NCC215300_NOI Application_20210927

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 9/20/2021 5:25:59 PM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 9/24/2021 11:53:14 AM (Review- Construction NOI 65304)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 9/20/2021 5:26 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 22, 2021 5:00
PM. The priority is: High 9/20/2021 5:26 PM
Submit by Selkane, Aziza 9/27/2021 11:13:54 AM (Payment Verification for NCC215300)
* Schoolhouse Development LLC
• Selkane, Aziza assigned the task to Selkane, Aziza 9/27/2021 11:12 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 5, 2021 5:00 PM.
The priority is: High 9/24/2021 11:53 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 65057
NOI No.
Prior Reviewer Brooklyn Broussard
Name
1a. Project Name * American Leadership Academy
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) 17JO8004
2. County* Johnston
3. Highway or Street 3770 US Hwy 70 Bus.
Address* Street name only is acceptable if no address number assigned yet
4. CityorTownship* Clayton
5. State * NC
6. Zip Code* 27520
7. Latitude* Enter the latitude in decimal degrees
35.5621
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-78.3877
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* 10/01/2021
Estimated Construction Project Start Date
10. Date to End* 08/01/2022
Estimated Construction Project End Date

11. SIC (Primary)* Commercial (1542)
Standard Industrial Classification for Development
12. Acres to be 30.50
disturbed* (including off -site borrow and waste areas)
13. Total site area 47.87
(acres) *
14. Post- 18.97
construction (Estirrated)
impervious area
(acres) *
Project Tracking ID NCC-JOHNS-2021-American Leadership Academy
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 Little Poplar Creek
Waterbody* %rreof waterbody into which storrrwater runoff will discharge
15b. Waterbody 27-41-1
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.
Fternittee 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
Johnston CD, LLC
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 * Scott
If Corporation, enter Faegistered Agent First Wre
3. Last Name* Brand
It Corporation, enter F;bgistered Agent Last %rre
3b. Title Owner / Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 702-528-1514
Telephone No.*
6. Permittee Mailing Street Address
Address* 3115 East Lion Lane
Address Line 2
Suite 300
Cty
Salt Lake City
Fbstal / Zip Code
84121
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
3115 East Lion Lane
Address Line 2
Suite 300
city
Salt Lake City
Fbstal / Zip Code
84121
State / Ffovince / Fbgion
Utah
Country
us
State / Frovince / Region
Utah
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
Jim
Contact - First
Name *
2. Primary Site
Way
Contact - Last
Name *
3. Title
Principal Project Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
702-528-1514
Telephone No.
6. Organization
Johnston CD, LLC
Name
7. Site Contact
Street Address
Mailing Address*
10320 Durant Road
Address Line 2
Suite 101
city
Raleigh
Fbstal / Zip Code
27614-6466
8. Consultant Name
(Optional)
David PoWen
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
7045613472
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
702-528-1514
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 09/15/2021
Approved *
2. E&SC Plan Project JOHNS-2022-017
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 JOHNS-2022-017_20210915_LOA.pdf 317.48KB
Approval letter or Mast beRDFformal
Grading Permit
6. Signed FRO Financial Pesponsibility/Ojvnership Form
Financial Responsibility Form —ALA Johnston.pdf 1.07MB
Mast be RDFfornal
7. Site Location Map Mast be RDFforrrat (lirrit 20IVB)
Site Location Map ALA Johnston.pdf 216.47KB
Rease do not upload entire set of E&SC plans.
8. 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.
9. NOI Certification Johnston NC DEMLR NOI 9-16-21.pdf 362.98KB
Form Mast be R7Ffon-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:* 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
5,C077—�
Type Name * Scott Brand
Title Onwer/Manager
Organization Legally Plesponsible Entity
Johnston CD LLC
Date * 09/20/2021

F. Tracking and COC Info
NOI Tracking No. 65304
NC Reference No.
NCG01-2021-5300
Uses 'count_nunber' variable (increrrented by SP)
Certificate of
NCC215300
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5300
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. NCC215300-2021
Invoice Due Date 10/24/2021
Initial Fee $ 100.00
Invoice Status OPEN