NCC205076_NOI Application_20201117

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 11/3/2020 11:51:06 AM (NCG01 NOI Submission)
Approve by Morman, Alaina 11/5/2020 3:56:53 PM (Review- Construction NOI 35022)
• Morman, Alaina reassigned the task to Morman, Alaina 11/3/2020 11:59 AM
• The task was assigned to Garcia, Lauren V by round robin distribution 11/3/2020 11:51 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: November 5, 2020 5:00
PM 11/3/2020 11:51 AM
Submit by Selkane, Aziza 11/17/2020 9:17:53 AM (Payment Verification for NCC205076)
* J. Charles Hendon Jr
• Selkane, Aziza assigned the task to Selkane, Aziza 11/17/2020 9:17 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: December 17, 2020 5:00
PM 11/5/2020 3:57 PM

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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 34548
NOI No.
Prior Reviewer Alaina Morman
Name
1a. Project Name* Hendon Properties
1 b. Specific Lot This field may be used to list specffc lot numbers.
Numbers
2. County* Alamance
3. Highway or Street Wilson Street Extension
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* Mebane
5. State * NC
6. Zip Code * 27302
7. Latitude * Enter the latitude in decirral degrees
36.0683
8. Longitude* Enter the longitude in decinal degrees (M. ST be negative)
-79.2694
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* 10/15/2020
Estimated Construction Project Start Date
10. Date to End* 10/14/2022
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 1.50
(acres) *
14. Post- 0.79
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-ALAMA-2020-Hendon Properties
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 Haw Creek
Wate rbody* %rre of waterbody into which stormwater runoff will discharge
15b. Waterbody 16-20-(1)
Index No.* NCWaterbody Index Number
Stormwater rJ No
discharges will flow r- Yes
to additional
wate rs *
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.
R:rmttee Inforrration - Legally Fbsponsible Entity and Individual
...........................................................................................................................................................
Important: The person vvho 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 ovvns 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 PesponsibleEntity
Name * Hendon Tiller Mebane 2.0, LLC
If perrrittee is an individual (i.e., organization does not apply), enter first and last nave 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 * J. Charles
If Corporation, enter Faegistered Agent First Nerre
3. Last Name* Hendon, Jr.
If Corporation, enter Plegistered Agent Last I\brre
3b. Title Managing Member
4. Permitee E-mail [e-mail]
Address*
5. Permittee 404-271-0243
Telephone No.*
6. Permittee Mailing Street Address
Address* 3445 Peachtree Road Northeast
Address Line 2
Suite 465
City
State / Province / Region
Atlanta
GA
Postal / Zip Code
Country
30326-3238
us
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
3445 Peachtree Road Northeast
Address Line 2
Suite 465
City
State / Province / Faegion
Atlanta
GA
Postal / Zip Code
Country
30326-3238
us
8. Type of
Non -Government
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Mark
Contact - First
Name *
2. Primary Site
Tiller
Contact - Last
Name *
3. Title
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
404-271-0243
Telephone No.
6. Organization
Name
7. Site Contact
Street Address
Mailing Address*
3445 Peachtree Rd. NE
Address Line 2
Suite 465
city
Atlanta
Fbstal / Zip Code
30326
8. Consultant Name
(Optional)
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
336819-5276
Telephone No.
State / Rovince / Region
GA
Country
USA

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 10/05/2020
Approved *
2. E&SC Plan Project ALAMA-2021-020
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 200015-DENR EC -Approval Letter.pdf 754.83KB
Approval letter or Mist beRDFforml
Grading Permit
6. Site Location Map Mist be RDFfornat (lint 20 NB)
Rease do not upload entire set of E&SC plans.
7. Notes (Optional) Provide 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 Signed-eNOI.pdf 410.24KB
Form Hendon Mebane Form for.pdf 410.24KB
Wst be RDFfornat
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 * J. Charles Hendon, Jr.
Title Managing Member
Organization Legally Responsible Entity
Hendon Tiller Mebane 2.0, LLC
Date * 11/03/2020

F. Tracking and COC Info
NOI Tracking No. 35022
NC Reference No.
NCG01-2020-5076
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC205076
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5076
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. NCC205076-2020
Invoice Due Date 12/5/2020
Initial Fee $ 100.00
Invoice Status OPEN