NCC201467_NOI Application_20200420

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 4/13/2020 10:05:24 AM (NCG01 NOI Submission)
Approve by Clark, Paul 4/13/2020 10:24:07 AM (Review- Construction NOI 24227)
• The task was assigned to Clark, Paul by round robin distribution 4/13/2020 10:06 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: April 15, 2020 5:00 PM
4/13/2020 10:06 AM
Submit by Garcia, Lauren V 4/20/2020 10:16:26 AM (Payment Verification for NCC201467)
* County of Wilkes
• Garcia, Lauren V assigned the task to Garcia, Lauren V 4/20/2020 10:15 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: May 25, 2020 5:00 PM
4/13/2020 10:24 AM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting IT No
an NOI that was r Yes
rejected before?
1a. Project Name * Wilkes County Landfill, Phase 5 Expansion
1 b. Specific Lot This field rray be used to list specifc lot numbers.
Numbers
2. County* Wilkes
3. Highway or Street 9219 Elkin Hwy
Address* Street narre only is acceptable if no address number assigned yet
4. City or Township* Roaring River
5. State * NC
6. Zip Code * 28669
7. Latitude* Enter the latitude in decimal degrees
36.2125
8. Longitude* Enter the longitude in decimal degrees (M.JST be negative)
-80.9888
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*
04/20/2020
Estinated Construction Project Start Date
10. Date to End*
11/20/2020
Estirrated Construction Project End Date
11. SIC (Primary) *
0000
Standard Industrial Classification for Leveloprrent
12. Acres to be
5.30
disturbed*
(including off -site borrow and waste areas)
13. Total site area 145.00
(acres) *

14. Post- 1.00
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-WILKE-2020-Wilkes County Landfill, Phase 5 Expansion
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 Yadkin River
Waterbody* Ilarre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 12-(45)
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. ^
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
Legally Pesponsible Entity
Name *
County of Wilkes
It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name *
Anderia
If Corporation, enter Faegistered Agent First %rre
3. Last Name*
Byrd
It Corporation, enter Pbegistered Agent Last %ne
3b. Title
Solid Waste Director
4. Permitee E-mail [e-mail]
Address*
5. Permittee 336-696-5806
Telephone No.*
6. Permittee Mailing Street Address
Address* PO Box389
Address Line 2
City
Roaring River
Fbstal / Zip Code
28669
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address *
F Yes
Street Address
9219 Elkin Highway
Address Line 2
city
Roaring River
Fbstal / Zip Code
28669
8. Type of Government - County
Ownership*
State / Rovince / F;bgion
NC
Country
USA
State / Ftovince / Faegion
NC
Country
US

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
..........................................................................................................................................................................................................
1. Primary Site
Anderia
Contact - First
Name *
2. Primary Site
Byrd
Contact - Last
Name *
3. Title
Solid Waste Management Director
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
[phone]
Telephone No.
6. Organization
Wilkes County Department of Solid waste
Name
7. Site Contact
Street Address
Mailing Address*
9219 Elkin Highway
Address Line 2
city
Roaring River
Fbstal / Zip Code
28669
8. Consultant Name
(Optional)
LaBella Associates
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
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 10/25/2019
Approved *
2. E&SC Plan Project WILKE-2020-004
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 * Winston-Salem (WSRO)
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 Wilkes County - E&S Plan Approval .pdf 7.49MB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Helpful for linear project review
(Optional) Mast be FCFfornat. Rease do not upload entire set of E&SCplans.
7. Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded docurrents support
the application. Include additional waterbodies for linear projects if necessary.
8. NOI Certification enoi p5 certificatio.pdf 742.34KB
Form Mist be RDFfornat
This is an Express r 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 * Anderia Byrd
Title Solid Waste Director
Organization Legally Responsible Entity
County of Wilkes
Date * 04/13/2020

F. Tracking and COC Info
NOI Tracking No. 24227
NC Reference No. NCG01-2020-1467
Uses 'count number' variable (incremrented by SP)
Certificate of NCC201467
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 1467
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.)