NCC205293_NOI Application_20210111

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 11/17/2020 10:32:07 AM (NCG01 NOI Submission)
Approve by Garcia, Lauren V 11/18/2020 8:51:05 AM (Review- Construction NOI 36369)
• The task was assigned to Garcia, Lauren V by round robin distribution 11/17/2020 10:33 AM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: November 19, 2020 5:00
PM. The priority is: High 11/17/2020 10:33 AM
Submit by Selkane, Aziza 1/11/2021 11:21:17 AM (Payment Verification for NCC205293)
* Brad Moore
• Selkane, Aziza assigned the task to Selkane, Aziza 1/11/2021 11:20 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: December 30, 2020 5:00
PM. The priority is: High 11/18/2020 8:51 AM

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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 * Elon University Engineering & Physics Building
1 b. Specific Lot This field rray be used to list specifc lot numbers.
Numbers
1 c. Parcel ID List all Ait associated w ith this project.
Number(s) (PIN)
2. County* Alamance
3. Highway or Street 307 N. O'Kelly Avenue
Address* Street name only is acceptable if no address number assigned yet
4. City or Township* Elon
5. State * NC
6. Zip Code* 27244
7. Latitude* Enter the latitude in decimal degrees
36.1046
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-79.5016
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 /30/2020
Estimated Construction Project Start Rate
10. Date to End*
01/01/2022
Estinated Construction Project End Date
11. SIC (Primary) *
Other (9999)
Standard Industrial C]assification for Development
12. Acres to be
5.31
disturbed*
(including off -site borrow and waste areas)

13. Total site area 5.50
(acres) *
14. Post- 1.88
construction (Estirreted)
impervious area
(acres) *
NCC Project NCC-ALAMA-2020-Eton University Engineering & Physics Building
Tracking ID Assigned autorratically
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 Dry Creek
Waterbody* Narreof waterbody into which storrrwater runoff will discharge
15b. Waterbody 16-3
Index No. * NCWaterbody Index Nurrber
Stormwater V 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. ^
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 Responsible Entity
Name * Elon University
IF 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 * Susan
If Corporation, enter Registered Agent First Wre
3. Last Name* Kirkland
IF Corporation, enter F;bgistered Agent Last %rre
3b. Title AVP for Business & Finance
4. Permitee E-mail [e-mail]
Address*
5. Permittee 336-278-5492
Telephone No.*
6. Permittee Mailing Street Address
Address* Elon University
Address Line 2
2060 Campus Box
City
Elon
Fbstal / Zip Code
27244
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
F Yes
Street Address
Alamance Building 107
Address Line 2
city
Elon
Fbstal / Zip Code
27244
State / Ffovince / Fbgion
NC
Country
USA
State / Frovince / Region
NC
Country
US
8. Type of Ownership is only individual if an individual is naned in B.1. above.
Ownership* Non -Government

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
...........................................................................................................................................................................................................................................................................
1. Primary Site
Brad
Contact - First
Name *
2. Primary Site
Moore
Contact - Last
Name *
3. Title
Director
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
336-278-5492
Telephone No.*
6. Organization
Elon University
Name
7. Site Contact
Street Address
Mailing Address*
2060 Campus Box
Address Line 2
City
State / Rovince / Region
Elon
NC
Postal / Zip Code
Country
27244
USA
8. Consultant Name
(Optional)
Ken Binkley
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
336-723-1067
Telephone No.
11. Billing E-mail (For Annual Fee correspondence)
Default is legally responsible person e-n-ail (older NOts may not populate)
12. Billing (For Annual Fee correspondence)
Telephone Default is legally responsible person telephone (older NOls rray not populate)

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 11/09/2020
Approved *
2. E&SC Plan Project ALAMA-2021-027
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. Please also upload a site map showing the overall extent of the project (for linear projects, can
include the beginning point and end point coordinates in the "Notes" box below).
5. E&SC Plan ALAMA-2021-027_20201109_Approval_Express.pdf 4.87MB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Mist be RDFforrret (lint 20 NB)
C-0.00.pdf 208.46KB
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 docurrents support
the application. Include additional waterbodies if necessary.
8. NOI Certification NOI Form -Engineering and Physics Building -
Form 75.18KB
SIGNED.pdf
Mast be R7Fformat
This is an Express r No
Review Project* F 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 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 Legally Responsible Person named on this Notice of Intent
f Authorized Responsible Person* (signing on behalf of Legally Responsible
Person named in Part B)
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
u�rrcl�r� rr't.�f�if�
Type Name* Susan Kirkland
Title AVP for Business and Finance
Organization Legally Responsible Entity
Elon University
Date * 11 /17/2020

F. Tracking and COC Info
NOI Tracking No. 36369
NC Reference No.
NCG01-2020-5293
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC205293
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5293
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. NCC205293-2020
Invoice Due Date 12/18/2020
Initial Fee $ 100.00
Invoice Status OPEN