NCC202921_NOI Application_20200716

Action History (UTC-05:00)Eastern Time(US&Canada)
Subrrit by Anonymous User 7/9/2020 11:30:56 AM(NCG01 NOI Submission)
Approve by Garcia, Lauren V 7/10/2020 10:33:22 AM(Review-Construction NOI 28017)
• The task was assigned to Garcia, Lauren V by round robin distribution 7/9/2020 11:32 AM
• The task was assigned to DEMLR NCG01 NOI Review Team.The due date is:July 13,2020 5:00 PM
7/9/2020 11:32 AM
Submit by Selkane,Aziza 7/16/2020 1:45:25 PM(Payment Verification for NCC202921)
* Brooks Engineering Associates, PA
• Selkane,Aziza assigned the task to Selkane,Aziza 7/16/2020 1:44 PM
• The task was assigned to DEMLR NCG01 Payment Team.The due date is:August 21, 2020 5:00 PM
7/10/2020 10:33 AM

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1Construction Stormwater: Notice of Intent (NOI)
National Pollutant Discharge Elimination System 'D application for•• - .•-under NorthCarolina's
General Permit 1 1111:STORIVWATER DISCHARGES associated with construction activities(or
NORTH CAROLINA
Enrlrnnmenfu�Qrlarlry
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* Higgins Branch Rd Subdivision
1 b.Specific Lot This field rray be used to list specifc lot numbers.
Numbers
2.County* Madison
3. Highway or Street 426 Higgins Branch Rd
Address* Street narre only is acceptable if no address number assigned yet
4.City or Township* Beech Glen Township
5.State* NC
6.Zip Code* 28754
7. Latitude* Enter the latitude in decimal degrees
35.8497
8. Longitude* Enter the longitude in decimal degrees(M.JST be negative)
-82.5341
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* 12/01/2020
Estimated Construction Project End Date
11.SIC(Primary)* Residential, Single Family Houses(SFE)(1521)
Standard Industrial Classification for Development
12.Acres to be 3.00
disturbed* (including off-site borrow and waste areas)
13.Total site area 19.00
(acres)*

14. Post- 0.75
construction (Estirrated)
impervious area
(acres)*
NCC Project NCC-MADIS-2020-Higgins Branch Rd Subdivision
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 Higgins Branch
Waterbody* llarre of waterbody into which storrrwater runoff will discharge
15b.Waterbody 6-96-10-2-5
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 Responsible Entity
Name* EBH Homes, LLC
IF pernittee is an individual(i.e.,organization does not apply),enter first and last narre in this field.
2. First Name* Clifton
If Corporation,enter Registered Agent First%rre
3. Last Name* Hamlin
IF Corporation,enter F;bgistered Agent Last%ne
3b.Title Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 828-712-9426
Telephone No.*
6. Permittee Mailing Street Address
Address* PO Box323
Address Line 2
City State/Rovince/F;bgion
Mars Hill NC
Flostal/Zip Code Country
28754 us
Check box if the F Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 106 Baybrook Court
Address Line 2
city State/Frovince/Region
Cary NC
Fbstal/Zip Code Country
27518-9422 us
8.Type of Non-Government
Ownership

C. Site Contact Information
Part C. ^
Roject Site Contact Inforrration
.......................................................................................................................................................................................................................................................................................................................................................................................
1. Primary Site Clifton
Contact-First
Name*
2. Primary Site Hamlin
Contact-Last
Name*
3.Title Manager
4.Site Contact E- [e-mail]
mail Address*
5.Site Contact 828-712-9426
Telephone No.*
6.Organization EBH Homes, LLC
Name
7.Site Contact Street Address
Mailing Address* PO Box323
Address Line 2
city State/Rovince/Region
Mars Hill NC
Fbstal/Zip Code Country
28754 US
8. Consultant Name (Optional)
Mark Brooks
First and Last nacre
9. Consultant E-mail [e-mail]
This person will be copied on all correspondence.
10. Consultant 828-232-4700
Telephone No.

D. E&SC Plan
Part D. ^
Erosion&Sediment Control(E&SC)Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 07/07/2020
Approved*
2. E&SC Plan Project MADIS-2020-005
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&CORA 7-7-2020.docx.pdf 152.79KB
Approval letter or Mist beRDFformat
Grading Permit
6.Site Location Map Helpful for linear project review
(Optional) Mist be RDFform3t.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 docurrents support
the application.Include additional waterbodies for linear projects if necessary.
8. NOI Certification SIGNED-eNO1_Form.pdf 72.99KB
Form Mist be RDF format
This is an Express r No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.6E(i) provides that:
Anyperson who knowinglymakes any false statement,representation,or certification in anyapplication,record,report,plan,or other
documentfiled 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 underthis 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 guiltyofa Class 2 misdemeanor which mayinclude 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
7�
Type Name* Clifton Hamlin
Title Manager
Organization Legally Responsible Entity
EBH Homes, LLC
Date* 07/09/2020

F. Tracking and COC Info
NOI Tracking No. 28017
NC Reference No. NCG01-2020-2921
Uses'count_nurrber'variable(increrrented by SP)
Certificate of NCC202921
Coverage (COC) Uses'count_nurrber'variable(increrrented by SP)
No.*
Count Number 2921
Sequential nurrber for subrrittal 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. NCC202921-2020
Invoice Due Date 8/9/2020
Initial Fee $ 100.00
Invoice Status OPEN