NCC201838_NOI Application_20200511

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 5/4/2020 6:09:24 PM (NCG01 NOI Submission)
Approve by Clark, Paul 5/5/2020 9:54:22 AM (Review- Construction NOI 25116)
. The task was assigned to Clark, Paul by round robin distribution 5/4/2020 6:09 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: May 6, 2020 5:00 PM
5/4/2020 6:09 PM
Submit by McCoy, Suzanne 5/11/2020 7:15:19 AM (Payment Verification for NCC201838)
* J Nicholas Childs
• McCoy, Suzanne assigned the task to McCoy, Suzanne 5/11/2020 7:14 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: June 16, 2020 5:00 PM
5/5/2020 9:55 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 * Scarborough Mitigation Project
1 b. Specific Lot This field nay be used to list specifc lot nunbers.
Numbers
2. County* Wayne
3. Highway or Street Casey Mill Road
Address* Street narre only is acceptable if no address number assigned yet
4.City orTownship* Dudley
5. State * NC
6. Zip Code * 28333
7. Latitude* Enter the latitude in decirral degrees
35.3211
8. Longitude* Enter the longitude in decir al degrees (MJST be negative)
-77.9897
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*
05/11/2020
Estimated Construction Project Start Date
10. Date to End*
12/31/2020
Estimated Construction Project End Date
11. SIC (Primary) *
Other (9999)
Standard Industrial aassification for Developrrent
12. Acres to be
250.40
disturbed*
(including off -site borrow and waste areas)
13. Total site area 261.88
(acres) *

14. Post- 0.01
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-WAYNE-2020-Scarborough Mitigation Project
Tracking ID Assigned autorretically
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 Neuse River
Waterbody* %rm of waterbody into which storrrwater runoff will discharge
15b. Waterbody 27-(56)
Index No.* NCWaterbody Index Nurrber
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 *
Water and Land Solutions
IF pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name *
Kayne
If Corporation, enter Faegistered Agent First %rre
3. Last Name*
VanStell
IF Corporation, enter F;bgistered Agent Last %ne
3b. Title
Vice President, Ecosystem Design Services
4. Permitee E-mail [e-mail]
Address*
5. Permittee [phone]
Telephone No.*
6. Permittee Mailing Street Address
Address* 7721 Six Forks Road
Address Line 2
Suite 130
aty
Raleigh
Fbstal / Zip Code
27615
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
7721 Six Forks Road
Address Line 2
Suite 130
city
Raleigh
Fbstal / Zip Code
27615
8. Type of Non -Government
Ownership *
State / Frovince / Fbgion
NC
Country
us
State / Frovince / Region
NC
Country
us

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Nick
Contact - First
Name *
2. Primary Site
Childs
Contact - Last
Name *
3. Title
Restoration Designer
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
[phone]
Telephone No.
6. Organization
Water and Land Solutions
Name
7. Site Contact
Street Address
Mailing Address*
7721 Six Forks Road
Address Line 2
Suite 130
city
Raleigh
Fbstal / Zip Code
27615
8. Consultant Name
(Optional)
Nick Childs
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
[phone]
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 03/19/2020
Approved *
2. E&SC Plan Project Wayne-2020-015
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. 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
Wayne-2020-015 Scarborough Mitigation Project -
Approval letter or
1.2MB
03192020.pdf
Grading Permit
Mast be RDFforrrat
6. Site Location Map
Helpful for linear project review
(Optional)
Map 1_Project Location.pdf 2.61MB
Mast be RDFfornat. Rease do not upload entire set of E&SCplans.
7. Notes (Optional)
Provide 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
NCG01-eNO1-Certification-Form-20190919-DEMLR-
Form
911.47KB
SW.pdf
Mast be R7Ffon-rat
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
ILAYAX VAV 5M-L
Type Name * Kayne Van Stell
Title Vice President, Ecosystem Design Services
Organization Legally Responsible Entity
Water and Land Solutions
Date * 05/04/2020

F. Tracking and COC Info
NOI Tracking No. 25116
NC Reference No. NCG01-2020-1838
Uses 'count number' variable (incremrented by SP)
Certificate of NCC201838
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 1838
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.)