NCC193194_NOI Application_20191218

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/13/2019 12:34:51 PM (NCG01 NOI Submission)
Approve by McCoy, Suzanne 12/13/2019 1:48:43 PM (Review- Construction NOI 19531)
• The task was assigned to McCoy, Suzanne by round robin distribution 12/13/2019 12:35 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: December 17, 2019 5:00
PM. The priority is: High 12/13/2019 12:35 PM
Submit by McCoy, Suzanne 12/18/2019 6:58:04 AM (Payment Verification for NCC193194)
* Hilton Inc.
• McCoy, Suzanne assigned the task to McCoy, Suzanne 12/18/2019 6:57 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: January 24, 2020 5:00 PM.
The priority is: High 12/13/2019 1:48 PM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name * Hilton Borrow Area
2. County* Caldwell
3. Highway or Street Glenn Ridge Dr.
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* Granite Falls
5. State * NC
6. Zip Code * 28630
7. Latitude * Enter the latitude in decimal degrees
35.7850
8. Longitude* Enter the longitude in decimal degrees (M. ST be negative)
-81.4060
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*
12/16/2019
Estimated Construction Project Start Date
10. Date to End*
10/22/2020
Estimated Construction Project End Cute
11. SIC (Primary)*
Commercial (1542)
Standard Industrial aassification for Developrrent
12. Acres to be
3.24
disturbed*
(including off -site borrow and waste areas)
13. Total site area
3.24
(acres) *
14. Post-
0.00
construction
(Estimated)
impervious area
(acres) *
NCC Project
NCC-CALDW-2019-Hilton Borrow Area
Tracking ID
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 Gunpowder Creek
Wate rbody* Narm of waterbody into which storrrwater runoff will discharge
15b. Waterbody 11-55-(4)
Index No.* NCWaterbody Index N nber
Stormwater V 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. ^
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 Hilton Inc.
Name *
2. First Name* Kip
IF Corporation, enter Fbgistered Agent First Barre
3. Last Name* Hilton
If Corporation, enter F3egistered Agent Last %rre
3b. Title President
4. Permitee E-mail [e-mail]
Address *
5. Permittee [phone]
Telephone No.*
6. Permittee Mailing Street Address
Address* 5979 Appaloosa Way
Address Line 2
city
Granite Falls
Fbstal / Zip Code
28630-9315
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
5979 Appaloosa Way
Address Line 2
city
Granite Falls
Fbstal / Zip Code
28630-9315
State / F rovince / Faegion
NC
Country
us
State / Frovince / Plegion
NC
Country
us

C. Site Contact Information
Part C.
Roject Site Contact Information
............................................................................................................................................................................................................................................................................................................................................................................................
1. Type of Individual
Ownership*
2. Primary Site Kip
Contact - First
Name *
3. Primary Site Hilton
Contact - Last
Name *
4. Title
5. Site Contact E- [e-mail]
mail Address*
6. Site Contact [phone]
Telephone No.*
7. Organization
Name
8. Site Contact Street Address
Mailing Address* 5979 Appaloosa Way
Address Line 2
City
Granite Falls
Rbstal / Zip Code
28630-9315
9. Consultant Name (Optional)
First and Last name
10. Consultant E- This person will be copied on all correspondence.
mail
11. Consultant
Telephone No.
State / Frovince / fbgion
NC
Country
Us

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 12/09/2019
Approved *
2. E&SC Plan Project CALDW-2020-011
Number/ID * Assigned by agency or local program
3. E&SC Plan r 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 LOAwMPR & COPA 12-9-2019.docx-2.pdf 124.17KB
Approval Wst be RDFfornat
letter/documentation
6. NOI Certification NCG01 NOI Form.pdf 448.72KB
Form Mist be R7Ffon-rat
This is an Express f No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.6E (i) 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 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
f Authorized Responsible Person*
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 * Dewey Kip Hilton
Title President
Organization Hilton Inc.
Date * 12/13/2019

F. Tracking and COC Info
NOI Tracking No. 19531
NC Reference No. NCG01-2019-3194
Uses 'count number' variable (incremrented by SP)
Certificate of NCC193194
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 3194
Sequential number for submittal that is incremented by Stored Frocedure
COC Year 2019
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)