NCC211297_NOI Application_20210304

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 3/2/2021 9:26:10 AM (NCG01 NOI Submission)
Approve by Gamble, Aana C 3/3/2021 2:26:55 PM (Review- Construction NOI 45993)
• Clark, Paul reassigned the task to Gamble, Aana C 3/2/2021 1:22 PM
* thx
• The task was assigned to Clark, Paul by round robin distribution 3/2/2021 9:26 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 4, 2021 5:00 PM
3/2/2021 9:26 AM
Subnut by Selkane, Aziza 3/4/2021 8:21:20 AM (Payment Verification for NCC211297)
* Brent Brinson
• Selkane, Aziza assigned the task to Selkane, Aziza 3/4/2021 8:20 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: April 14, 2021 5:00 PM
3/3/2021 2:27 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 45793
NOI No.
Prior Reviewer Aana Gamble
Name
1a. Project Name* ATMC Pender Reconnect
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) Various -State Right of Way
2. County* Pender
3. Highway or Street Various Locations
Address* Street name only is acceptable if no address number assigned yet
4. City or Township* Atkinson, Currie, Burgaw, Maple Hill, Et
5. State * NC
6. Zip Code* 28421
7. Latitude* Enter the latitude in decimal degrees
34.5001
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-78.0270
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* 09/01/2021
Estimated Construction Project Start Date
10. Date to End * 09/29/2023
Estimated Construction Project End Cate

11. SIC (Primary)* Other (9999)
Standard Industrial aasslfication for Development
12. Acres to be 16.26
disturbed* (including off -site borrow and waste areas)
13. Total site area 16.26
(acres) *
14. Post- 0.00
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-PENDE-2021-ATMC Pender Reconnect
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 Ashes Creek
Waterbody* Name of waterbody into which stormwater runoff will discharge
15b. Waterbody 18-74-34
Index No. * NCWaterbody Index Nurrber
Stormwater F No
discharges will flow 17 Yes
to additional
wate rs *
15c. Additional Bear Den Branch
Receiving Waterbody narre
Waterbody
15d. Waterbody 18-68-18-7
Index No. NCWaterbody Index Nunber
15e. Additional Beaver Dam Creek
Receiving Waterbody narre
Waterbody
15f. Waterbody 18-61-4
Index No. NCWaterbody Index N nber
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 * Atlantic Telephone Membership Corporation
IF pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
Note: The organization name must match the business entity name registered with the NC Secretary of State. You can
verify the registration here.
2. First Name * Brent
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Brinson
IF Corporation, enter F;bgistered Agent Last %rre
3b. Title Director of Outside Plant Engineering
4. Permitee E-mail [e-mail]
Address*
5. Permittee 910-754-4311
Telephone No.*
6. Permittee Mailing Street Address
Address* 640 Whiteville Road Northwest
Address Line 2
City
Shallotte
Fbstal / Zip Code
28470-6503
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
640 Whiteville Road Northwest
Address Line 2
City
Shallotte
Fbstal / Zip Code
28470-6503
State / Frovince / Pegion
NC
Country
us
State / Frovince / Faegion
NC
Country
us
8. Type of Ojvnership 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
Brent
Contact - First
Name *
2. Primary Site
Brinson
Contact - Last
Name *
3. Title
Director of Outside Plant Engineering
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
910-754-4311
Telephone No.*
6. Organization
Atlantic Telephone Membership Corporation
Name
7. Site Contact
Street Address
Mailing Address*
640 Whiteville Road Northwest
Address Line 2
City
State / Rovince / Region
Shal lotte
NC
Postal / Zip Code
Country
28470-6503
us
8. Consultant Name
(Optional)
Alex Lapinsky
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
910-755-5872
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
910-754-4311
Default is legally responsible person telephone

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 02/23/2021
Approved *
2. E&SC Plan Project PENDE-2021-018
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 * Wilmington (WiRO)
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 PENDE-2021-018 Approval 2-23-2021.pdf 292.16KB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Mist be RDFforrret (lint 20 NB)
20.07137-Pender Site Location Aerial-8.5x11.pdf 897.95KB
Rease do not upload entire set of E&SC plans.
7. Notes (Optional) Rovide any additional information that night help the reviewer better understand how uploaded docurrents support
the application. Include additional waterbodies if necessary.
Due to the nature of this project, the Lat/Long coordinates provided
are for the center point of the project area. Project includes multiple
sites throughout the county.
Below is a complete listing of the stream crossings:
Pender Co. ATMC Reconnect
Stream Name Stream Index
Ashes Creek18-74-34
Bear Den Branch 18-68-18-7
Beaverdam Creek 18-61-4
Bee Branch 18-74-55-2-1
Big Branch 18-68-16-2
Big Branch 18-74-55-4
Big Rattlesnake Creek 18-68-18-5-1
Birch Creek 18-74-55-9-1-1
Black River 18-68
Black Swamp Creek 18-68-22-1-2-1
Buckle Swamp Creek 18-68-22-1-2
Bull Branch 18-74-29-3-3
Bullhead Branch 18-68-18-1
Bulltail Creek 18-68-18-2
Buxton Branch 18-68-18-9
Cape Fear River 18-(59)
Colly Creek 18-68-17
Colvins Creek 18-68-16
Copper Smith Branch 18-61-1
Crab Branch 18-68-18-5-2
Cypress Creek 18-74-55-2
Deer Valley Branch 18-68-18-11
Dero Creek 18-74-32

Dry Branch 18-68-18-4
Fishing Creek 18-74-35
Gum Branch 18-68-18-2-1
Harrisons Creek 18-74-49
Holly Shelter Creek 18-74-33
Jones Creek 18-68-16-1
Jumping Run 18-74-3
Jumping Run Branch 18-74-55-5
Keith Branch 18-74-55-1-2
Laurel Creek 18-68-18-3
Lee Ditch 18-68-18-11-1-1
Lewis Branch 18-68-18-11-1
Lewis Creek 18-74-31
Lillington Creek 18-74-42
Long Creek 18-74-55
Lyon Swamp Canal 18-68-22-1-1
Merricks Creek 18-74-49-2
Mill Branch 18-68-18-10
Mill Branch 18-68-18-9-1
Mill Branch 18-74-55-3
Mill Branch 18-74-55-6
Mill Creek 18-74-55-9-2
Mill Pond 18-74-33-5
Mill Run 18-74-55-8
Moores Creek 18-68-18
Moores Creek 18-74-33-1
Northeast Cape Fear River 18-74-(29.5)
Northeast Cape Fear River 18-74-(47.5)
Peggy Island Creek 18-74-36
Red Bank Branch 18-68-18-8
Ricefield Branch 15-2-6-2-1
Rileys Creek 18-74-55-9
Riao Creek 18-74-55-9-1
Rock Fish Creek 18-74-29
Sandy Run Swamp 18-74-33-2
Sawyer Creek 18-74-29-5
Shelter Swamp Creek 18-74-33-2-2
Sills Creek 18-74-29-4
Taylor Branch 18-68-18-6
Trumpeters Swamp 18-74-49-2-1-1
Tuckahoe Branch 18-68-18-5-3
Turner Branch 18-61-3
Washington Creek 18-74-30
Watermelon Run 18-74-32.5
Weyman Creek 18-61
White Oak Branch 18-68-18-5
White Oak Canal 18-68-22-1-2-2
8. NOI Certification NCG01-eNO1-Certification- Form- PENDE 2021-
Form 1.05MB
018. pdf
Mist be FDFforrrat
This is an Express t: 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 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:* 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
Type Name* Brent Brinson
Title Director of Outside Plant Engineering
Organization Legally Plesponsible Entity
Atlantic Telephone Membership Corporation
Date * 03/02/2021

F. Tracking and COC Info
NOI Tracking No. 45993
NC Reference No.
NCG01-2021-1297
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC211297
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 1297
Sequential nurrber for subrrittal 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. NCC211297-2021
Invoice Due Date 4/2/2021
Initial Fee $ 100.00
Invoice Status OPEN