NCC202884_NOI Application_20200710

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 7/7/2020 9:46:49 AM (NCG01 NOI Submission)
Approve by Garcia, Lauren V 7/8/2020 4:12:22 PM (Review- Construction NOI 27878)
• The task was assigned to Garcia, Lauren V by round robin distribution 7/7/2020 9:47 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: July 9, 2020 5:00 PM
7/7/2020 9:47 AM
Submit by Selkane, Aziza 7/10/2020 8:02:17 AM (Payment Verification for NCC202884)
* Davis DWSolutions
• Selkane, Aziza assigned the task to Selkane, Aziza 7/10/2020 8:00 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: August 19, 2020 5:00 PM
7/8/2020 4:12 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 * Caldwell Community College & Technical Institute Electrial Lineman
Facility
1 b. Specific Lot This field may be used to list specifc lot numbers.
Numbers
2. County* Caldwell
3. Highway or Street 200 Roy E. Coffey Drive
Address* Street name only is acceptable if no address number assigned yet
4. CityorTownship* Hudson
5. State * NC
6. Zip Code* 28638
7. Latitude* Enter the latitude in decimal degrees
35.8530
8. Longitude * Enter the longitude in decimal degrees (M-ST be negative)
-81.4860
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*
07/15/2020
Estimated Construction Project Start Date
10. Date to End*
07/31/2021
Estimated Construction Project End Cate
11. SIC (Primary) *
Other (9999)
Standard Industrial C]assification for Development
12. Acres to be
2.62
disturbed*
(including off -site borrow and waste areas)
13. Total site area 20.25
(acres) *

14. Post- 1.46
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-CALDW-2020-Caldwell Community College & Technical
Tracking ID Institute Electrial Lineman Facility
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 Gunpowder Creek
WaterbodY * Ibrre of w aterbody into w hich storrrw ater runoff w ill discharge
15b. Waterbody 11-55-(0.5)
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. ^
Fl rnittee 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 *
Caldwell Community College & Technical Institute
It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name *
Dr, Mark
If Corporation, enter Faegistered Agent First %rre
3. Last Name*
Poarch
It Corporation, enter F;bgistered Agent Last %ne
3b. Title
President
4. Permitee E-mail [e-mail]
Address*
5. Permittee 828.726.2211
Telephone No.*
6. Permittee Mailing Street Address
Address* 2855 Hickory Boulevard
Address Line 2
City State / Rovince / F;bgion
Hudson NC
Fbstal / Zip Code Country
28638-2672 us
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
2855 Hickory Boulevard
Address Line 2
City
State / Frovince / Faegion
Hudson
NC
Fbstal / Zip Code
Country
28638-2672
us
8. Type of
Government - County
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
...........................................................................................................................................................................................................................................................................
1. Primary Site
Dr. Mark
Contact - First
Name *
2. Primary Site
Poarch
Contact - Last
Name *
3. Title
President
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
828.726.2211
Telephone No.*
6. Organization
Caldwell Community College & Technical
Name
Institute
7. Site Contact
Street Address
Mailing Address*
2855 Hickory Boulevard
Address Line 2
city
State / Province / Region
Hudson
NC
Postal / Zip Code
Country
28638-2672
us
8. Consultant Name (Optional)
Gary D. Davis, P.E. - Davis CivilSolutions, P.A.
First and Last narre
9. Consultant E-mail [e-mail]
This person will be copied on all correspondence.
10. Consultant 828.299.9449
Telephone No.

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 07/01/2020
Approved *
2. E&SC Plan Project CALDW-2020-018
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 LOA COPA 7-1-2020.pdf 110.75KB
Approval letter or Mast beRFformat
Grading Permit
6. Site Location Map Helpful for linear project review
(Optional) C200 - GRADING, SW, EC. 6.29.20-Gd-Ec-Stw.pdf 962.92KB
Mast be RDFformat. 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.
The project is located at 200 Roy E. Coffey Drive on the CCCTI
Campus in Hudson, NC. The project includes the construction of a
new single story 7,000 sf Electrical Lineman Facility Building,
Sidewalks, driveway and parking areas. The site was previously an
undeveloped gravel and grassed area.
8. NOI Certification SIGNED -NCG01-eNO1-Certification-Form-
Form 269.16KB
20190507-DEMLR-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 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
Type Name * Dr. Mark Poarch
Title President
Organization Legally Plesponsible Entity
Caldwell Community College & Technical Institute
Date * 07/07/2020

F. Tracking and COC Info
NOI Tracking No. 27878
NC Reference No.
NCG01-2020-2884
Uses 'count_nunber' variable (increrrented by SP)
Certificate of
NCC202884
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 2884
Sequential nunber for subnittal 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. NCC202884-2020
Invoice Due Date 8/7/2020
Initial Fee $ 100.00
Invoice Status OPEN