NCC200071_NOI Application_20200107

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/6/2020 12:17:22 PM (NCG01 NOI Submission)
Approve by McCoy, Suzanne 1/7/2020 10:46:44 AM (Review- Construction NOI 20244)
• The task was assigned to McCoy, Suzanne by round robin distribution 1/6/2020 12:17 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 8, 2020 5:00
PM 1/6/2020 12:17 PM
Submit by McCoy, Suzanne 1/7/2020 11:34:23 AM (Payment Verification for NCC200071)
* Glenn White
• McCoy, Suzanne assigned the task to McCoy, Suzanne 1/7/2020 11:33 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: February 18, 2020 5:00
PM 1/7/2020 10:46 AM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name * McPherson Heirs - Clearing & Grubbing
2. County* Camden
3. Highway or Street NC 343
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* South Mills
5. State * NC
6. Zip Code * 27976
7. Latitude * Enter the latitude in decirral degrees
36.4657
8. Longitude* Enter the longitude in decinal degrees (M. ST be negative)
-76.3356
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*
01/06/2020
Estirrated Construction Project Start Cate
10. Date to End*
05/04/2020
Estimated Construction Project End Cute
11. SIC (Primary)*
Other (0000)
Standard Industrial Classification for Ceveloprrent
12. Acres to be
1.50
disturbed*
(including off -site borrow and waste areas)
13. Total site area
6.40
(acres) *
14. Post-
0.00
construction
(Estimated)
impervious area
(acres) *
NCC Project
NCC-CAMDE-2020-McPherson Heirs - Clearing & Grubbing
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. 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 Dismal Swamp Canal
Wate rbody* Ibrre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 30-3-2
Index No.* NCWaterbody Index Number
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 McPherson Heirs
Name *
2. First Name* Virginia Ann M.
IF Corporation, enter Fbgistered Agent First Barre
3. Last Name* White
IF Corporation, enter F3egistered Agent Last %rre
3b. Title Owner
4. Permitee E-mail [e-mail]
Address *
5. Permittee 610-388-7586
Telephone No.*
6. Permittee Mailing Street Address
Address* 46 Blue Stone Drive
Address Line 2
city
Chadds Ford
Fbstal / Zip Code
19317-9311
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
46 Blue Stone Drive
Address Line 2
City
Chadds Ford
Fbstal / Zip Code
19317-9311
State / Frovince / Region
PA
Country
us
State / Frovince / Fbgion
PA
Country
us

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Type of
Individual
Ownership *
2. Primary Site
Glenn
Contact - First
Name *
3. Primary Site
White
Contact - Last
Name *
4. Title
spouse of heir
5. Site Contact E-
[e-mail]
mail Address*
6. Site Contact
610-388-7586
Telephone No.*
7. Organization
McPherson Heirs
Name
8. Site Contact
Street Address
Mailing Address*
46 Blue Stone Drive
Address Line 2
1805 West City Drive, Unit E
Cty
Elizabeth City
Fbstal / Zip Code
27909
9. Consultant Name
(Optional)
Kimberly Hamby
First and Last narre
10. Consultant E-
[e-mail]
mail
This person will be copied on all correspondence.
11.Consultant
252-621-5029
Telephone No.
State / Rovince / Fbgion
NC
Country
United States

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 12/11/2019
Approved *
2. E&SC Plan Project Camde-2020-003
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 * Washington (WaRO)
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 Camde-2020-003 McPherson Heirs - Clearing
Approval 1.12MB
Grubbing - 12182019.pdf
letter/documentation
Mist be R7Ffon-rat
6. NOI Certification McPherson Heirs.pdf 982.64KB
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 * Virginia Ann M. White
Title Mrs.
Organization McPherson Heirs
Date * 01 /06/2020

F. Tracking and COC Info
NOI Tracking No. 20244
NC Reference No. NCG01-2020-0071
Uses 'count number' variable (incremrented by SP)
Certificate of NCC200071
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 71
Sequential number for submittal that is incremented by Stored Frocedure
COC Year 2020
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)