NCC204698_NOI Application_20201019

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/16/2020 12:19:32 PM (NCG01 NOI Submission)
Approve by Meloy, Michael 10/16/2020 12:38:51 PM (Review- Construction NOI 33264)
• The task was assigned to Meloy, Michael by round robin distribution 10/16/2020 12:20 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 20, 2020 5:00
PM 10/16/2020 12:20 PM
Submit by Selkane, Aziza 10/19/2020 9:37:38 AM (Payment Verification for NCC204698)
* Jordan Gougeon
• Selkane, Aziza assigned the task to Selkane, Aziza 10/19/2020 9:35 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 27, 2020 5:00
PM 10/16/2020 12:39 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 * Tommy's Express Car Wash
1 b. Specific Lot This field may be used to list specifc lot numbers.
Numbers LOT 31
2. County* Cabarrus
3. Highway or Street 2493 Coldwater Ridge Drive
Address* Street narre only is acceptable if no address number assigned yet
4.City orTownship* Kannapolis
5. State * NC
6. Zip Code * 28083
7. Latitude* Enter the latitude in decimal degrees
35.4660
8. Longitude* Enter the longitude in decimal degrees (M.JST be negative)
-80.6000
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*
10/23/2020
Estimated Construction Project Start Date
10. Date to End *
05/10/2021
Estimated Construction Project End Date
11. SIC (Primary)*
Commercial (1542)
Standard Industrial Classification for Leveloprrent
12. Acres to be
1.30
disturbed*
(including off -site borrow and waste areas)
13. Total site area 1.85
(acres) *

14. Post- 1.00
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-CABAR-2020-Tommy's Express Car Wash
Tracking ID Assigned autorraticaly
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 Threemile Branch
Waterbody * %rre of waterbody into which stornwater runoff will discharge
15b. Waterbody 13-17-9-4-5
Index No.* NCWaterbody Index Nunber
Stormwater r No
discharges will flow pr Yes
to additional
wate rs *
15c. Additional Coldwater Creek
Receiving Waterbody narre
Waterbody
15d. Waterbody 13-17-9-4-(1.5)
Index No. NCWaterbody Index Nunber
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. ^
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 Pesponsible Entity
Name * EV Construction
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 * Chase
IF Corporation, enter Faegistered Agent First Wre
3. Last Name* Burns
It Corporation, enter F;bgistered Agent Last %rre
3b. Title Principle
4. Permitee E-mail [e-mail]
Address*
5. Permittee 9062316905
Telephone No.*
6. Permittee Mailing Street Address
Address* 86 East 6th Street
Address Line 2
City State / Frovince / Fbgion
Holland MI
Fbstal / Zip Code Country
49423-2912 us
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
86 East 6th Street
Address Line 2
City
State / Frovince / Region
Holland
MI
Fbstal / Zip Code
Country
49423-2912
us
8. Type of
Non -Government
Ownership

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Dave
Contact - First
Name *
2. Primary Site
Jasper
Contact - Last
Name *
3. Title
Field Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
616-377-9290
Telephone No.
6. Organization
EV Construction
Name
7. Site Contact
Street Address
Mailing Address*
86 East 6th Street
Address Line 2
city
Holland
Fbstal / Zip Code
49423-2912
8. Consultant Name
(Optional)
First and Last nacre
9. Consultant E-mail
This person will be copied on all correspondence.
10. Consultant
Telephone No.
State / Rovince / Region
MI
Country
us

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 06/17/2020
Approved *
2. E&SC Plan Project CABAR-2020-077
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 * Mooresville (MRO)
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 NCDEQ Letter of Approval - Tommys Express
Approval letter or 1.36MB
Kannapolis - 2020-06-17.pdf
Grading Permit
Mast be RDFfon-rat
6. Site Location Map Helpful for linear project review
(Optional) Pages from Approved Civil Set - Tommy's
4.99MB
Kannapolis - 2020-08-07.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 documents support
the application. Include additional w aterbodies for linear projects if necessary.
8. NOI Certification eNO1 Certfication Form Signed.pdf 689.73KB
Form Mast be RDFformat
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
r 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
�� rrr7` "% :'?";'V
Type Name * Matt Wintjes
Title Project Manager
Organization Legally Plesponsible Entity
EV Construction
Date * 10/16/2020

F. Tracking and COC Info
NOI Tracking No. 33264
NC Reference No.
NCG01-2020-4698
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC204698
Coverage (COC)
Uses 'count number' variable (increrrented by SP)
No.*
Count Number 4698
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. NCC204698-2020
Invoice Due Date 11/15/2020
Initial Fee $ 100.00
Invoice Status OPEN