NCC202570_NOI Application_20200623

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/17/2020 3:50:13 PM (NCG01 NOI Submission)
Approve by Clark, Paul 6/17/2020 4:09:07 PM (Review- Construction NOI 27171)
• The task was assigned to Clark, Paul by round robin distribution 6/17/2020 3:51 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: June 19, 2020 5:00 PM
6/17/2020 3:51 PM
Submit by Selkane, Aziza 6/23/2020 8:05:08 AM (Payment Verification for NCC202570)
* Tim J Manson
• Selkane, Aziza assigned the task to Selkane, Aziza 6/23/2020 8:04 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: July 29, 2020 5:00 PM
6/17/2020 4:09 PM

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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 * Half Way Tree MHP Sewer Extension
1 b. Specific Lot This field nay be used to list specifc lot nunbers.
Numbers
2. County* Henderson
3. Highway or Street 248 Ironwood Dr
Address* Street narre only is acceptable if no address number assigned yet
4. City or Township* Hendersonville
5. State * NC
6. Zip Code * 28739
7. Latitude* Enter the latitude in decimal degrees
35.2890
8. Longitude* Enter the longitude in decinal degrees (MUST be negative)
-82.4480
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*
06/19/2020
Estimated Construction Project Start Date
10. Date to End *
10/16/2020
Estimated Construction Project End [date
11. SIC (Primary)*
Residential, Other than SFE (1522)
Standard Industrial aassification for Developrrent
12. Acres to be
2.80
disturbed*
(including off -site borrow and waste areas)
13. Total site area 19.08
(acres) *

14. Post- 0.00
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-HENDE-2020-Half Way Tree MHP Sewer Extension
Tracking ID Assignedautorraticaly
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 Meninger Creek
Waterbody * %rre of waterbody into which stornwater runoff will discharge
15b. Waterbody 6-55-8-1-2-3
Index No.* NCWaterbody Index Nunber
Stormwater r No
discharges will flow pr Yes
to additional
wate rs *
15c. Additional King Creek
Receiving Waterbody narre
Waterbody
15d. Waterbody 6-55-8-1-2-1
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. ^
Fbrnittee 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 %sponsible Entity
Name *
MVF Half Way Tree LLC
IF pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name *
Tim
IF Corporation, enter Faegistered Agent First %rre
3. Last Name*
Manson
IF Corporation, enter F;bgistered Agent Last %ne
3b. Title
Chief Operating Officer
4. Permitee E-mail [e-mail]
Address*
5. Permittee 423-309-0130
Telephone No.*
6. Permittee Mailing Street Address
Address* PO Box6010
Address Line 2
aty
Spartanburg
Fbstal / Zip Code
29304
Check box if the F Yes
street address the
same as mailing
address
State / Rovince / Pbegion
SC
Country
USA
7. Permittee Street
Street Address
Address*
1451 East Main Street
Address Line 2
Suite 2C
Qty
State / Ftovince / Faegion
Spartanburg
SC
Fbstal / Zip Code
Country
29302
USA
8. Type of
Non -Government
Ownership

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Tim
Contact - First
Name *
2. Primary Site
Manson
Contact - Last
Name *
3. Title
Chief Operating Officer
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
423-309-0130
Telephone No.
6. Organization
MVF Half Way Tree LLC
Name
7. Site Contact
Street Address
Mailing Address*
1451 East Main Street
Address Line 2
Suite 2C
city
Spartanburg
Postal / Zip Code
29302
8. Consultant Name
(Optional)
Timothy Thomason
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
864-630-7524
Telephone No.
State / Rovince / Region
SC
Country
USA

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 06/17/2020
Approved *
2. E&SC Plan Project 2020-053
Number/ID * Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* Henderson County
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 20200053 HALF WAY TREE SWR LOA 6-17-
Approval letter or 134.16KB
2020.pdf
Grading Permit
Mast be FDFfon-rat
6. Site Location Map Helpful for linear project review
(Optional) Henderson CoGIS. pdf 1.43MB
Mast be RDFfornat. 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 documents support
the application. Include additional waterbodies for linear projects if necessary.
8. NOI Certification NCG01-eNO1-Certification-Form-20190919-DEMLR-
Form 702.67KB
SW(Signed).pdf
Mast be FCFfon-rat
This is an Express r No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.66 (1) 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 If the Erosion and Sediment Control Plan approved by the delegated program is
not compliant with Part II (Stormwater Pollution Prevention Plan) of the
NCG010000 General Permit. I will nonetheless ensure that all conditions of Part
II of the permit are met on the project at all times.
* 17 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
60l-
Type Name* Tim J. Manson IV
Title Chief Operating Officer
Organization Legally Iesponsible Entity
MVF Half Way Tree LLC
Date * 06/17/2020

F. Tracking and COC Info
NOI Tracking No. 27171
NC Reference No. NCG01-2020-2570
Uses 'count number' variable (incremrented by SP)
Certificate of NCC202570
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 2570
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.)