NCC203048_NOI Application_20200717

Action History (UTC-05:00)Eastern Time(US&Canada)
Subrrit by Anonymous User 7/15/2020 2:33:45 PM(NCG01 NOI Submission)
Approve by Garcia, Lauren V 7/17/2020 8:42:20 AM(Review-Construction NOI 28334)
• The task was assigned to Garcia, Lauren V by round robin distribution 7/15/2020 2:34 PM
• The task was assigned to DEMLR NCG01 NOI Review Team.The due date is:July 17,2020 5:00 PM
7/15/2020 2:34 PM
Submit by Selkane,Aziza 7/17/2020 10:11:47 AM(Payment Verification for NCC203048)
* Jeffrey C.Justus
• Selkane,Aziza assigned the task to Selkane,Aziza 7/17/2020 10:10 AM
• The task was assigned to DEMLR NCG01 Payment Team.The due date is:August 28, 2020 5:00 PM
7/17/2020 8:42 AM

�ThF1
1Construction Stormwater: Notice of Intent (NOI)
National Pollutant Discharge Elimination System 'D application for•• - .•-under NorthCarolina's
General Permit 1 1111:STORIMATER DISCHARGES associated with construction activities(or
NORTH CAROLINA
Enrlrnnmenfu�Qr�arlry
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 28206
NOI No.
Prior Reviewer Jim Farkas
Name
1a. Project Name* Jeff Justus Commercial Project
1 b.Specific Lot This field rray be used to list specifc lot nunbers.
Numbers 9578-51-0342
2.County* Henderson
3. Highway or Street Corner of Old Spartanburg Rd and Shepherd St
Address* Street nacre only is acceptable if no address nunber assigned yet
4. City or Township* Hendersonville
5.State* NC
6.Zip Code* 28792
7. Latitude* Enter the latitude in decimal degrees
35.2990
8. Longitude* Enter the longitude in decimal degrees(MJSTbe negative)
-82.4360
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* 05/27/2020
Estimated Construction Project Start Date
10. Date to End* 07/05/2021
Estirreted Construction Project End Cute
11.SIC(Primary)* Commercial(1542)
Standard Industrial Classification for Development

12.Acres to be 5.10
disturbed* (including off-site borrow and waste areas)
13.Total site area 6.73
(acres)*
14. Post- 3.50
construction (Estimated)
impervious area
(acres)*
NCC Project NCC-HENDE-2020-Jeff Justus Commercial Project
Tracking ID Assigned automatically
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 King Creek
Wate rbody* %rre of waterbody into which stormwater runoff will discharge
15b.Waterbody 6-55-8-1-2-(2)
Index No.* NCWaterbody Index Number
Stormwater rJ 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 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* Jeff Justus
It pernittee is an individual(i.e.,organization does not apply),enter first and last narre in this field.
2. First Name* Jeff
If Corporation,enter Faegistered Agent First%rre
3. Last Name* Justus
It Corporation,enter F;bgistered Agent Last Iona
3b.Title Owner
4. Permitee E-mail [e-mail]
Address*
5. Permittee 8286915500
Telephone No.*
6. Permittee Mailing Street Address
Address* 303 South Church Street
Address Line 2
City State/Rovince/F;bgion
Hendersonville North Carolina
Fbstal/Zip Code Country
28792 United States
Check box if the F Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 303 South Church Street
Address Line 2
City State/Frovince/Region
Hendersonville North Carolina
Fbstal/Zip Code Country
28792 United States
8.Type of Individual
Ownership*

C. Site Contact Information
Part C. ^
Roject Site Contact Inforrration
.......................................................................................................................................................................................................................................................................................................................................................................................
1. Primary Site Robbie
Contact-First
Name*
2. Primary Site Allison
Contact-Last
Name*
3.Title Owner/Contractor
4.Site Contact E- [e-mail]
mail Address*
5.Site Contact 8286928720
Telephone No.*
6.Organization Allison Contractors, LLC
Name
7.Site Contact Street Address
Mailing Address* 16 Towne Place Drive, STE. 100
Address Line 2
City State/Rovince/Region
Hendersonville, North Carolina
Fbstal/Zip Code Country
28792 United States
8. Consultant Name (Optional)
Joel D. Lenk
First and Last nacre
9. Consultant E-mail [e-mail]
This person will be copied on all correspondence.
10. Consultant 8282808375
Telephone No.

D. E&SC Plan
Part D. ^
Erosion&Sedirrent Control(E&SC)Ran Approval Inforrration
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 05/27/2020
Approved*
2. E&SC Plan Project 2020-047
Number/ID* Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* Henderson County
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 2020-047 JEFF JUSTUS PROJECT LOA.pdf 141.58KB
Approval letter or Mast beRDFformat
Grading Permit
6.Site Location Map Helpful for linear project review
(Optional) P20003-Justus-SESC Control Plan-Sheet 1.pdf 1.16MB
Mast be RDFforrrat.Rease do not upload entire set of E&SCplans.
7. Notes(Optional) Rovide any additional information that night help the reviewer better understand how uploaded docurrents support
the application.Include additional waterbodies for linear projects if necessary.
8. NOI Certification P20003-Justus NOI signed-rec 20200707-
Form 560.02KB
Doc 07072020_001.pdf
Mast be R7Fforrrat
This is an Express r No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.66(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 knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case underthis 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 guiltyofa Class 2 misdemeanor which mayinclude 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 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.
* 17 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 r
[ �;.dJ
Type Name* Jeff C.Justus
Title Owner
Organization Legally Ibsponsible Entity
Jeff C.Justus
Date* 07/15/2020

F. Tracking and COC Info
NOI Tracking No. 28334
NC Reference No. NCG01-2020-3048
Uses'count_nurrber'variable(increrrented by SP)
Certificate of NCC203048
Coverage (COC) Uses'count_nurrber'variable(increrrented by SP)
No.*
Count Number 3048
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. NCC203048-2020
Invoice Due Date 8/16/2020
Initial Fee $ 100.00
Invoice Status OPEN