NCC203785_NOI Application_20200901

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 8/28/2020 9:16:14 AM (NCG01 NOI Submission)
Approve by Garcia, Lauren V 8/31/2020 9:05:35 AM (Review- Construction NOI 30573)
• Gwinn, Matt reassigned the task to Garcia, Lauren V 8/28/2020 9:47 AM
. The task was assigned to Gwinn, Matt by round robin distribution 8/28/2020 9:17 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 1, 2020 5:00
PM 8/28/2020 9:17 AM
Submit by Selkane, Aziza 9/1/2020 8:35:24 AM (Payment Verification for NCC203785)
* Atlantic Telephone Corp
Brent Brinson
• Selkane, Aziza assigned the task to Selkane, Aziza 9/1/2020 8:34 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 12, 2020 5:00 PM
8/31/2020 9:05 AM

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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 30243
NOI No.
Prior Reviewer Lauren Garcia
Name
1a. Project Name * ATMC Columbus ReConnect
1 b. Specific Lot This field may be used to list specffc lot numbers.
Numbers
2. County* Columbus
3. Highway or Street Various Locations
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* Tabor City, Whiteville, Clarkton, etc
5. State * NC
6. Zip Code * 28463
7. Latitude * Enter the latitude in decimal degrees
34.2718
8. Longitude* Enter the longitude in decimal degrees (M. ST be negative)
-78.6888
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* 08/31/2020
Estimated Construction Project Start late
10. Date to End* 09/30/2022
Estimated Construction Project End late
11. SIC (Primary) * Other (9999)
Standard Industrial Classification for lkveloprrent

12. Acres to be 8.30
disturbed* (including off -site borrow and waste areas)
13. Total site area 8.30
(acres) *
14. Post- 0.00
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-COLUM-2020-ATMC Columbus ReConnect
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 Ricefield Branch
Waterbody * %rre of waterbody into which stornwater runoff will discharge
15b. Waterbody 15-2-6-2-1
Index No.* NCWaterbody Index Nunber
Stormwater r No
discharges will flow Pf Yes
to additional
wate rs *
15c. Additional Buckhead Branch
Receiving Waterbody narre
Waterbody
15d. Waterbody 15-2-6-1
Index No. NCWaterbody Index Nunber
15e. Additional Sasspan Branch
Receiving Waterbody narre
Waterbody
15f. Waterbody 15-2-6-3-3
Index No. NCWaterbody Index Narrber
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. ^
F2rnittee 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 *
Atlantic Telephone Membership Corporation
It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name *
Brent
IF Corporation, enter Faegistered Agent First %rre
3. Last Name*
Brinson
It Corporation, enter F;bgistered Agent Last %ne
3b. Title
Director of Outside Plant Engineering
4. Permitee E-mail [e-mail]
Address*
5. Permittee 910-754-4311
Telephone No.*
6. Permittee Mailing Street Address
Address* 640 Whiteville Road
Address Line 2
City State / Rovince / F;bgion
Shal lotte NC
Fbstal / Zip Code Country
28470 us
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
640 Whiteville Road
Address Line 2
City
State / Frovince / Region
Shal lotte
NC
Fbstal / Zip Code
Country
28470
us
8. Type of
Non -Government
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
...................................................................................................................................................................................................................
1. Primary Site
Brent
Contact - First
Name *
2. Primary Site
Brinson
Contact - Last
Name *
3. Title
Director of Outside Plant Engineering
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
910-754-4311
Telephone No.*
6. Organization
Atlantic Telephone Membership Corporation
Name
7. Site Contact
Street Address
Mailing Address*
640 Whiteville Road
Address Line 2
City
State / Rovince / Region
Shal lotte
NC
Flostal / Zip Code
Country
28470
us
8. Consultant Name
(Optional)
Alex Lapinsky
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
910-755-5872
Telephone No.

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 08/17/2020
Approved *
2. E&SC Plan Project COLUM-2021-001
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 * Wilmington (WiRO)
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 COLUM-2021-001 Approval 8-17-2020.pdf 294.03KB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Helpful for linear project review
(Optional) 20.07072 ATMC Columbus Reconnect ISSUED
3.42MB
FOR CONST.pdf
Mast be RDF format. Rease do not upload entire set of E&SC plans.

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.
Friar Swamp 15-2-6-3
Slap Swamp 15-2-6-4
Horse Creek 15-2-6-4-5-1
Big Creek 15-2-6
Unnamed Tributary at Wananish 15-2-2
Alligator Branch 15-3-7
Bogue Swamp 15-3
Jockey Branch 15-3-5
Palmetto Branch 15-3-6
Big Fork 15-3-6-1
Richlands Branch 15-2-6-4-4
Middle Swamp 15-4-1-1-2-4
Slades Swamp 15-4-1-2
Spring Branch 15-3-1
Boggy Branch 15-3-3
Welch Creek 15-4-5
Troy Mill Branch 15-4-3
Puncheon Branch 15-4-6
Red Hill Swamp 15-4-1
Mill Branch 15-4-1-3
Butler Branch 15-4-2-4
Curries Branch 15-4-2-4-1
Western Prong Creek 15-4-2
Mill Branch 15-4-4
Soules Swamp 15-4-8
Deep Branch 15-4-8-6
Big Pond Branch 15-17-1-12-1-5
Beaver Dam Swamp 15-17-1-12-1
Mill Branch 15-17-1-12-1-6-1
Gum Swamp 15-17-1-12-3
Mill Branch Swamp 15-17-1-12-3-1
Grissett Swamp 15-17-1-(5)
Black Creek 15-17-1-3
Cypress Branch 15-17-1-9
Big Branch 15-17-1-12-1-1
Calf Ford Creek 14-36-1
Boggy Hill Branch 15-17-1-2
Simmons Branch 15-17-1-4
Town Canal 15-17-1-6
Skeebo Branch 15-17-1-7
Spring Branch 15-17-1-8
Ironhill Branch 15-17-1-10-1
Grissett Swamp 15-17-1-(1)
8. NOI Certification NCG01-eNO1-Certification-FormCOLUM-2021-
Form 001. pdf 744.62KB
Mast be FDFfornat
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 * Brent Brinson
Title Director of Outside Plant Engineering
Organization Legally Plesponsible Entity
Atlantic Telephone Membership Corporation
Date * 08/28/2020

F. Tracking and COC Info
NOI Tracking No. 30573
NC Reference No.
NCG01-2020-3785
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC203785
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 3785
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. NCC203785-2020
Invoice Due Date 9/30/2020
Initial Fee $ 100.00
Invoice Status OPEN