NCC204092_NOI Application_20200922

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 9/15/2020 11:40:54 AM (NCG01 NOI Submission)
Approve by Gwinn, Matt 9/17/2020 3:11:53 PM (Review- Construction NOI 31453)
• The task was assigned to Gwinn, Matt by round robin distribution 9/15/2020 11:41 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 17, 2020 5:00
PM 9/15/2020 11:41 AM
Submit by Selkane, Aziza 9/22/2020 8:48:50 AM (Payment Verification for NCC204092)
* Jacob McLean
• Selkane, Aziza assigned the task to Selkane, Aziza 9/22/2020 8:48 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 29, 2020 5:00 PM
9/17/2020 3:12 PM

.• SThF� ';
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 * Ward Mill Dam Removal Project
1 b. Specific Lot This field rray be used to list specifc lot nunbers.
Numbers
2. County* Watauga
3. Highway or Street Old Watauga River Road
Address* Street narre only is acceptable if no address number assigned yet
4. City or Township* Laurel Creek
5. State * NC
6. Zip Code * 28679
7. Latitude* Enter the latitude in decinal degrees
36.2413
8. Longitude* Enter the longitude in decir al degrees (MJST be negative)
-81.8304
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*
10/21/2020
Estimated Construction Project Start Date
10. Date to End *
04/30/2021
Estinated Construction Project End Date
11. SIC (Primary) *
Other (9999)
Standard Industrial aassification for Developrrent
12. Acres to be
2.00
disturbed*
(including off -site borrow and waste areas)
13. Total site area 2.00
(acres) *

14. Post- 0.00
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-WATAU-2020-Ward Mill Dam Removal Project
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 Watauga River
Waterbody* Nsrre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 8-(1)
Index No.* NCWaterbody Index Nurrber
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. ^
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 * Blue Ridge Resource Conservation & Development Council, Inc.
It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
Note: The organization name must match the business entity name registered with the NC Secretary of State. You can
verify the registration here.
2. First Name * Jonathan
IF Corporation, enter Faegistered Agent First %rre
3. Last Name* Hartsell
It Corporation, enter Pbegistered Agent Last %rre
3b. Title Executive Director
4. Permitee E-mail [e-mail]
Address*
5. Permittee 828-284-9818
Telephone No.*
6. Permittee Mailing Street Address
Address* PO Box782
Address Line 2
City
Spruce Pine
Fbstal / Zip Code
28777
Check box if the F Yes
street address the
same as mailing
address
State / Frovince / Pegion
NC
Country
USA
7. Permittee Street
Street Address
Address*
31 Cross Street
Address Line 2
Suite 215
City
State / F rovince / Faegion
Spruce Pine
NC
Fbstal / Zip Code
Country
28777
USA
8. Type of
Non -Government
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Jonathan
Contact - First
Name *
2. Primary Site
Hartsell
Contact - Last
Name *
3. Title
Executive Director
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
828-284-9818
Telephone No.
6. Organization
Blue Ridge Resource Conservation &
Name
Development Council, Inc.
7. Site Contact
Street Address
Mailing Address*
PO Box782
Address Line 2
city
Spruce Pine
Fbstal / Zip Code
28777
8. Consultant Name
(Optional)
Jacob McLean
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
828-545-3865
Telephone No.
State / Rovince / Region
NC
Country
USA

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 08/06/2020
Approved *
2. E&SC Plan Project WATAU-2020-006
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 * Winston-Salem (WSRO)
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 WATAU-2020-006_20200806_A-M.pdf 5.87MB
Approval letter or Mist beRDFformat
Grading Permit
6. Site Location Map Helpful for linear project review
(Optional) Mist 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.
This is a dam removal being overseen by Blue Ridge RC&D with
designer/engineer Wildlands Engineering. The project oversight is
being supported by American Rivers and MountainTrue and the
project is being constructed by US Fish & Wildlife Aquatic
Restoration Team. The dam is on the Watauga River and is on the
Ray and Virginia Ward property.
8. NOI Certification NCG01-eNO1-Certification-Form-20190919-DEMLR-
Form 525.37KB
SW_BRRCD.pdf
Mast be FCFformat
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 * Jonathan Hartsell
Title Executive Director
Organization Legally Responsible Entity
Blue Ridge Resource Conservation & Development, Inc.
Date * 09/15/2020

F. Tracking and COC Info
NOI Tracking No. 31453
NC Reference No.
NCG01-2020-4092
Uses 'count_nunber' variable (increrrented by SP)
Certificate of
NCC204092
Coverage (COC)
Uses 'count nurrber' variable (increrrented by SP)
No.*
Count Number 4092
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. NCC204092-2020
Invoice Due Date 10/17/2020
Initial Fee $ 100.00
Invoice Status OPEN