NCC211860_NOI Application_20210329

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 3/23/2021 1:47:25 PM (NCG01 NOI Submission)
Approve by Clark, Paul 3/25/2021 11:07:33 AM (Review- Construction NO148401)
• Gamble, Aana C reassigned the task to Clark, Paul 3/24/2021 8:40 AM
• The task was assigned to Gamble, Aana C by round robin distribution 3/23/2021 1:48 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 25, 2021 5:00
PM 3/23/2021 1:48 PM
Submit by Selkane, Aziza 3/29/2021 2:20:33 PM (Payment Verification for NCC211860)
p There were 4 checks used to pay this permit, each check is for $25.
The four checks used are 283415, 283416, 283417, and 283419.
All checks vere received from County of Columbus.
• Selkane, Aziza assigned the task to Selkane, Aziza 3/29/2021 2:17 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: May 6, 2021 5:00 PM
3/25/2021 11:07 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 48112
NOI No.
Prior Reviewer Paul Clark
Name
1a. Project Name * Columbus County -Water and Sewer Districts I, II, III & V - Water System Improve
1 b. Specific Lot This field rray be used to list specifc lot numbers.
Numbers
1 c. Parcel ID List all R% associated w ith this project.
Number(s) (PIN) 0261.00-83-9440.000
2. County* Columbus
3. Highway or Street Various - US Hwy 74/76, SR
Address* 1311,1401,1317,1558,1585,1586,1457,1749 & N. Lakes Road
Street name only is acceptable if no address number assigned yet
4. City or Township* Chadbourn, Cerro Gordo, Nakina
5. State * NC
6. Zip Code* 28472
7. Latitude* Enter the latitude in decimal degrees
34.2849
8. Longitude * Enter the longitude in decimal degrees (MBTbe negative)
-78.8378
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* 04/05/2021
Estimated Construction Project Start Date
10. Date to End* 12/31/2021
Estimated Construction Project End Cate

11. SIC (Primary)* Other (9999)
Standard Industrial aassification for Development
12. Acres to be 8.00
disturbed* (including off -site borrow and waste areas)
13. Total site area 50.00
(acres) *
14. Post- 0.01
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-COLUM-2021-Columbus County -Water and Sewer Districts I,
Tracking ID II, III & V - Water System Improve
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 Water Branch
Waterbody* Narreof waterbody into which stormwater runoff will discharge
15b. Waterbody 14-27-2
Index No. * NCWaterbody Index Number
Stormwater F No
discharges will flow 17 Yes
to additional
wate rs *
15c. Additional Pine Log Branch
Receiving Waterbody narre
Waterbody
15d. Waterbody 15-4-8-7
Index No. NCWaterbody Index Number
15e. Additional Mill Branch
Receiving Waterbody narre
Waterbody
15f. Waterbody 15-4-4
Index No. NCWaterbody Index Number
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 * Columbus County
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 * Ricky
IF Corporation, enter Faegistered Agent First %rre
3. Last Name* Bullard
IF Corporation, enter Fbgistered Agent Last %rre
3b. Title Chairman, Columbus County Board of Commissioners
4. Permitee E-mail [e-mail]
Address*
5. Permittee 910-640-6600
Telephone No.*
6. Permittee Mailing Street Address
Address* 111 Washington Street
Address Line 2
City
Whiteville
Fbstal / Zip Code
28472
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
F Yes
Street Address
111 Washington Street
Address Line 2
city
Whiteville
Fbstal / Zip Code
28472
State / Ffovince / Fbgion
NC
Country
United States
State / Frovince / Region
NC
Country
United States
8. Type of Ojvnership is only individual if an individual is naned in B.1. above.
Ownership* Government -County

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
.....................................................................................................................................................................................................................................
1. Primary Site
Gail
Contact - First
Name *
2. Primary Site
Edwards
Contact - Last
Name *
3. Title
Assistant to County Manager / CFO
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
910-640-6600
Telephone No.
6. Organization
Columbus County, North Carolina
Name
7. Site Contact
Street Address
Mailing Address*
111 Washington Street
Address Line 2
city State / Rovince / Region
Whiteville NC
Fbstal / Zip Code Country
28472 United States
8. Consultant Name (Optional)
W Landon Younce PE / Green Engineering, PLLC
First and Last narre
9. Consultant E-mail [e-mail]
This person will be copied on all correspondence.
10. Consultant 252-237-5365
Telephone No.
11. Billing E-mail
(For Annual Fee correspondence)
[e-mail]
Default is legally responsible person e-rrail
12. Billing
(For Annual Fee correspondence)
Telephone
910-640-6600
Default is legally responsible person telephone

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 11/18/2020
Approved *
2. E&SC Plan Project COLUM-2021-005
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 * Wilmington (WiRO)
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
COLUM-2021-005 EandS Approval WD 1 II III and V
Approval letter or
289.71KB
11-18-2020.pdf
Grading Permit
Mast be FCFfon-rat
6. Site Location Map
Wst be RDFforrret (lint 201VB)
COLUM Co Location Map WD 1 11 111 V.pdf 1.51 MB
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.
eNO1 no. 48112........ Part A- Nos. 15c. 15d - water with index no.
15-4-8-7 is Pine Log Formerly Rejected due to Branch on NC
Surface Water Classifications Map. Site location map indicates
other water(s) that may be impacted, please note those as well. 3
Waters have now been reflected on the updated form. There are
more.......... Uncles Branch, Index No. 14-27-3.......... Grissett Swamp
(Lake Tabor), Index No. 15-17-1-(1) (in Tabor City)......... and Sand
Pit Branch, Index No. 15-13-1-2 (in Nakina)
8. NOI Certification
NOI Certification- Col.Cnty- Water and Sewer District
Form
I,II,III & V-Water System Improvements- 497.34KB
03232021132943. pdf
Mist be RDFformat
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 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:* IT 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
Type Name* Ricky Bullard
Title Chairman, Columbus County Board of Commissioners
Organization Legally Plesponsible Entity
Columbus County, North Carolina
Date * 03/23/2021

F. Tracking and COC Info
NOI Tracking No. 48401
NC Reference No.
NCG01-2021-1860
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC211860
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 1860
Sequential nurrber for subrrittal that is incremented by Stored Frocedure
COC Year 2021
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)
Initial Invoice No. NCC211860-2021
Invoice Due Date 4/24/2021
Initial Fee $ 100.00
Invoice Status OPEN