NCC202684_NOI Application_20200629

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 6/23/2020 5:37:42 PM (NCG01 NOI Submission)
Approve by Clark, Paul 6/24/2020 3:27:24 PM (Review- Construction NOI 27398)
. The task was assigned to Clark, Paul by round robin distribution 6/23/2020 5:38 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: June 25, 2020 5:00 PM
6/23/2020 5:38 PM
Submit by Selkane, Aziza 6/29/2020 3:46:56 PM (Payment Verification for NCC202684)
* Jordan Grant & Associates
• Selkane, Aziza assigned the task to Selkane, Aziza 6/29/2020 3:45 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: August 5, 2020 5:00 PM
6/24/2020 3:27 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 27365
NOI No.
Prior Reviewer Paul Clark
Name
1a. Project Name * Dobbs Valley Phase III
1 b. Specific Lot This field may be used to list specifc lot numbers.
Numbers 53-60
2. County* Iredell
3. Highway or Street Backrush Court off Cedar lake Drive, SR 2054
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* Bethany Township
5. State * NC
6. Zip Code * 28625
7. Latitude * Enter the latitude in decimal degrees
35.8272
8. Longitude* Enter the longitude in decimal degrees (M. ST be negative)
-80.8994
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* 06/15/2020
Estimated Construction Project Start Date
10. Date to End* 09/30/2020
Estimated Construction Project End Date
11. SIC (Primary)* Residential, Single Family Houses (SFE) (1521)
Standard Industrial aassification for Developrrent

12. Acres to be 3.07
disturbed* (including off -site borrow and waste areas)
13. Total site area 20.14
(acres) *
14. Post- 4.00
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-IREDE-2020-Dobbs Valley Phase III
Tracking ID Assignedautonatically
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 Fourth Creek
Wate rbody* %rre of waterbody into which stornwater runoff will discharge
15b. Waterbody 12-108-20
Index No.* NCWaterbody Index Nurrber
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. ^
Fternittee 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 *
BCIT Estate Holdings, LLC
It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name *
Marvin
IF Corporation, enter Faegistered Agent First %rre
3. Last Name*
Cline
It Corporation, enter F;bgistered Agent Last %ne
3b. Title
Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 704-872-8585
Telephone No.*
6. Permittee Mailing Street Address
Address* 141 Cedar Lake Drive
Address Line 2
aty State / Rovince / F;bgion
Statesville NC
Fbstal / Zip Code Country
28625 us
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
141 Cedar Lake Drive
Address Line 2
city
State / Frovince / Region
Statesville
NC
Fbstal / Zip Code
Country
28625
us
8. Type of
Individual
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Marvin
Contact - First
Name *
2. Primary Site
Cline
Contact - Last
Name *
3. Title
Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
704-872-8585
Telephone No.
6. Organization
BCIT Estate Holdings, LLC
Name
7. Site Contact
Street Address
Mailing Address*
141 Cedar Lake Drive
Address Line 2
city
Statesville
Fbstal / Zip Code
28625
8. Consultant Name
(Optional)
Jordan Grant & Associates, PLLC
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
704-928-7919
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 03/23/2020
Approved *
2. E&SC Plan Project IREDE-2020-076
Number/ID * Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* Iredell 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 LOAM.pdf 82.38KB
Approval letter or Dobbs Valley P3 LOA 6-11-20.pdf 60.54KB
Grading Permit
Mast be FDFfon-rat
6. Site Location Map Helpful for linear project review
(Optional) C1.pdf 1.41MB
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 SW.pdf 1023.56KB
Mast be FDFfon-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 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 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* Marvin Bob Cline
Title Manager
Organization Legally Ibsponsible Entity
BCIT Estate Holdings, LLC
Date * 06/23/2020

F. Tracking and COC Info
NOI Tracking No. 27398
NC Reference No. NCG01-2020-2684
Uses 'count number' variable (incremrented by SP)
Certificate of NCC202684
Coverage (COC) Uses 'count number' variable (incremented by SF)
No.*
Count Number 2684
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.)
Initial Invoice No.
Invoice Due Date
Initial Fee $
Invoice Status