NCC214498_NOI Application_20210810

Action History (UTC-05:00)Eastern Time(US&Canada)
Subrrit by Anonymous User 8/6/2021 8:26:15 AM(NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 8/6/2021 8:33:11 AM(Review-Construction NOI 61515)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 8/6/2021 8:27 AM
• The task was assigned to DEMLR NCG01 NOI Review Team.The due date is:August 10,2021 5:00
PM 8/6/2021 8:27 AM
Submit by McCoy, Suzanne 8/10/2021 8:37:09 AM(Payment Verification for NCC214498)
* Travis Alley
• McCoy,Suzanne assigned the task to McCoy, Suzanne 8/10/2021 8:36 AM
• The task was assigned to DEMLR NCG01 Payment Team.The due date is: September 17,2021 5:00
PM 8/6/2021 8:33 AM

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1Construction Stormwater: Notice of Intent (NOI)
National Pollutant Discharge Eliminatio em 'D application for•• - .•-under NorthCarolina's
General Permit 1 1111:STORIMATER DISCHARGES associated with construction acti\Aties(or
NORTH CAROLINA
Enrlrnnmenfu�Qr�arlry
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 61436
NOI No.
Prior Reviewer Brooklyn Broussard
Name
1a. Project Name* Hawthorne Commons
1 b.Specific Lot This field may be used to list specifc lot numbers.
Numbers
1 c. Parcel ID List all Rios associated w ith this project.
Number(s)(PIN) 6519-0481-4478, 6519-0491-2756
2. County* Stanly
3. Highway or Street Hatley Farm Rd
Address* Street name only is acceptable if no address number assigned yet
4. City or Township* Stanley County
5.State* NC
6.Zip Code* 28001
7. Latitude* Enter the latitude in decimal degrees
35.3682
8. Longitude* Enter the longitude in decinal degrees(MJSTbe negative)
-80.2798
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* 08/23/2021
Estimated Construction Project Start Date
10. Date to End* 11/25/2021
Estimated Construction Project End Date

11.SIC(Primary)* Residential, Single Family Houses(SFE) (1521)
Standard Industrial aassification for Development
12.Acres to be 4.11
disturbed* (including off-site borrow and waste areas)
13.Total site area 20.30
(acres)*
14. Post- 3.50
construction (Estimated)
impervious area
(acres)*
Project Tracking ID NCC-STANL-2021-Hawthorne Commons
Assigned automatically(not used)
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 Long Creek
Waterbody* Narreof waterbody into which stormwater runoff will discharge
15b.Waterbody 13-17-31
Index No.* NCWaterbody Index Number
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. ^
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* Stanly Construction Co
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* Travis
If Corporation,enter Faegistered Agent First Wre
3. Last Name* Alley
It Corporation,enter F;bgistered Agent Last%rre
3b.Title President
4. Permitee E-mail [e-mail]
Address*
5. Permittee 7042441239
Telephone No.*
6. Permittee Mailing Street Address
Address* 28081 Austin Rd
Address Line 2
City State/Frovince/Fbgion
Albemarle NC
Fbstal/Zip Code Country
28001 United States
Check box if the F Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 28081 Austin Rd
Address Line 2
City State/Frovince/Faegion
Albemarle NC
Fbstal/Zip Code Country
28001 United States
8.Type of Ojvnership 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 Travis
Contact-First
Name*
2. Primary Site Alley
Contact-Last
Name*
3.Title President
4.Site Contact E- [e-mail]
mail Address*
5.Site Contact 7042441239
Telephone No.*
6.Organization Stanly Construction
Name
7.Site Contact Street Address
Mailing Address* 28081 Austin Road
Address Line 2
City State/Rovince/Region
Albemarle NC
Postal/Zip Code Country
28001-8304 us
8. Consultant Name (Optional)
Scott Bell
First and Last narre
9. Consultant E-mail [e-mail]
This person will be copied on all correspondence.
10. Consultant 704-880-0143
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 [phone]
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 07/14/2020
Approved*
2. E&SC Plan Project stanl-2020-030
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* Mooresville(MRO)
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 STANL-2020-030-07142020.pdf 1.62MB
Approval letter or Mast beRDFformat
Grading Permit
6.Site Location Map Mist be RDFfornat(linit 20 NB)
3.pdf 683.71 KB
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 cic.pdf 539.33KB
Form Wst be RDFfornat
This is an Express r No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.66(1) provides that:
Anyperson who knowinglymakes any false statement,representation,or certification in anyapplication,record,report,plan,or other
documentfiled 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 underthis 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 guiltyofa Class 2 misdemeanor which mayinclude 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
014&�Z
Type Name* Travis Alley
Title President
Organization Legally Pesponsible Entity
Stanly Construction
Date* 08/06/2021

F. Tracking and COC Info
NOI Tracking No. 61515
NC Reference No. NCG01-2021-4498
Uses'count_nurrber'variable(increrrented by SP)
Certificate of NCC214498
Coverage (COC) Uses'count_nurrber'variable(increrrented by SP)
No.*
Count Number 4498
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. NCC214498-2021
Invoice Due Date 9/5/2021
Initial Fee $ 100.00
Invoice Status OPEN