NCC214717_NOI Application_20210820

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 8/17/2021 1:15:19 PM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 8/18/2021 7:23:44 AM (Review- Construction NOI 62327)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 8/17/2021 1:16 PM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 19, 2021 5:00
PM. The priority is: High 8/17/2021 1:16 PM
Submit by Miller, Ariyelle L 8/20/2021 3:43:41 PM (Payment Verification for NCC214717)
* Two Dots LLC
• Miller, Ariyelle L assigned the task to Miller, Ariyelle L 8/20/2021 3:42 PM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: September 29, 2021 5:00
PM. The priority is: High 8/18/2021 7:24 AM

.• SThF� ';
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 *
Two Dots Storage
1 b. Specific Lot
This field may be used to list specifc lot numbers.
Numbers
4-R
1 c. Parcel ID List all Rim associated w ith this project.
Number(s) (PIN) 857000705573
2. County* Moore
3. Highway or Street 205 PARKWAY DR.
Address* Street name only is acceptable if no address number assigned yet
4.CityorTownship* ABERDEEN
5. State * NC
6. Zip Code* 28315
7. Latitude* Enter the latitude in decimal degrees
35.1249
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-79.4090
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*
09/30/2021
Estirrated Construction Project Start Late
10. Date to End *
03/30/2022
Estinated Construction Project End Date
11. SIC (Primary)*
Commercial (1542)
Standard Industrial aassification for Development
12. Acres to be
4.14
disturbed*
(including off -site borrow and waste areas)

13. Total site area 4.14
(acres) *
14. Post- 61,251.00
construction (Estimated)
impervious area
(acres) *
Project Tracking ID NCC-MOORE-2021-Two Dots Storage
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 ABERDEEN CREEK
Waterbody* Narreof waterbody into which stormwater runoff will discharge
15b. Waterbody 14-2-11-(6)
Index No. * NCWaterbody Index Number
Stormwater V No
discharges will flow r Yes
to additional
wate rs *
16a. Is this project
subject to the NC
Sediment Pollution
Control Act?*
16b. Is this project
subject to the US
Clean Water Act?
r Yes
r No, not subject to NC SPCA
r Yes
r No, not subject to US CWA

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 * TWO DOTS 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 * LEASA
If Corporation, enter Faegistered Agent First %rre
3. Last Name* HASELDEN
It Corporation, enter Pbegistered Agent Last %rre
3b. Title Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 770-315-3053
Telephone No.*
6. Permittee Mailing Street Address
Address* P.O. BOX3123
Address Line 2
City
State / Frovince / Fbgion
Pinehurst
NC
Fbstal / Zip Code
Country
28374
MOORE
Check box if the F Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
325 LINDEN RD.
Address Line 2
City
State / Frovince / Faegion
PINEHURST
NC
Fbstal / Zip Code
Country
28374
MOORE
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
JOHN
Contact - First
Name *
2. Primary Site
HARVEL
Contact - Last
Name *
3. Title
CONTRACTOR
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
910-315-2222
Telephone No.
6. Organization
US 1 REALTY
Name
7. Site Contact
Street Address
Mailing Address*
1930 N Poplar St # 1
Address Line 2
City State / Rovince / Region
SOUTHERN PINES NC
Fbstal / Zip Code Country
28387 MOORE
8. Consultant Name (Optional)
SEVEN LAKES ENGINEERING SERVICES INC, LLC.
First and Last narre
9. Consultant E-mail [e-mail]
This person will be copied on all correspondence.
10. Consultant 910-638-0965
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
770-315-3053
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 08/02/2021
Approved *
2. E&SC Plan Project MOORE-2022-005
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 * 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 moo re-2022-005exa p. pdf 773.45KB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Mist be RDFforrret (lint 20 NB)
TS 1.pdf 4.12MB
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 NCG01 Certification Form Two Dots, LLC.pdf 475.84KB
Form Wst be RDF formal
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 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 * LEASA HASELDEN
Title MANAGER
Organization Legally Plesponsible Entity
TWO DOTS LLC.
Date * 08/17/2021

F. Tracking and COC Info
NOI Tracking No. 62327
NC Reference No.
NCG25-2021-4717
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC214717
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 4717
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. NCC214717-2021
Invoice Due Date 9/17/2021
Initial Fee $ 100.00
Invoice Status OPEN