NCC211947_NOI Application_20210331

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 3/26/2021 12:27:12 PM (NCG01 NOI Submission)
Approve by Clark, Paul 3/30/2021 12:45:18 PM (Review- Construction NOI 48731)
• The task was assigned to Clark, Paul by round robin distribution 3/26/2021 12:28 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 30, 2021 5:00 PM.
The priority is: High 3/26/2021 12:27 PM
Submit by McCoy, Suzanne 3/31/2021 1:45:02 PM (Payment Verification for NCC211947)
* J. Todd Rouse
• McCoy, Suzanne assigned the task to McCoy, Suzanne 3/31/2021 1:44 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: May 11, 2021 5:00 PM. The
priority is: High 3/30/2021 12:46 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 *
Shoe Creek Solar
1 b. Specific Lot
This field rray be used to list specffc lot numbers.
Numbers
1 c. Parcel ID List all Rios associated w ith this project.
Number(s) (PIN) 03-0418-01-001; 03-0418-01-016; 03-0418-01-017; 03-0418-01-020;
03-0418-01-057;03-0418-01-058
2. County* Scotland
3. Highway or Street 20882 McIntosh Road
Address* Street name only is acceptable if no address number assigned yet
4. CityorTownship* Spring Hill
5. State * NC
6. Zip Code* 28352
7. Latitude* Enter the latitude in decimal degrees
34.8450
8. Longitude * Enter the longitude in decimal degrees (MJST be negative)
-79.3846
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*
03/27/2017
Estimated Construction Project Start Date
10. Date to End*
07/31/2021
Estinated Construction Project End Date
11. SIC (Primary) *
Other (9999)
Standard Industrial C]assification for Developrrent
12. Acres to be
520.00
d istu rbe d *
(including off -site borrow and waste areas)

13. Total site area 598.00
(acres) *
14. Post- 11.70
construction (Estirreted)
impervious area
(acres) *
NCC Project NCC-SCOTL-2017-Shoe Creek Solar
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 Shoe Heel Creek
Waterbody* Narreof waterbody into which storrrwater runoff will discharge
15b. Waterbody 14-34
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. ^
Fl rnittee 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 * Cypress Creek EPC, 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 * Kayti
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Curtis
It Corporation, enter Pbegistered Agent Last %rre
3b. Title Director of Construction Management
4. Permitee E-mail [e-mail]
Address*
5. Permittee 252.361.4588
Telephone No.*
6. Permittee Mailing Street Address
Address* 5310 South Alston Avenue
Address Line 2
City
Durham
Fbstal / Zip Code
27713-4381
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
5310 South Alston Avenue
Address Line 2
City
Durham
Fbstal / Zip Code
27713-4381
State / Frovince / Pegion
NC
Country
us
State / Frovince / Faegion
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
Bill
Contact - First
Name *
2. Primary Site
McNichols
Contact - Last
Name *
3. Title
Plant Manager - Shoe Creek Facility
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
910.995.0768
Telephone No.
6. Organization
Cypress Creek Renewables
Name
7. Site Contact
Street Address
Mailing Address*
5310 South Alston Avenue
Address Line 2
City
Durham
Postal / Zip Code
27713-4381
8. Consultant Name
(Optional)
Mario Carreon
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
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
424.334.0845
Default is legally responsible person telephone
State / Rovince / Region
NC
Country
us

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 03/23/2021
Approved *
2. E&SC Plan Project SCOTL-2017-006
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 * Fayetteville (FRO)
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 scotl-2017-006exap.pdf 805.95KB
Approval letter or Mast beRFformat
Grading Permit
6. Site Location Map Mast be RDFfornat (lint 20 [vB)
Shoe Creek Site Location.pdf 298.96KB
C3.0_ OVERALL SITE PLAN Rev.0 markup.pdf 3.64MB
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 ShoeCreek NOI signed.pdf 442.99KB
Form Mast be FDFfon-rat
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 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 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* Todd Rouse
Title Sr. Director of Special Projects
Organization Legally Responsible Entity
Cypress Creek EPC, LLC
Date * 03/26/2021

F. Tracking and COC Info
NOI Tracking No. 48731
NC Reference No.
NCG01-2021-1947
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC211947
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 1947
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. NCC211947-2021
Invoice Due Date 4/29/2021
Initial Fee $ 100.00
Invoice Status OPEN