NCC203608_NOI Application_20200820

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 8/18/2020 4:16:58 PM (NCG01 NOI Submission)
Approve by Clark, Paul 8/19/2020 9:01:09 AM (Review- Construction NOI 30082)
• The task was assigned to Clark, Paul by round robin distribution 8/18/2020 4:19 PM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 20, 2020 5:00
PM. The priority is: High 8/18/2020 4:19 PM
Submit by McCoy, Suzanne 8/20/2020 8:26:27 AM (Payment Verification for NCC203608)
* Muter Construction
• McCoy, Suzanne assigned the task to McCoy, Suzanne 8/20/2020 8:25 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: September 30, 2020 5:00
PM. The priority is: High 8/19/2020 9:01 AM

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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 * Oxford Preparatory School - Lower School
1 b. Specific Lot This field rray be used to list specifc lot numbers.
Numbers
2. County* Granville
3. Highway or Street 6041 Landis Road
Address* Street narre only is acceptable if no address number assigned yet
4.CityorTownship* Oxford
5. State * NC
6. Zip Code * 27565
7. Latitude* Enter the latitude in decimal degrees
36.3364
8. Longitude* Enter the longitude in decimal degrees (M.JST be negative)
-78.5590
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*
08/03/2020
Estinated Construction Project Start Date
10. Date to End *
07/22/2021
Estinated Construction Project End Date
11. SIC (Primary)*
Commercial (1542)
Standard Industrial Classification for Developrrent
12. Acres to be
15.00
disturbed*
(including off -site borrow and waste areas)
13. Total site area 15.00
(acres) *

14. Post- 15.00
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-GRANV-2020-Oxford Preparatory School - Lower School
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 Coon Creek
Waterbody * %rre of waterbody into which stornwater runoff will discharge
15b. Waterbody 28-11-5
Index No.* NCWaterbody Index Nunber
Stormwater r No
discharges will flow pr Yes
to additional
wate rs *
15c. Additional Waterbody narre
Receiving
Waterbody
15d. Waterbody NCWaterbody Index Nunber
Index No.
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. ^
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 * Muter Construction
It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name * Bryan
IF Corporation, enter Faegistered Agent First %rre
3. Last Name* Braddy
It Corporation, enter F;bgistered Agent Last %ne
3b. Title Building Division Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 9194953667
Telephone No.*
6. Permittee Mailing Street Address
Address* 111 East Vance Street
Address Line 2
City State / Rovince / F;bgion
Zebulon NC
Fbstal / Zip Code Country
27597-2837 us
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
111 East Vance Street
Address Line 2
City
State / Ftovince / Faegion
Zebulon
NC
Fbstal / Zip Code
Country
27597-2837
us
8. Type of
Non -Government
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
ED
Contact - First
Name *
2. Primary Site
Crammer
Contact - Last
Name *
3. Title
Superintendent
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
910-336-6924
Telephone No.
6. Organization
Muter Construction
Name
7. Site Contact
Street Address
Mailing Address*
111 East Vance Street
Address Line 2
city
Zebulon
Fbstal / Zip Code
27597
8. Consultant Name
(Optional)
First and Last narre
9. Consultant E-mail
This person will be copied on all correspondence.
10. Consultant
Telephone No.
State / Rovince / Region
NORTH CAROLINA
Country
United States

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 06/11/2020
Approved *
2. E&SC Plan Project GRANV-2020-013
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 * Raleigh (RRO)
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
Dept. Of Environmental Quality.pdf 2.52MB
Approval letter or
SKM_C36820081715300.pdf 89.73KB
Grading Permit
Mist be FDFfon-rat
6. Site Location Map
Helpful for linear project review
(Optional)
Mast be FCFfornat. 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
SKM_C36820081715300.pdf 89.73KB
Form
Wst be RDFfornat
This is an Express
f 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
ZT
Type Name * Bryan Braddy
Title Building Division Manager
Organization Legally Plesponsible Entity
Muter Construction
Date * 08/18/2020

F. Tracking and COC Info
NOI Tracking No. 30082
NC Reference No.
NCG01-2020-3608
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC203608
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 3608
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. NCC203608-2020
Invoice Due Date 9/18/2020
Initial Fee $ 100.00
Invoice Status OPEN