NCC205519_NOI Application_20210128

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 11/30/2020 12:14:10 PM (NCG01 NOI Submission)
Approve by Gamble, Aana C 11/30/2020 3:18:38 PM (Review- Construction NOI 37489)
• The task was assigned to Gamble, Aana C by round robin distribution 11/30/2020 12:14 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: December 2, 2020 5:00
PM. The priority is: High 11/30/2020 12:14 PM
Submit by Selkane, Aziza 1/28/2021 8:20:09 AM (Payment Verification for NCC205519)
* Eliott Hooper
• Selkane, Aziza assigned the task to Selkane, Aziza 1/28/2021 8:19 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: January 11, 2021 5:00 PM.
The priority is: High 11/30/2020 3:19 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 * West Property
1 b. Specific Lot This field nay be used to list specifc lot nunbers.
Numbers
1 c. Parcel ID List all AEt associated w ith this project.
Number(s) (PIN)
2. County* Jackson
3. Highway or Street Beck Branch Rd
Address* Street name only is acceptable if no address nunber assigned yet
4. Cityor Township* Whittier
5. State * NC
6. Zip Code* 28789
7. Latitude* Enter the latitude in decinal degrees
35.4314
8. Longitude * Enter the longitude in decinal degrees (MJSTbe negative)
-83.3119
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*
11/23/2020
Estimated Construction Project Start Rate
10. Date to End*
01/31/2021
Estinated Construction Project End Late
11. SIC (Primary)*
Residential, Single Family Houses (SFE) (1521)
Standard Industrial Oassification for Development
12. Acres to be
1.80
disturbed*
(including off -site borrow and waste areas)

13. Total site area 36.15
(acres) *
14. Post- 0.60
construction (Estirreted)
impervious area
(acres) *
NCC Project NCC-JACKS-2020-West Property
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 Tuckaseegee River
Waterbody* Narreof waterbody into which storrrwater runoff will discharge
15b. Waterbody 2-79-(40.5)
Index No. * NCWaterbody Index Nurrber
Stormwater F No
discharges will flow 17 Yes
to additional
wate rs *
15c. Additional Beck Branch
Receiving Waterbody narre
Waterbody
15d. Waterbody 2-79-49-1
Index No. NCWaterbody Index Number
15e. Additional Camp Creek
Receiving Waterbody narre
Waterbody
15f. Waterbody 2-79-49
Index No. NCWaterbody Index Narrber
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 * Adam West
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 * Adam
If Corporation, enter Faegistered Agent First Wre
3. Last Name* West
It Corporation, enter F;bgistered Agent Last %rre
3b. Title Owner
4. Permitee E-mail [e-mail]
Address*
5. Permittee [phone]
Telephone No.*
6. Permittee Mailing Street Address
Address* 31 Jim West Rd
Address Line 2
City
State / Frovince / Fbgion
Cherokee
NC
Fbstal / Zip Code
Country
28719
us
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
31 Jim West Rd
Address Line 2
City
State / Frovince / Faegion
Cherokee
NC
Fbstal / Zip Code
Country
28719
us
8. Type of
ONnership is only individual if an individual is naned in B.1. above.
Ownership*
Individual

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
...........................................................................................................................................................................................................................................................................
1. Primary Site
Adam
Contact - First
Name *
2. Primary Site
West
Contact - Last
Name *
3. Title
Owner
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
[phone]
Telephone No.
6. Organization
Name
7. Site Contact
Street Address
Mailing Address*
31 Jim West Rd
Address Line 2
Oty
State / Rovince / Region
Cherokee'
NC
Fbstal / Zip Code
Country
28719
us
8. Consultant Name
(Optional)
Eliott Hooper
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
[phone]
Telephone No.
11. Billing E-mail (For Annual Fee correspondence)
Default is legally responsible person e-n-ail (older NOts rray 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 11/13/2020
Approved *
2. E&SC Plan Project 20-116
Number/ID * Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* Jackson County
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 West Property LOA 20-116, 11.13.20.pdf 105.27KB
Approval letter or Mast beRDFforml
Grading Permit
6. Site Location Map Mast be RDFfornat (lint 20 NB)
01-Cover Sheet.pdf 269.08KB
03-Erosion Control Plan.pdf 250.55KB
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 if necessary.
8. NOI Certification NOI Certification Form.pdf 470.99KB
Form Mast be FDFformat
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 Legally Responsible Person named on this Notice of Intent
r 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
Type Name* Adam West
Title Owner
Organization Legally Ibsponsible Entity
Owner
Date * 11 /30/2020

F. Tracking and COC Info
NOI Tracking No. 37489
NC Reference No.
NCG01-2020-5519
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC205519
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5519
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. NCC205519-2020
Invoice Due Date 12/30/2020
Initial Fee $ 100.00
Invoice Status OPEN