NCC191591_NOI Application_20190828

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/25/2019 11:57:21 AM (NCG01 NOI Submission)
Approve by Morman, Alaina 8/26/2019 2:46:52 PM (Review- Construction NOI 15258)
• The task was assigned to Morman, Alaina by round robin distribution 8/25/2019 11:57 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 28, 2019 5:00
PM 8/25/2019 11:57 AM
Submit by McCoy, Suzanne 8/28/2019 3:31:54 PM (Payment Verification for NCC191591)
* Dan Ryan Builders
• McCoy, Suzanne assigned the task to McCoy, Suzanne 8/28/2019 3:30 PM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: September 9, 2019 5:00
PM 8/26/2019 2:46 PM

STME
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name * Ashberry Phase 1 C - Long Mill Road Widening
2. County* Franklin
3. Highway or Street Ashberry Lane
Address * Street name only is acceptable if no address number assigned yet
4. City or Township* Franklinton
5. State * NC
!17-8)aIsT2,G)M111if_T1IIa10141
6. Zip Code* 27596
7. Latitude * Enter the latitude in decimal degrees
36.0726
8. Longitude * Enter the longitude in decimal degrees (MIST be negative)
-78.5058
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*
08/26/2019
Estimated Construction Project Start Date
10. Date to End*
04/30/2020
Estimated Construction Project End Date
11. SIC (Primary)*
Residential, Single
Family Houses (SFE)
(1521)
Standard Industrial aassification for Development
12. Acres to be
1.10
disturbed*
(including off -site borrow and waste areas)
13. Total site area 1.50
(acres)*
14. Post- 0.80
construction (Estimated)
impervious area
(acres) *

NCC Project NCC-F RANK-2019-Ash berry Phase 1C - Long Mill Road Widening
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. You may
enter up to 3 waterbodies.
15a. Receiving Cedar Creek
Wate rbody* l\brre of waterbody into which stornvwater runoff will discharge
15b. Waterbody 28-29-(2)
Index No. * WWaterbody Index Ninber
Stormwater fJ 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.
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 Dan Ryan Builders - North Carolina, LLC
Name *
2. First Name* Jay
ff Corporation, enter Registered Agent First l\brre
3. Last Name * Lewis
ff Corporation, enter Registered Agent Last Barre
3b. Title Division President
4. Permitee E-mail [e-mail]
Address*
5. Permittee 9192251078
Telephone No.*
6. Permittee Mailing Street Address
Address* 3000 RDU Center Drive, Suite 202
Address Line 2
4588 Carlton Crossing Drive
City State / Province / Region
Morrisville NC
Postal / Zip Code Country
27560 United States
Check box if the r% Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 3000 RDU Center Drive, Suite 202
Address Line 2
4588 Carlton Crossing Drive
City State / Province / Region
Morrisville NC
Postal / Zip Code Country
27560 United States

C. Site Contact Information
Part C.
Roiect Site Contact Information
1. Type of Non -Government
Ownership*
2. Primary Site Taylor
Contact - First
Name *
3. Primary Site Holt
Contact - Last
Name *
4. Title Land Project Manager
5. Site Contact E- [e-mail]
mail Address*
6. Site Contact 919-407-1149
Telephone No.*
7. Organization Dan Ryan Builders
Name
8. Site Contact Street Address
Mailing Address* 3000 RDU Center Drive, Suite 202
Address Line 2
city
Morrisville
Fbstal / Zip Code
27560
State / Province / Region
NC
Country
United States

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 06/26/2019
Approved *
2. E&SC Plan Project FRANK-2019-028
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 * Raleigh (RRO)
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 FRANK-2019-028 LID permit for Long Mill
Approval 60.2KB
Widening.pdf
letter/documentation
Mist be RJF forrret
6. NOI Certification NOI Form Ph 1C and Long Mill Rd Signed
Form 35.5KB
8.21.19.pdf
Mist be RDFforrrat
This is an Express f• No
Review Project* r Yes

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
J tm
Type Name * Jay Lewis
Title Division President
Organization Dan Ryan Builders - North Carolina, LLC
Date * 08/25/2019

F. Tracking and COC Info
NOI Tracking No. 15258
NC Reference No. NCG01-2019-1591
Uses 'count number variable (incremrented by SP)
Certificate of NCC191591
Coverage (COC) Uses 'count _nunber'variable (increrrented bySP)
No. *
Count Number 1591
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.)