NCC215098_NOI Application_20210910

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 9/8/2021 9:51:22 PM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 9/9/2021 9:01:36 AM (Review- Construction NOI 64434)
. The task was assigned to Broussard, Brooklyn C by round robin distribution 9/8/2021 9:52 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 10, 2021 5:00
PM 9/8/2021 9:52 PM
Submit by Selkane, Aziza 9/10/2021 10:14:18 AM (Payment Verification for NCC215098)
* Chris Albertson
• Selkane, Aziza assigned the task to Selkane, Aziza 9/10/2021 10:13 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 21, 2021 5:00 PM
9/9/2021 9:01 AM

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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 * Advanced Systems and Integration
1 b. Specific Lot This field may be used to list specifc lot numbers.
Numbers Street Address not yet assigned by Franklin County
1 c. Parcel ID List all Rios associated w ith this project.
Number(s) (PIN) 1883-70-7096
2. County* Franklin
3. Highway or Street Airport Road - NCSR 1798
Address* Street name only is acceptable if no address number assigned yet
4. City or Township* Harris
5. State * NC
6. Zip Code* 27549
7. Latitude* Enter the latitude in decimal degrees
36.0289
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-78.3311
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*
09/15/2021
Estimated Construction Project Start Rate
10. Date to End *
07/29/2022
Estinated Construction Project End Date
11. SIC (Primary)*
Commercial (1542)
Standard Industrial aassification for Development
12. Acres to be
2.30
disturbed*
(including off -site borrow and waste areas)

13. Total site area 4.20
(acres) *
14. Post- 1.27
construction (Estimated)
impervious area
(acres) *
Project Tracking ID NCC-FRANK-2021-Advanced Systems and Integration
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 Cedar Creek
Waterbody* Narreof waterbody into which stormwater runoff will discharge
15b. Waterbody 28-29-(2)
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 must 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. Permittee * Legally Pesponsible Entity
Christopher Albertson
It pernittee is an individual, enter first and last narre in this field. Otherwise, enter organization/business narre.
Note: If the permittee is a business, the business must be registered with the NC Secretary of State. You can verify the
registration here.
2. First Name * Christopher
If Corporation, enter Faegistered Agent First Wre
3. Last Name* Albertson
It Corporation, enter Pbegistered Agent Last %rre
3b. Title Owner
4. Permitee E-mail [e-mail]
Address*
5. Permittee 260-241-5959
Telephone No.*
6. Permittee Mailing Street Address
Address* 8512 Mangum Hollow Drive
Address Line 2
City State / Rovince / Pegion
Wake Forest NC
Fbstal / Zip Code Country
27587-6127 us
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
8512 Mangum Hollow Drive
Address Line 2
City
State / Frovince / Faegion
Wake Forest
NC
Postal / Zip Code
Country
27587-6127
us
8. Type of
ONnership is only individual if an individual is named in B.1. above.
Ownership*
Individual

C. Site Contact Information
Part C.
^
Project Site Contact Inforrration
.......................................................................................................................................................................................................................................................................................................................................................................................
1. Primary Site
Christopher
Contact - First
Name *
2. Primary Site
Albertson
Contact - Last
Name *
3. Title
Owner
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
260-241-5959
Telephone No.*
6. Organization
Advanced Systems and Integration
Name
7. Site Contact
Street Address
Mailing Address*
8512 Mangum Hollow Drive
Address Line 2
City
State / Province / Region
Wake Forest
NC
Postal / Zip Code
Country
27587-6127
us
8. Consultant Name
(Optional)
James O. Murphy Engineering & Surveying
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
919-818-2795
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
260-241-5959
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 08/11/2021
Approved *
2. E&SC Plan Project FRANK-2021-024
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 * Raleigh (RRO)
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 EPSON354.PDF 96.48KB
Approval letter or Mast beRDFformat
Grading Permit
6. Signed FRO Financial Pesponsibility/Ownership Form
Mast be RDFfornat
7. Site Location Map Mist be RDFforrret (lint 201VB)
EPSON355.PDF 34.15KB
Rease do not upload entire set of E&SC plans.
8. Notes (Optional) Provide any additional information that night help the reviewer better understand how uploaded docurrents support
the application. Include additional waterbodies if necessary.
9. NOI Certification ASI NC Notice of Intent Signed 09082021 J Murphy
Form 540.5KB
Signature Page.pdf
Mast be R7Ffon-rat
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
C r�L", ttV,W
Type Name * Christopher. Albertson
Title Owner
Organization Legally Responsible Entity
Christopher Albertson
Date * 09/08/2021

F. Tracking and COC Info
NOI Tracking No. 64434
NC Reference No.
NCG01-2021-5098
Uses 'count_nunber' variable (increrrented by SP)
Certificate of
NCC215098
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5098
Sequential nunber for subnittal 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. NCC215098-2021
Invoice Due Date 10/9/2021
Initial Fee $ 100.00
Invoice Status OPEN