NCC214878_NOI Application_20210916

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 8/25/2021 3:59:57 PM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 8/26/2021 7:08:38 AM (Review- Construction NOI 63000)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 8/25/2021 4:00 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 27, 2021 5:00
PM 8/25/2021 4:00 PM
Submit by Miller, Ariyelle L 9/16/2021 11:21:59 AM (Payment Verification for NCC214878)
* Max Prestwood
• Miller, Ariyelle L assigned the task to Miller, Ariyelle L 9/16/2021 11:21 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 7, 2021 5:00 PM
8/26/2021 7:10 AM

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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 62865
NOI No.
Prior Reviewer Brooklyn Broussard
Name
1a. Project Name * ASU - 105 Athletics Facility
1 b. Specific Lot This field may be used to list specffc lot numbers.
Numbers
1 c. Parcel ID List all R% associated w ith this project.
Number(s) (PIN) 2910027414000
2. County* Watauga
3. Highway or Street Hwy 105
Address* Street name only is acceptable if no address number assigned yet
4. CityorTownship* Boone
5. State * NC
6. Zip Code* 28607
7. Latitude* Enter the latitude in decimal degrees
36.2002
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-81.6762
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* 08/30/2021
Estimated Construction Project Start Rate
10. Date to End * 08/30/2022
Estimated Construction Project End late

11. SIC (Primary)* Commercial (1542)
Standard Industrial Classification for Development
12. Acres to be 12.00
disturbed* (including off -site borrow and waste areas)
13. Total site area 74.63
(acres) *
14. Post- 3.20
construction (Estimated)
impervious area
(acres) *
Project Tracking ID NCC-WATAU-2021-ASU - 105 Athletics Facility
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 Winkler Creek
Waterbody* Narreof waterbody into which stormwater runoff will discharge
15b. Waterbody 10-1-4-(3.5)
Index No. * NCWaterbody Index Nurrber
Stormwater V 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.
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 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 NCG010000 General Permit. For more information on signatory requirements, see Part
IV, Section B, Item (6) of that permit.
1. Permittee * Legally Pesponsible Entity
Board of Trustees of the Endowment Fund of Appalachian State
University
It pernittee is an individual, enter first and last narre in this field. Ctherwise, enter organization/business narre.
Note: If the permittee is a business, the business must be registered with the NC Secretary of State. You can verify the
registration here.
2. First Name* Nicholas
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Katers
It Corporation, enter Pbegistered Agent Last %ne
3b. Title Associate Vice Chancellor for Facilities
4. Permitee E-mail [e-mail]
Address*
5. Permittee 8282622030
Telephone No.*
6. Permittee Mailing Street Address
Address* PO Box32126
Address Line 2
City
Boone
Fbstal / Zip Code
28608
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
F Yes
Street Address
2458 Hwy 105 S.
Address Line 2
city
BOONE
Fbstal / Zip Code
28607
State / Ffovince / Pegion
NC
Country
USA
State / Frovince / Region
NORTH CAROLINA
Country
US
8. Type of Ownership 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
Brett
Contact - First
Name *
2. Primary Site
Scantlin
Contact - Last
Name *
3. Title
Project Engineer
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
828-773-5575
Telephone No.
6. Organization
BREC, PA
Name
7. Site Contact
Street Address
Mailing Address*
2458 Hwy 105 S.
Address Line 2
City
BOONE
Postal / Zip Code
28607
8. Consultant Name
(Optional)
Max Prestwood
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
336-844-4088
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
8282622030
Default is legally responsible person telephone
State / Province / Region
NORTH CAROLINA
Country
us

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 08/13/2021
Approved *
2. E&SC Plan Project WATAUA-2022-001
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 * Winston-Salem (WSRO)
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 ASU - 105 Athletics Facility [WATAU-2022-001] A -
Approval letter or 122.07KB
M.pdf
Grading Permit
Mist be FDFforrrat
6. Signed FRO Financial Pesponsibility/Ownership Form
Mast be FDFfornat
7. Site Location Map Wst be RDFforrret (lint 201VB)
USDA MAP.pdf 1.26MB
Rease do not upload entire set of E&SC plans.
8. Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded docurrents support
the application. Include additional waterbodies if necessary.
9. NOI Certification eNOI.pdf 586.86KB
Form Mist be RDFforrret
This is an Express r 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 * Nicholas W. Katers
Title Associate Vice Chancellor for Facilities
Organization Legally Responsible Entity
Board of Trustees of the Endowment Fund of Appalachian State
University
Date * 08/25/2021

F. Tracking and COC Info
NOI Tracking No. 63000
NC Reference No.
NCG01-2021-4878
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC214878
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 4878
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. NCC214878-2021
Invoice Due Date 9/25/2021
Initial Fee $ 100.00
Invoice Status OPEN