NCC202681_NOI Application_20200625

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 6/23/2020 3:47:55 PM (NCG01 NOI Submission)
Approve by Morman, Alaina 6/24/2020 1:38:48 PM (Review- Construction NOI 27391)
. The task was assigned to Morman, Alaina by round robin distribution 6/23/2020 3:48 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: June 25, 2020 5:00 PM
6/23/2020 3:48 PM
Submit by Selkane, Aziza 6/25/2020 7:44:36 AM (Payment Verification for NCC202681)
* ALex T carter
• Selkane, Aziza assigned the task to Selkane, Aziza 6/25/2020 7:43 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: August 5, 2020 5:00 PM
6/24/2020 1:39 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 * High Knoll Subdivision, Section 3
1 b. Specific Lot This field any be used to list specifc lot numbers.
Numbers 34
2. County* Forsyth
3. Highway or Street Cranfill Lane, Walkertown, NC 27051
Address* Street narre only is acceptable if no address number assigned yet
4.CityorTownship* Walkertown
5. State * NC
6. Zip Code * 27051
7. Latitude* Enter the latitude in decimal degrees
36.1535
8. Longitude* Enter the longitude in decimal degrees (M.JST be negative)
-80.1516
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*
06/29/2020
Estimated Construction Project Start Date
10. Date to End *
06/25/2021
Estinated Construction Project End Date
11. SIC (Primary)*
Residential, Single Family Houses (SFE) (1521)
Standard Industrial Classification for Developrrent
12. Acres to be
14.00
disturbed*
(including off -site borrow and waste areas)
13. Total site area 22.05
(acres) *

14. Post- 3.96
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-FORSY-2020-High Knoll Subdivision, Section 3
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 Lowery Mill Creek
Waterbody* Nbrre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 12-94-12-3-(0.5)
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. ^
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 Pesponsible Entity
Name *
Ramey Properties, LLC
IF pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name *
CJ (Pete)
IF Corporation, enter Faegistered Agent First %rre
3. Last Name*
Ramey
IF Corporation, enter F;bgistered Agent Last %ne
3b. Title
Member -Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 336-922-4000
Telephone No.*
6. Permittee Mailing Street Address
Address* PO Box 10
Address Line 2
aty
Bethania
Fbstal / Zip Code
27010
Check box if the F Yes
street address the
same as mailing
address
State / Rovince / Pbegion
NC
Country
us
7. Permittee Street
Street Address
Address*
5121 North Causeway Road
Address Line 2
city
State / Frovince / Faegion
Winston-Salem
NC
Fbstal / Zip Code
Country
27106-9695
us
8. Type of
Non -Government
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Pete
Contact - First
Name *
2. Primary Site
Ramey
Contact - Last
Name *
3. Title
Member -Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
336-978-4728
Telephone No.
6. Organization
Ramey Properties, LLC
Name
7. Site Contact
Street Address
Mailing Address*
5121 North Causeway Road
Address Line 2
city
Winston-Salem
Fbstal / Zip Code
27106-9695
8. Consultant Name
(Optional)
Alex Carter
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
336-748-0071
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 06/23/2020
Approved *
2. E&SC Plan Project EN2000064
Number/ID * Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* Winston-Salem/Forsyth 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
Review Completed - High Knoll Subdivision, Section
Approval letter or
3.pdf 141.56KB
Grading Permit
Mast be RDFforrrat
6. Site Location Map
Helpful for linear project review
(Optional)
02-202 HIGH KNOLL Approved WS C-1_3.pdf 1.27MB
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 documents support
the application. Include additional waterbodies for linear projects if necessary.
Approved watershed permit map included in uploads
8. NOI Certification
[e-mail]_20200623_0747... 462.08KB
Form
Wst be RDF format
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
Type Name* CJ (Pete) Ramey
Title Member -Manager
Organization Legally Ibsponsible Entity
Ramey Properties, LLC
Date * 06/23/2020

F. Tracking and COC Info
NOI Tracking No. 27391
NC Reference No. NCG01-2020-2681
Uses 'count number' variable (incremrented by SP)
Certificate of NCC202681
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 2681
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.)