NCC205216_NOI Application_20201117

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 11/12/2020 7:03:57 PM (NCG01 NOI Submission)
Approve by Meloy, Michael 11/13/2020 7:49:03 AM (Review- Construction NOI 35941)
• The task was assigned to Meloy, Michael by round robin distribution 11/12/2020 7:05 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: November 16, 2020 5:00
PM 11/12/2020 7:05 PM
Submit by Selkane, Aziza 11/17/2020 9:04:09 AM (Payment Verification for NCC205216)
* R L Hutchison Jr
• Selkane, Aziza assigned the task to Selkane, Aziza 11/17/2020 9:03 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: December 25, 2020 5:00
PM 11/13/2020 7:49 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 35838
NOI No.
Prior Reviewer Michael Meloy
Name
1a. Project Name * JAZZ INVESTMENTS, LLC COMMERCIAL SITE
1 b. Specific Lot This field rray be used to list specifc lot numbers.
Numbers
2. County* Buncombe
3. Highway or Street 250 Dix Creek Chapel Road
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* Leicester
5. State * NC
6. Zip Code * 28806
7. Latitude * Enter the latitude in decimal degrees
35.6294
8. Longitude* Enter the longitude in decimal degrees (MJSTbe negative)
-82.6458
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* 11/16/2020
Estimated Construction Project Start Date
10. Date to End* 12/28/2020
Estimated Construction Project End Cute
11. SIC (Primary)* Commercial (1542)
Standard Industrial aassification for Developrrent

12. Acres to be 1.50
disturbed* (including off -site borrow and waste areas)
13. Total site area 3.16
(acres) *
14. Post- 0.76
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-BUNCO-2020-JAZZ INVESTMENTS, LLC COMMERCIAL SITE
Tracking ID Assigned automatically
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 Dix Creek
Waterbody* IN}ame of waterbody into which stormwater runoff will discharge
15b. Waterbody 6-84-7
Index No.* NC Waterbody Index Nmber
Stormwater rJ 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. ^
Fl rnittee 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 * Jazz Investments, LLC
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 * Julian
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Agbala
It Corporation, enter Pbegistered Agent Last %rre
3b. Title owner
4. Permitee E-mail [e-mail]
Address*
5. Permittee 828-712-6818
Telephone No.*
6. Permittee Mailing Street Address
Address* 1525 Patton Avenue
Address Line 2
Cty
Asheville
Fbstal / Zip Code
28806-1747
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
F Yes
Street Address
1525 Patton Avenue
Address Line 2
city
Asheville
Fbstal / Zip Code
28806-1747
8. Type of Non -Government
Ownership *
State / Frovince / Fbgion
NC
Country
us
State / Frovince / Region
NC
Country
us

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Julian
Contact - First
Name *
2. Primary Site
Agbala
Contact - Last
Name *
3. Title
owner
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
828-712-6818
Telephone No.
6. Organization
Jazz Investments
Name
7. Site Contact
Street Address
Mailing Address*
1525 Patton Avenue
Address Line 2
city
Asheville
Fbstal / Zip Code
28806-1747
8. Consultant Name
(Optional)
Melanie Brethauer, PE, CFM, LEED AP
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
828-674-9128
Telephone No.
State / Rovince / Region
NC
Country
us

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 09/30/2020
Approved *
2. E&SC Plan Project ERO2020-00035
Number/ID * Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* Buncombe County
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 ERO202000035LOA.pdf 231.85KB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Mast be RDFfornat (lint 20 NB)
191111-250 Dix Creek Chapel Road -EC & SITE
898.18KB
PLAN-2-REVISED-200928. pdf
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 julian state form complete.pdf 3.01 MB
Form Mast be RDFformat
This is an Express F No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.66 (1) 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 If the Erosion and Sediment Control Plan approved by the delegated program is
not compliant with Part II (Stormwater Pollution Prevention Plan) of the
NCG010000 General Permit. I will nonetheless ensure that all conditions of Part
II of the permit are met on the project at all times.
* 17 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* Julian Agbala
Title owner
Organization Legally Ibsponsible Entity
Jazz Investiments
Date * 11 /12/2020

F. Tracking and COC Info
NOI Tracking No. 35941
NC Reference No.
NCG01-2020-5216
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC205216
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5216
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. NCC205216-2020
Invoice Due Date 12/13/2020
Initial Fee $ 100.00
Invoice Status OPEN