 - NHM signature.pdf
Form Mist be RJFformat
This is an Express f• No
Review Project* r Yes
101.5KB
338.21 KB

E. Certification
North Carolina General Statute 143-215.613 (1) provides that:
Anyperson who knowinglymakes any false statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained under this Article or a rule implementing this Article; or who knowinglymakes 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 deice or method required to be operated or maintained under this Article or rules of the
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine not to exceed ten thousand
dollars ($10,000).
Under penalty of law, I certify that:
rJ 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.
* I7 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
r Authorized Responsible Person*
Important: The person who signs this Certification above and signs the NOI Certification Form should be the same
person (or authorized responsible person within the same organization) as listed in Section B (Permittee Information)
of this form. *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 * Bill Newman
Title Member Manager
Organization NHM Constructor,LLC
Date * 07/26/2019

F. Tracking and COC Info
NOI Tracking No. 14037
NC Reference No. NCG01-2019-1090
Uses 'count number variable (incremrented by SP)
Certificate of NCC191090
Coverage (COC) Uses 'count _nunber'variable (increrrented bySP)
No. *
Count Number 1090
Sequential nunber for subrrittal that is incremented by Stored Procedure
COC Year 2019
Year of date reviewed (used to assign YY digits after "NGC' in OOCno.)