NCC200533_NOI Application_20200217

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 2/10/2020 11:34:59 AM (NCG01 NOI Submission)
Approve by McCoy, Suzanne 2/10/2020 3:52:34 PM (Review- Construction NOI 21704)
• The task was assigned to McCoy, Suzanne by round robin distribution 2/10/2020 11:35 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: February 12, 2020 5:00
PM 2/10/2020 11:35 AM
Submit by McCoy, Suzanne 2/17/2020 11:34:19 AM (Payment Verification for NCC200533)
* Vanguard Ventures
• McCoy, Suzanne assigned the task to McCoy, Suzanne 2/17/2020 11:33 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: March 23, 2020 5:00 PM
2/10/2020 3:52 PM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name * Dollar General- Lizard Lick
2. County* Wake
3. Highway or Street 1800 Lizard Lick Road
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* Zebulon
5. State * NC
6. Zip Code * 27597
7. Latitude * Enter the latitude in decimal degrees
35.8170
8. Longitude* Enter the longitude in decimal degrees (M. ST be negative)
-78.3747
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*
02/14/2020
Estimated Construction Project Start Date
10. Date to End*
06/20/2020
Estimated Construction Project End Cute
11. SIC (Primary)*
Commercial (1542)
Standard Industrial aassification for Developrrent
12. Acres to be
1.33
disturbed*
(including off -site borrow and waste areas)
13. Total site area
1.54
(acres) *
14. Post-
0.64
construction
(Estimated)
impervious area
(acres) *
NCC Project
NCC-WAKE-2020-Dollar General- Lizard Lick
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 Fall Branch
Wate rbody* INbrre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 27-57-9
Index No.* NCWaterbody Index Nirrber
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. ^
F2rnittee 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 Vanguard Ventures LLC
Name *
2. First Name* George
IF Corporation, enter Fbgistered Agent First Barre
3. Last Name* Barnes
If Corporation, enter Faegistered Agent Last %rre
3b. Title member/manager
4. Permitee E-mail [e-mail]
Address *
5. Permittee 9194592601
Telephone No.*
6. Permittee Mailing Street Address
Address* 3825 Barrett Drive
Address Line 2
Suite 100
City State / Ftovince / Faegion
Raleigh NC
Fostal / Zip Code Country
27609 USA
Check box if the rJ Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
3825 Barrett Drive
Address Line 2
Suite 100
City
State / Frovince / Fbgion
Raleigh
NC
Fbstal / Zip Code
Country
27609
USA
8. Type of
Non -Government
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Ashley
Contact - First
Name *
2. Primary Site
Davis
Contact - Last
Name *
3. Title
project manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
9194592603
Telephone No.
6. Organization
Vanguard Ventures LLC
Name
7. Site Contact
Street Address
Mailing Address*
3825 Barrett Drive
Address Line 2
Suite 100
city
Raleigh
Fbstal / Zip Code
27609
8. Consultant Name
(Optional)
First and Last narre
9. Consultant E-mail
This person will be copied on all correspondence.
10. Consultant
Telephone No.
State / Rovince / Region
NC
Country
USA

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 01/10/2019
Approved *
2. E&SC Plan Project SEC-027007-2019
Number/ID * Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* Wake County
Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a
complete application. For linear projects, please also upload a site map showing the overall extent of the project.
5. E&SC Plan Dollar General - Lizard
Approval Lick WatershedManagementApproval_V.2 1-10- 325.2KB
letter/documentation
20.pdf
Mist be RDFfornat
Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded docurrents support
the application.
6. NOI Certification NOI - Lizard Lick.pdf 532.84KB
Form Mist be RDFfornat
This is an Express r No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.66 (1) 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 If the Erosion and Sediment Control Plan approved by the delegated program is
not compliant with Part II (Stormwater Pollution Prevention Plan) of the
NCG010000 General Permit. I will nonetheless ensure that all conditions of Part
II of the permit are met on the project at all times.
* 17 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* George Barnes
Title member/manager
Organization Vanguard Ventures LLC
Date * 02/10/2020

F. Tracking and COC Info
NOI Tracking No. 21704
NC Reference No. NCG01-2020-0533
Uses 'count number' variable (incremrented by SP)
Certificate of NCC200533
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 533
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.)