NCC230200_NOI Application_20230125

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 1/23/2023 9:03:37 AM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 1/23/2023 9:14:06 AM (Review - NOI 123606 KPG Properties, LLC Dental Office
1007 Newman Rd)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 1/23/2023 9:04 AM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 26, 2023 5:00
PM 1/23/2023 9:04 AM
by Workflow 1/23/2023 9:14:14 AM (Workflow Start Event)
Submit by Holloman, Tevye L 1/25/2023 1:42:15 PM (Payment Verification for NCC230200)
F William Kincaid
• Holloman, Tevye L assigned the task to Holloman, Tevye L 1/25/2023 1:41 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: March 6, 2023 5:00 PM
1/23/2023 9:14 AM

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A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting an NOI that was rejected before?
No
+ Yes
Previous Rejected NOI No.
123584
Prior Reviewer Name
Brooklyn Broussard
la. Project Name*
KPG Properties, LLC Dental Office 1007 Newman Rd
1b. Specific Lot Numbers
This field may be used to list specifc lot numbers.
1c. Parcel ID Number(s) (PIN)
List all PINs associated with this project.
8-212-2009
2. County*
Craven
3. Highway or Street Address
1007 Newman Rd
Street name only is acceptable if no address number assigned yet
4. City or Township*
New Bern
5. State* NC
6. Zip Code* 28562
7. Latitude* Enter the latitude in decimal degrees
35.1067
8. Longitude* Enter the longitude in decimal degrees (MUST be negative)
-77.0915
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*
01/30/2023
Estimated Construction Project Start Date
10. Date to End*
05/31/2023
Estimated Construction Project End Date
11. SIC (Primary)*
Commercial (1542)
Standard Industrial Classification for Development
12. Acres to be
1.50
disturbed*
(including off -site borrow and waste areas)
13. Total site area 1.50
(acres)*
14. Post -construction 0.56
impervious area (Estimated)
(acres) *
Project Tracking ID NCC-CRAVE-2023-KPG Properties, LLC Dental Office 1007
Newman Rd
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 Waterbody*
Neuse River - Lawson Creek
Name of waterbody into which stormwater runoff will discharge
15b. Waterbody Index No.*
27-101-42
NC Waterbody Index Number
Stormwater discharges will flow to additional waters*
No
Yes
16a. Is this project subject to the NC Sediment Pollution Control Act?*
+ Yes
No, not subject to NC SPCA
17. Is this project funded with ARPA (American Rescue Plan Act) grant funds?*
+ No
Yes
Reviewer: Revise if necessary until this question is included on the eNO1.

B. Permittee Information
Part B.
Permittee Information - Legally Responsible 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 NCGO10000 General Permit. For more information on signatory requirements, see Part IV, Section B,
Item (6) of that permit.
1. Permittee* Legally Responsible Entity
KPG Properties, LLC
If permittee is an individual, enter first and last name in this field. Otherwise, enter organization/business name.
Note: If the permittee is a business, the business must be registered with the NC Secretary of State. You can verify the
registration here. Permittee must be the same entity that is responsible for the land -disturbing activity as listed on the NC
SPCA Financial Responsibility/Ownership (FRO) Form.
2. First Name* William
If Corporation, enter Registered Agent First Name
3. Last Name* Kincaid
If Corporation, enter Registered Agent Last Name
3b. Title Member -Manager KPG Properties, LLC
4. Permitee E-mail [e-mail]
Address*
5. Permittee 252-636-0011
Telephone No.*
6. Permittee Mailing Street Address
Address* 635 McCarthy Blvd
Address Line 2
City State / Province / Region
New Bern NC
Postal / Zip Code Country
28562-5232 US
Check box if the Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address *
635 McCarthy Blvd
Address Line 2
City
State / Province / Region
New Bern
NC
Postal / Zip Code
Country
28562-5232
US
8. Type of
Ownership is only individual if an individual
is named in B.1. above.
Ownership*
Non -Government

C. Site Contact Information
Part C.
Project Site Contact Information
.................................................................................................................................................................................................................................................................................................................................................................................................
1. Primary Site Bobby
Contact - First
Name*
2. Primary Site Evans
Contact - Last Name*
3. Title Superintendent
4. Site Contact E-mail [e-mail]
Address*
5. Site Contact 252-531-9000
Telephone No.*
6. Organization Name Farrior And Sons
7. Site Contact Street Address
Mailing Address* 635 McCarthy Boulevard
Address Line 2
City
New Bern
Postal / Zip Code
28562-5232
8. Consultant Name (optional)
Robert "Pete" Chiles, P.E.
First and Last name
9. Consultant E-mail [e-mail]
This person will be copied on all correspondence.
10. Consultant 252-637-4702
Telephone No.
11. Billing E-mail (For Annual Fee correspondence)
[e-mail]
Default is legally responsible person e-mail
12. Billing Telephone (For Annual Fee correspondence)
252-636-0011
Default is legally responsible person telephone
State / Province / Region
NC
Country
us

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Plan Approval Information
1. Date E&SC Plan 01/19/2023
Approved *
2. E&SC Plan Project Crave-2023-012
Number/ID* Assigned by agency or local program
3. E&SC Plan State DEQ Office
Approved by* Local Program
4. State DEQ Office* Washington (WaRO)
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 Crave-2023-012 KPG Properties, LLC - Dental Office
Approval letter or 1.51 MB
1007 Newman Road - 01192023.pdf
Grading Permit
Must be PDF format
6. Signed FRO Financial Responsibility/Ownership Form
2022063-ESC Financial FRO FUII Signed.pdf 690.63KB
Must be PDF format
7. Site Location Map Must be PDF format (limit 20 MB)
2022063-kpg vicinty.pdf 80.32KB
Please do not upload entire set of E&SC plans.
8. Notes (Optional) Provide any additional information that might help the reviewer better understand how uploaded documents
support the application. Include additional waterbodies if necessary.
9. NOI Certification 2022039-NCGO1-eNOI-Certification-Form-20210917-
Form 773.17KB
DEMLR-SW-1_SIGNED-revised.pdf
Must be PDF format
This is an Express No
Review Project* Yes

E. Certification
North Carolina General Statute 143-215.613 (i) provides that:
Any person who knowingly makes any false 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 Article; 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 Article shall
be guilty of a Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000).
Under penalty of law, I certify that:
* 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.
* 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.
* I will abide by all conditions of the NCG010000 General Permit and the approved
Erosion and Sediment Control Plan.
* 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:* The Legally Responsible Person named on this Notice of Intent
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
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Type Name* William Kincaid
Title Member -Manager
Organization Legally Responsible Entity
KPG Properties, LLC
Date * 01 /23/2023

F. Tracking and COC Info
NOI Tracking No. 123606
NC Reference No. NCG01-2023-0200
Indicates NCG01 or NCG25. Uses NOI number until approved, then uses NUMBER incremented by SP (passed
from workflow if eNOI approved)
Certificate of NCC230200
Coverage (COC) No.* Uses NOI number until approved, then uses NUMBER incremented by SIP (formatted and passed from workflow if
eNOI approved)
Initial Invoice No. NCC230200-2023
Invoice Due Date 2/22/2023
Initial Fee $ 100.00
Invoice Status OPEN