NCC201953_NOI Application_20200513

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 5/6/2020 9:30:18 AM (NCG01 NOI Submission)
Approve by Farkas, Jim J 5/11/2020 3:52:35 PM (Review- Construction NOI 25195)
• Morman, Alaina reassigned the task to Farkas, Jim J 5/6/2020 11:33 AM
. The task was assigned to Morman, Alaina by round robin distribution 5/6/2020 9:30 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: May 8, 2020 5:00 PM
5/6/2020 9:30 AM
Submit by McCoy, Suzanne 5/13/2020 7:37:43 AM (Payment Verification for NCC201953)
* Debbie Dodson
• McCoy, Suzanne assigned the task to McCoy, Suzanne 5/13/2020 7:37 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: June 22, 2020 5:00 PM
5/11/2020 3:52 PM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting r No
an NOI that was r Yes
rejected before?
Previous Rejected 24999
NOI No.
Prior Reviewer
Name
1a. Project Name * Western North Carolina Stream Initiative - Beasley Site
1 b. Specific Lot This field may be used to list specffc lot numbers.
Numbers
2. County* Avery
3. Highway or Street 1064 Shawneehaw Avenue
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* Banner Elk
5. State * NC
6. Zip Code * 28604
7. Latitude * Enter the latitude in decimal degrees
36.1520
8. Longitude* Enter the longitude in decimal degrees (M. ST be negative)
-81.8656
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* 05/13/2020
Estimated Construction Project Start Date
10. Date to End* 07/31/2020
Estimated Construction Project End Cute
11. SIC (Primary) * Other (9999)
Standard Industrial Classification for Ceveloprrent

12. Acres to be 5.00
disturbed* (including off -site borrow and waste areas)
13. Total site area 28.00
(acres) *
14. Post- 0.00
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-AVERY-2020-Western North Carolina Stream Initiative -
Tracking ID Beasley Site
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 Elk River
Wate rbody* N larre of waterbody into which stormwater runoff will discharge
15b. Waterbody 8-22-(3)
Index No.* NCWaterbody Index Number
Stormwater rJ 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
Legally Pesponsible Entity
Name *
Resource Institute, Inc.
It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name *
Debbie
If Corporation, enter Faegistered Agent First %rre
3. Last Name*
Dobson
It Corporation, enter Pegistered Agent Last %ne
3b. Title
CFO
4. Permitee E-mail [e-mail]
Address*
5. Permittee 336-750-0522
Telephone No.*
6. Permittee Mailing Street Address
Address* 2631 Reynolda Road
Address Line 2
aty
Winston-Salem
F bstal / Zip Code
27106-3862
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address *
V Yes
Street Address
2631 Reynolda Road
Address Line 2
city
Winston-Salem
Fbstal / Zip Code
27106-3862
8. Type of Non -Government
Ownership*
State / Rovince / F;bgion
NC
Country
us
State / Frovince / Faegion
NC
Country
us

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
_...............................................................................................................................................................
1. Primary Site
Aaron
Contact - First
Name *
2. Primary Site
Earley
Contact - Last
Name *
3. Title
Project Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
704-332-7754
Telephone No.
6. Organization
Wildlands Engineering, Inc.
Name
7. Site Contact
Street Address
Mailing Address*
1430 South Mint Street
Address Line 2
Suite 104
city
Charlotte
Fbstal / Zip Code
28203
8. Consultant Name
(Optional)
First and Last nacre
9. Consultant 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 04/27/2020
Approved *
2. E&SC Plan Project AVERY-2020-003
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
LOAwMPR & COPA 4-27-2020.docx.pdf 120.52KB
Approval letter or
Mast beRDFformat
Grading Permit
6. Site Location Map
Helpful for linear project review
(Optional)
Mast be FDFfornat. 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
NCG01-eNO1-Certification-Form-20190919-DEMLR-
Form
2.26MB
SW.pdf
Mast be FDFfon-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 Atide; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case under this Atcle; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring device or method required to be operated or maintained under this Atide or rules of the
Commission implementing this Atcle 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 * Debbie Dodson
Title CFO
Organization Legally Plesponsible Entity
Resource Institute, Inc.
Date * 05/06/2020

F. Tracking and COC Info
NOI Tracking No. 25195
NC Reference No. NCG01-2020-1953
Uses 'count number' variable (incremrented by SP)
Certificate of NCC201953
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 1953
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.)