NCC202853_NOI Application_20200708

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 7/6/2020 10:43:10 AM (NCG01 NOI Submission)
Approve by Garcia, Lauren V 7/7/2020 3:10:30 PM (Review- Construction NOI 27825)
. The task was assigned to Garcia, Lauren V by round robin distribution 7/6/2020 10:43 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: July 8, 2020 5:00 PM
7/6/2020 10:43 AM
Submit by Selkane, Aziza 7/8/2020 4:41:41 PM (Payment Verification for NCC202853)
* Robert Menzies
• Selkane, Aziza assigned the task to Selkane, Aziza 7/8/2020 4:40 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: August 18, 2020 5:00 PM
7/7/2020 3:11 PM

.• SThF� ';
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 27694
NOI No.
Prior Reviewer Alaina Morman
Name
1a. Project Name * Mass Grading Improvements for the +/1 98 Acre Downtown Candor
1 b. Specific Lot This field may be used to list specffc lot numbers.
Numbers
2. County* Montgomery
3. Highway or Street Packhouse Road (SR 1579)
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* Candor
5. State * NC
6. Zip Code * 27209
7. Latitude * Enter the latitude in decimal degrees
35.2998
8. Longitude* Enter the longitude in decimal degrees (M. ST be negative)
-79.7492
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* 01/01/2021
Estimated Construction Project Start Date
10. Date to End* 07/31/2022
Estimated Construction Project End Date
11. SIC (Primary)* Industrial (1541)
Standard Industrial aassification for Developrrent

12. Acres to be 82.70
disturbed* (including off -site borrow and waste areas)
13. Total site area 98.58
(acres) *
14. Post- 28.22
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-MONTG-2021-Mass Grading Improvements for the +/1 98
Tracking ID Acre Downtown Candor
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. 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 Bridgers Creek
Waterbody* N larre of waterbody into which stormwater runoff will discharge
15b. Waterbody 13-25-24
Index No.* NCWaterbody Index Number
Stormwater r No
discharges will flow pr Yes
to additional
wate rs *
15c. Additional Cabin Creek
Receiving Waterbody narre
Waterbody
15d. Waterbody 17-26-5-(1)
Index No. NCWaterbody Index Number
15e. Additional Waterbody narre
Receiving
Waterbody
15f. Waterbody NCWaterbody Index Number
Index No.
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 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 *
Aberdeen Carolina & Western Railway Company
It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name *
Jennifer
IF Corporation, enter Faegistered Agent First %rre
3. Last Name*
White
It Corporation, enter F;bgistered Agent Last %ne
3b. Title
President
4. Permitee E-mail [e-mail]
Address*
5. Permittee 910.974.4219
Telephone No.*
6. Permittee Mailing Street Address
Address* 967 NC Hwy 211 E
Address Line 2
City State / Rovince / F;bgion
Candor NC
Fbstal / Zip Code Country
27229 USA
Check box if the F Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
967 NC Hwy 211 E
Address Line 2
City
State / Frovince / Faegion
Candor
NC
Fbstal / Zip Code
Country
27229
USA
8. Type of
Non -Government
Ownership*

C. Site Contact Information
Part C.
Project Site Contact Information
..............................................................................................................................................................................................................................................................................................................................................................................................
1. Primary Site Jennifer
Contact - First
Name *
2. Primary Site White
Contact - Last
Name *
3. Title President
4. Site Contact E- [e-mail]
mail Address*
5. Site Contact 9109744219
Telephone No.*
6. Organization
Aberdeen Carolina & Western Railway
Name
Company
7. Site Contact
Street Address
Mailing Address*
967 NC Hwy 211 E
Address Line 2
city
Candor
Postal / Zip Code
27229
8. Consultant Name (Optional)
First and Last nave
9. Consultant E-mail This person will be copied on all correspondence.
10. Consultant
Telephone No.
State / Province / 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 06/26/2020
Approved *
2. E&SC Plan Project MONTG-2020-003
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. For linear projects, please also upload a site map showing the overall extent of the project or
include the beginning point and end point coordinates in the "Notes" box below.
5. E&SC Plan montg-2020-003apRev. pdf 784.58KB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Helpful for linear project review
(Optional) 19221-1062 Downtown Candor Site - Site Location
697.47KB
Map.pdf
Mast be RDF format. Rease do not upload entire set of E&SC plans.
7. Notes (Optional) Provide any additional information that night help the reviewer better understand how uploaded documents support
the application. Include additional w aterbodies for linear projects if necessary.
8. NOI Certification NCG01 Certification Form.pdf 37.77KB
Form Mast be RDFfon-rat
This is an Express F No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.6E (i) 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 Responsible Person named on this Notice of Intent
f Authorized Responsible Person*
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 * Jennifer White
Title President
Organization Legally Plesponsible Entity
Aberdeen Carolina & Western Railway Company
Date * 07/06/2020

F. Tracking and COC Info
NOI Tracking No. 27825
NC Reference No.
NCG01-2020-2853
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC202853
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 2853
Sequential nurrber for subrrittal that is incremented by Stored Frocedure
COC Year 2020
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)
Initial Invoice No. NCC202853-2020
Invoice Due Date 8/6/2020
Initial Fee $ 100.00
Invoice Status OPEN