NCC205555_NOI Application_20201203

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/1/2020 4:05:26 PM (NCG01 NOI Submission)
Approve by Gamble, Aana C 12/1/2020 5:10:17 PM (Review- Construction NOI 37853)
• Clark, Paul reassigned the task to Gamble, Aana C 12/1/2020 4:08 PM
* THX
• The task was assigned to Clark, Paul by round robin distribution 12/1/2020 4:05 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: December 3, 2020 5:00
PM 12/1/2020 4:05 PM
Submit by Selkane, Aziza 12/3/2020 11:42:56 AM (Payment Verification for NCC205555)
* Michael Cain
• Selkane, Aziza assigned the task to Selkane, Aziza 12/3/2020 10:59 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: January 12, 2021 5:00 PM
12/1/2020 5:10 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 37782
NOI No.
Prior Reviewer Aana Gamble
Name
1a. Project Name* The Goddard School
1 b. Specific Lot This field rray be used to list specifc lot numbers.
Numbers
2. County* Buncombe
3. Highway or Street 99999 Sand Hill Road
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* Asheville
5. State * NC
6. Zip Code * 28806
7. Latitude * Enter the latitude in decimal degrees
35.5390
8. Longitude* Enter the longitude in decimal degrees (M. ST be negative)
-82.6550
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* 01/01/2021
Estimated Construction Project Start Date
10. Date to End* 12/31/2021
Estimated Construction Project End Date
11. SIC (Primary)* Commercial (1542)
Standard Industrial aassification for Developrrent

12. Acres to be 1.18
disturbed* (including off -site borrow and waste areas)
13. Total site area 2.04
(acres) *
14. Post- 1.13
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-BUNCO-2021-The Goddard School
Tracking ID Assignedautonatically
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 Hominy Creek
Waterbody * %rre of waterbody into which stornwater runoff will discharge
15b. Waterbody 6-76
Index No.* NCWaterbody Index Nunber
Stormwater r No
discharges will flow Pf Yes
to additional
wate rs *
15c. Additional French Broad River
Receiving Waterbody narre
Waterbody
15d. Waterbody 6-(54.75)
Index No. NCWaterbody Index Nunber
15e. Additional Waterbody narre
Receiving
Waterbody
15f. Waterbody NCWaterbody Index Nunber
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. ^
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 * Cheatham Land Holdings, 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 * John
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Cheatham
It Corporation, enter Pbegistered Agent Last %rre
3b. Title Operator/Owner
4. Permitee E-mail [e-mail]
Address*
5. Permittee 704-614-8948
Telephone No.*
6. Permittee Mailing Street Address
Address* 1091 Hendersonville Rd
Address Line 2
city State / Frovince / Fbgion
Asheville NC
Fbstal / Zip Code Country
28803 United States
Check box if the F Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
1091 Hendersonville Rd
Address Line 2
city
State / Frovince / Region
Asheville
NC
Fbstal / Zip Code
Country
28803
United States
8. Type of
Non -Government
Ownership

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Michael
Contact - First
Name *
2. Primary Site
Cain
Contact - Last
Name *
3. Title
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
828-252-5388
Telephone No.
6. Organization
Civil Design Concepts
Name
7. Site Contact
Street Address
Mailing Address*
168 Patton Avenue
Address Line 2
city
Asheville
Fbstal / Zip Code
28801
8. Consultant Name
(Optional)
Stephen Pierson
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
828-252-5388
Telephone No.
State / Rovince / Region
North Carolina
Country
United States

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 11/19/2020
Approved *
2. E&SC Plan Project ERO2020-00047
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 ERO2020-00047LOA.pdf 228.46KB
Approval letter or ERO2020-00047PERMIT. pdf 222.45KB
Grading Permit
Mast be RDFfon-rat
6. Site Location Map Mist be RDFforrret (lint 20 NB)
VICINITY MAP. pdf 864.82KB
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 docurrents support
the application. Include additional waterbodies for linear projects if necessary.
8. NOI Certification NCG01 Notice of Intent.pdf 105.14KB
Form Mist be RDFforrret
This is an Express r 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 Atide; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case under this Atcle; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring device or method required to be operated or maintained under this Atide or rules of the
Commission implementing this Atcle 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
IT 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* John H Cheatham IV
Title Owner/Operator
Organization Legally Iesponsible Entity
Cheatham Land Holdings LLC
Date * 12/01 /2020

F. Tracking and COC Info
NOI Tracking No. 37853
NC Reference No.
NCG01-2020-5555
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC205555
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5555
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. NCC205555-2020
Invoice Due Date 12/31/2020
Initial Fee $ 100.00
Invoice Status OPEN