NCC201241_NOI Application_20200326

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 3/26/2020 11:57:58 AM (NCG01 NOI Submission)
Approve by McCoy, Suzanne 3/26/2020 12:33:46 PM (Review- Construction NOI 23676)
• The task was assigned to McCoy, Suzanne by round robin distribution 3/26/2020 11:58 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 30, 2020 5:00
PM 3/26/2020 11:58 AM
Submit by Garcia, Lauren V 3/26/2020 1:08:42 PM (Payment Verification for NCC201241)
* DH Griffin Infrastructure LLC
• Garcia, Lauren V assigned the task to Garcia, Lauren V 3/26/2020 1:05 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: May 7, 2020 5:00 PM
3/26/2020 12:33 PM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
la. Project Name* SITE IMPROVEMENTS FOR LNR
1 b. Specific Lot This field may be used to list specifc lot nunbers.
Numbers
2. County* Caldwell
3. Highway or Street 708 LYNHAVEN ST SW
Address* Street name only is acceptable if no address number assigned yet
4. CityorTownship* LENOIR
5. State * NC
6. Zip Code* 28645
7. Latitude* Enter the latitude in decimal degrees
35.8975
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-81.5481
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*
04/01/2020
Estimated Construction Project Start Date
10. Date to End*
04/01/2021
Estinated Construction Project End Date
11. SIC (Primary)*
Industrial (1541)
Standard Industrial C]assification for Development
12. Acres to be
63.00
disturbed*
(including off -site borrow and waste areas)
13. Total site area 207.20
(acres)*
14. Post- 25.00
construction (Estirated)
impervious area
(acres) *

NCC Project NCC-CALDW-2020-SITE IMPROVEMENTS FOR LNR
Tracking ID Assignedautorratically
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 Lower Creek
Wate rbody* Nacre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 11-39-(0.5)
Index No. * NC Waterbody Index Minter
Stormwater V No
discharges will flow r Yes
to additional
wate rs *
16a. Is this project r 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 D.H. Griffin Infrastructure, LLC
Name * If pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name* David
IF Corporation, enter Fbgistered Agent First Barre
3. Last Name* Griffin Jr.
If Corporation, enter Faegistered Agent Last Wre
3b. Title Owner
4. Permitee E-mail [e-mail]
Address *
5. Permittee 3368557030
Telephone No.*
6. Permittee Mailing Street Address
Address* 4716 Hilltop Road
Address Line 2
city State / Frovince / Region
Greensboro NC
Fbstal / Zip Code Country
27407 us
Check box if the rJ Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
4716 Hilltop Road
Address Line 2
City
State / Ffovince / Plegion
Greensboro
NC
Flostal / Zip Code
Country
27407
us
8. Type of
Non -Government
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Clayton
Contact - First
Name *
2. Primary Site
Fleming
Contact - Last
Name *
3. Title
Project Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
8283100423
Telephone No.
6. Organization
D.H. Griffin Infrastructure, LLC
Name
7. Site Contact
Street Address
Mailing Address*
4449 Little Mountain Road
Address Line 2
city
Catawba
Postal / Zip Code
28609-8209
8. Consultant Name
(Optional)
Caleb Peeler
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
7043386771
Telephone No.
State / Rovince / Region
NC
Country
us

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 03/13/2020
Approved *
2. E&SC Plan Project CALDW-2013-006
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. For linear projects, please also upload a site map showing the overall extent of the project or
include the beginning point and end point coordinates in the "Notes" box below.
5. E&SC Plan LOAwPR pdf (3-13-2020).pdf 1.11MB
Approval letter or Mast beRDFforml
Grading Permit
Site Map (Optional) Helpful for linear project review
Mast be R7Fform3t
Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded documents support
the application. Include additional w aterbodies for linear projects if necessary.
6. NOI Certification Substation Notice of Intent.pdf 549.18KB
Form Mast be FDFfon-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
r 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
C tear. &t ' C'�t t
Type Name * Christopher Carter
Title Manager
Organization D.H. Griffin Infrastructure, LLC
Date * 03/26/2020

F. Tracking and COC Info
NOI Tracking No. 23676
NC Reference No. NCG01-2020-1241
Uses 'count number' variable (incremrented by SP)
Certificate of NCC201241
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 1241
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.)