NCC201704_NOI Application_20200428

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 4/24/2020 4:56:42 PM (NCG01 NOI Submission)
Approve by Clark, Paul 4/27/2020 8:25:43 AM (Review- Construction NOI 24810)
• The task was assigned to Clark, Paul by round robin distribution 4/24/2020 4:56 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: April 28, 2020 5:00 PM
4/24/2020 4:56 PM
Submit by McCoy, Suzanne 4/28/2020 7:51:05 AM (Payment Verification for NCC201704)
* Brent Detwiler City of Hendersonville
• McCoy, Suzanne assigned the task to McCoy, Suzanne 4/28/2020 7:50 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: June 8, 2020 5:00 PM
4/27/2020 8:25 AM

.• SThF� ';
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 *
Northside Water System Improvements
1 b. Specific Lot
This field may be used to list specifc lot numbers.
Numbers
Parcel ID 9652672788
Parcel ID 9663544661
2. County*
Henderson
3. Highway or Street 999 Woodhill Drive
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* Fletcher
5. State * NC
6. Zip Code * 28732
7. Latitude * Enter the latitude in decimal degrees
35.4246
8. Longitude* Enter the longitude in decir al degrees (M. ST be negative)
-82.5041
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*
06/01/2020
Estimated Construction Project Start Date
10. Date to End*
07/01/2020
Estimated Construction Project End Cute
11. SIC (Primary) *
Other (9999)
Standard Industrial aassification for Ceveloprrent
12. Acres to be
1.46
disturbed*
(including off -site borrow and waste areas)
13. Total site area 5.91
(acres) *

14. Post- 0.43
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-HENDE-2020-Northside Water System Improvements
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 Cane Creek
Waterbody * %rre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 6-57-(9)
Index No.* NCWaterbody Index Number
Stormwater r No
discharges will flow pr Yes
to additional
wate rs *
15c. Additional Hoopers Creek
Receiving Waterbody narre
Waterbody
15d. Waterbody 6-57-19
Index No. NCWaterbody Index Narrber
15e. Additional Waterbody narre
Receiving
Waterbody
15f. Waterbody NCWaterbody Index N nber
Index No.
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. ^
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 Legally Pesponsible Entity
Name * City of Hendersonville
It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name * Brent
IF Corporation, enter Faegistered Agent First %rre
3. Last Name* Detwiler
It Corporation, enter F;bgistered Agent Last %ne
3b. Title City Engineer
4. Permitee E-mail [e-mail]
Address*
5. Permittee 828-697-3060
Telephone No.*
6. Permittee Mailing Street Address
Address* 305 Williams Street
Address Line 2
aty
State / Rovince / F;bgion
Hendersonville
NC
Fbstal / Zip Code
Country
28792
us
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
305 Williams Street
Address Line 2
city
State / Frovince / Region
Hendersonville
NC
Fbstal / Zip Code
Country
28792
us
8. Type of
Government - Municipal
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Brent
Contact - First
Name *
2. Primary Site
Detwiler
Contact - Last
Name *
3. Title
City Engineer
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
828-697-3060
Telephone No.
6. Organization
City of Hendersonville
Name
7. Site Contact
Street Address
Mailing Address*
305 Williams Street
Address Line 2
city
Hendersonville
Fbstal / Zip Code
28792
8. Consultant Name
(Optional)
Zachary Trammel
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
336-301-2626
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 07/29/2019
Approved *
2. E&SC Plan Project HENDE 2019-011
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. 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 LOAwM revision 7-29-2019.docx.pdf 84.17KB
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 20200424_eNO1_DEMLR_signed.pdf 1.11MB
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 * Brent Detwiler, PE
Title City Engineer
Organization Legally Plesponsible Entity
City of Hendersonville
Date * 04/24/2020

F. Tracking and COC Info
NOI Tracking No. 24810
NC Reference No. NCG01-2020-1704
Uses 'count number' variable (incremrented by SP)
Certificate of NCC201704
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 1704
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.)