NCC190266_NOI Application_20190513

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 5/13/2019 4:10:50 PM (NCG01 NOI Submission)
Approve by McCoy, Suzanne 5/14/2019 9:09:49 AM (Review- Construction NOI 10952)
• The task was assigned to McCoy, Suzanne by round robin distribution 5/13/2019 4:11 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: May 15, 2019 5:00 PM
5/13/2019 4:11 PM
Submit by McCoy, Suzanne 5/14/2019 9:10:31 AM (Payment Verification - NCG25-2019-0266)
• The task was assigned to McCoy, Suzanne. The due date is: May 15, 2019 5:00 PM
5/14/2019 9:09 AM

STME
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1. Project Name * Lance Road
2. County* Buncombe
3. Highway or Street Lance Road
Address * Street name only is acceptable if no address nurrtrer assigned yet
4. City or Township* Arden
5. State * NC
1r-i)iTII1T7G)MFalif_T1IIa10141
6. Zip Code* 28704
7. Latitude * Enter the latitude in decirral degrees
35.4181
8. Longitude * Enter the longitude in decirral degrees (MIST be negative)
-82.5668
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*
05/14/2019
Estimated Construction Project Start Date
10. Date to End*
05/14/2021
Estimated Construction Project End Date
11. SIC (Primary)*
Residential, Single
Family Houses (SFE)
(1521)
Standard Industrial aassification for Development
12. Acres to be
27.75
disturbed*
(including off -site borrow and waste areas)
13. Total site area 29.79
(acres)*
14. Post- 9.46
construction (Estimated)
impervious area
(acres) *

NCC Project NCC-BUNCO-2019-1-ance Road
Tracking ID Assigned autorratically
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. You may
enter up to 3 waterbodies.
15a. Receiving Avery Creek
Wate rbody* l\bre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 6-34-16
Index No. * NCWaterbody Index Ninber
Stormwater fJ 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
This project will be issued a Certificate of Coverage under NCG250000 rather than NCG010000. The Erosion and
Sediment Control Plan shall be reviewed and approved by the appropriate DEMLR Regional Office, and then this Notice
of Intent form shall be completed and submitted.

B. Permittee Information
Part B.
Perrrittee Information - Legally Responsible Entity and Individual
.....................................................................................................................................................................
h
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 Lance Road Holdings, LLC
Name *
2. First Name* Viktor
ff Corporation, enter Registered Agent First l\b e
3. Last Name * Matciychuk
Y Corporation, enter Registered Agent Last Barre
3b. Title Member -Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 828-242-1879
Telephone No.*
6. Permittee Mailing Street Address
Address* 52 Big Bear Trail
Address Line 2
City
Asheville
Postal / Zip Code
28805
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
r Yes
Street Address
10 Woodberry Lane
Address Line 2
City
Asheville
Fbstal / Zip Code
28806
State / Province / Region
North Carolina
Country
United States
State / Province / Region
North Carolina
Country
United States

C. Site Contact Information
Part C.
Roiect Site Contact hforrration
1. Type of Individual
Ownership*
2. Primary Site Art
Contact - First
Name *
3. Primary Site Bayluk
Contact - Last
Name *
4. Title
5. Site Contact E- [e-mail]
mail Address*
6. Site Contact 828-242-1879
Telephone No.*
7. Organization
Name
8. Site Contact Street Address
Mailing Address* 52 Big Bear Trail
Address Line 2
city
Asheville
Fbstal / Zip Code
28805
State / Rovince / Region
North Carolina
Country
United States

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 05/13/2019
Approved *
2. E&SC Plan Project ER02019-00019
Number/ID* Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by r Local Program
4. Local Program* Buncombe County
Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a
complete application.
5. E&SC Plan 20190513140444415.pdf 582.3KB
Approval 20190513140457221.pdf 1.91 MB
letter/documentation
Mist be R7F forrret
6. NOI Certification 2019-05-13 Signed NOI.pdf 311.76KB
Form Mist be RDFfornet
This is an Express r No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.6B (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 knowinglymakes 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 deice or method required to be operated or maintained under this Article or rules of the
Commission implementing this Article 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:
rJ 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.
* V 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.
* I7 I will abide by all conditions of the NCG010000 General Permit and the
approved Erosion and Sediment Control Plan.
* V If the Erosion and Sediment Control Plan approved by the delegated program is
not compliant with Part II (Stormwater Pollution Prevention Plan) of the
NCG010000 General Permit, I will nonetheless ensure that all conditions of Part
II of the permit are met on the project at all times.
* I7 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 Responsible Person named on this Notice of Intent
r Authorized Responsible Person*
Important: The person who signs this Certification above and signs the NOI Certification Form should be the same
person (or authorized responsible person within the same organization) as listed in Section B (Permittee Information)
of this form. *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
evvS 77Jnf 511TWA�Lr
Type Name* Houston Stewart
Title Authorized Responsible Person
Organization Advantage Civil Engineering
Date * 05/13/2019

F. Tracking and COC Info
NOI Tracking No. 10952
NC Reference No. NCG25-2019-0266
Uses 'count_nunber variable (incremrented by SP)
Certificate of NCC190266
Coverage (COC) Uses 'count _nunber'variable (increrrented bySP)
No. *
Count Number 266
Sequential nunber for subrrittal that is incremented by Stored Procedure
COC Year 2019
Year of date reviewed (used to assign YY digits after "NGC' in OOCno.)