NCC202208_NOI Application_20200601

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 5/22/2020 9:25:38 AM (NCG01 NOI Submission)
Approve by Garcia, Lauren V 5/26/2020 4:40:15 PM (Review- Construction NOI 26007)
Reviewer confirmed with Fred Walker that the approved acreage is 3.91.
• The task was assigned to Garcia, Lauren V by round robin distribution 5/22/2020 9:26 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: May 26, 2020 5:00 PM
5/22/2020 9:26 AM
Submit by Garcia, Lauren V 6/1/2020 12:42:31 PM (Payment Verification for NCC202208)
* Graham County & Rural DevAuth
• Garcia, Lauren V assigned the task to Garcia, Lauren V 6/1/2020 12:40 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: July 7, 2020 5:00 PM
5/26/2020 4:40 PM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting f• No
an NOI that was r Yes
rejected before?
1a. Project Name * Moose Branch Subdivision
1 b. Specific Lot This field nay be used to list specifc lot nunbers.
Numbers
2. County* Graham
3. Highway or Street Moose Branch Road
Address* Street narre only is acceptable if no address number assigned yet
4. City or Township* Robbinsville
5. State * NC
6. Zip Code * 28771
7. Latitude* Enter the latitude in decirral degrees
35.3265
8. Longitude* Enter the longitude in decir al degrees (NALIST be negative)
-83.8190
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*
06/22/2020
Estimated Construction Project Start Date
10. Date to End *
03/22/2021
Estimated Construction Project End [date
11. SIC (Primary)*
Residential, Single Family Houses (SFE) (1521)
Standard Industrial Classification for Developrrent
12. Acres to be
3.91
disturbed*
(including off -site borrow and waste areas)
13. Total site area 11.88
(acres) *

14. Post- 1.20
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-G RAHA-2020- Moose Branch Subdivision
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 Unnamed Tributary to Mauney Branch
Waterbody* Kane of waterbody into which storrrwater runoff will discharge
15b. Waterbody 2-190-4-9
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 * Graham County Rural Development Authority
It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name * Brian
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Johnson
It Corporation, enter F;bgistered Agent Last %ne
3b. Title Chairman of the Board
4. Permitee E-mail [e-mail]
Address*
5. Permittee 828-479-7984
Telephone No.*
6. Permittee Mailing Street Address
Address* 12 N. Main Street
Address Line 2
City
Robbinsville
Fbstal / Zip Code
28771
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address *
V Yes
Street Address
12 N. Main Street
Address Line 2
city
Robbinsville
Fbstal / Zip Code
28771
8. Type of Government - County
Ownership*
State / Rovince / F;bgion
NC
Country
Graham
State / Ftovince / Region
NC
Country
Graham

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Brian
Contact - First
Name *
2. Primary Site
Johnson
Contact - Last
Name *
3. Title
Chairman of the Board
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
828-479-7984
Telephone No.
6. Organization
Graham County Rural Development
Name
Authority
7. Site Contact
Street Address
Mailing Address*
12 N. Main Street
Address Line 2
city
Robbinsville
Fbstal / Zip Code
28771
8. Consultant Name
(Optional)
Christine Brown CPSWQ, CPESC
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
828-234-2044
Telephone No.
State / Rovince / Region
NC
Country
Graham

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................................................................................................__
1. Date E&SC Plan 04/03/2020
Approved *
2. E&SC Plan Project GRAHA-2020-001
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 4-3-2020.docx.pdf 128.65KB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Helpful for linear project review
(Optional) Area Map.pdf 685.25KB
Mast be RDFfon- at. Rease do not upload entire set of E&SCplans.
7. Notes (Optional) Rovide 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 DOI GCRDA.pdf 524.95KB
Form Wst 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
fYJ lfr w' 01&w -w
Type Name * Brian Johnson
Title Chairman of the Board
Organization Legally Plesponsible Entity
Graham County Rural Development
Date * 05/22/2020

F. Tracking and COC Info
NOI Tracking No. 26007
NC Reference No. NCG01-2020-2208
Uses 'count number' variable (incremrented by SP)
Certificate of NCC202208
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 2208
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.)