NCC215221_NOI Application_20211007

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 9/15/2021 3:12:51 PM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 9/16/2021 7:31:37 AM (Review- Construction NOI 64919)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 9/15/2021 3:14 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 17, 2021 5:00
PM 9/15/2021 3:14 PM
Submit by Evans, Shaundra M 10/7/2021 8:15:34 AM (Payment Verification for NCC215221)
* MatthewEaker
• Evans, Shaundra M assigned the task to Evans, Shaundra M 10/7/2021 8:15 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 28, 2021 5:00 PM
9/16/2021 7:31 AM

d� #
NORTH CAROLINA
Ernvlronmental qualily
A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting r No
an NOI that was IT Yes
rejected before?
Previous Rejected 64712
NOI No.
Prior Reviewer Brooklyn Broussard
Name
1a. Project Name * Cabin Creek Solar
1 b. Specific Lot This field rray be used to list specifc lot nunbers.
Numbers
1 c. Parcel ID List all PINS associated w ith this project.
Number(s) (PIN) 7588-00-06-5777, 7588-00-22-0505, 7578-00-91-9223, 7578-00-90-9376, 7587-
00-08-8988, 7577-00-97-7758, 7587-00-36-2902, 7587-00-34-8727, 7577-00-76-
4635, 7577-00-77-5251, 7577-00-78-9920, 7577-00-69-2448, 7577-00-68-6091
2. County* Montgomery
3. Highway or Street Cole Road
Address* Street name only is acceptable if no address nunber assigned yet
4. City or Township* Biscoe
5. State * NC
6. Zip Code* 27209
7. Latitude* Enter the latitude in decimal degrees
35.3248
8. Longitude * Enter the longitude in decimal degrees (MIST be negative)
-79.7226
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* 09/27/2021
Estir ated Construction Project Start Date
10. Date to End * 02/18/2023
Estimated Construction Project End Cate

11. SIC (Primary)* Commercial (1542)
Standard Industrial Classification for Development
12. Acres to be 558.00
disturbed* (including off -site borrow and waste areas)
13. Total site area 558.00
(acres) *
14. Post- 7.70
construction (Estimated)
impervious area
(acres) *
Project Tracking ID NCC-MONTG-2021-Cabin Creek Solar
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 Cabin Creek
Waterbody* Name of waterbody into which stormwater runoff will discharge
15b. Waterbody 17-26-5-(1)
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
Cabin Creek Solar, LLC
It pernittee is an individual, enter first and last narre in this field. Otherwise, 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 * Matt
If Corporation, enter Faegistered Agent First Wre
3. Last Name* Eaker
It Corporation, enter F;bgistered Agent Last %rre
3b. Title EPC - Project Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee [phone]
Telephone No.*
6. Permittee Mailing Street Address
Address* 130 Roberts Street
Address Line 2
Suite 120
aty
Asheville
Fbstal / Zip Code
28801-3129
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
130 Roberts Street
Address Line 2
Suite 120
city
Asheville
Fbstal / Zip Code
28801-3129
State / Ffovince / Fbgion
NC
Country
us
State / Frovince / Region
NC
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
David
Contact - First
Name *
2. Primary Site
Fowler
Contact - Last
Name *
3. Title
Construction Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
[phone]
Telephone No.
6. Organization
Blue Ridge Power
Name
7. Site Contact
Street Address
Mailing Address*
130 Roberts Street
Address Line 2
Suite 120
city
Asheville
Fbstal / Zip Code
28801-3129
8. Consultant Name
(Optional)
Greg Hoffman
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
[phone]
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
[phone]
Default is legally responsible person telephone
State / Rovince / Region
NC
Country
us

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 09/10/2021
Approved *
2. E&SC Plan Project MONTG-2021-008
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. 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 montg-2021-008apMod.pdf 808.42KB
Approval letter or Mast beRDFformat
Grading Permit
6. Signed FRO Financial Pesponsibility/Ojvnership Form
FRO form —me 09.14.21.pdf 3.04MB
Mist be RDFfornat
7. Site Location Map Mast be RDFforrrat (lirrit 20 M3)
C200_ MASTER SITE PLAN Rev.1.pdf 1.19MB
Rease do not upload entire set of E&SC plans.
8. Notes (Optional) Ffovide any additional information that night help the reviewer better understand how uploaded documents support
the application. Include additional w aterbodies if necessary.
Main site entrance and project office trailers located at substation:
1799 Cole Rd., Biscoe, NC. This is the southeast most project
entrance on the attached site plan drawing.
9. NOI Certification NCG01-eNOI-Certification-Form-20210514-DEMLR-
Form 710.68KB
SW me 09.13.21.pdf
Mist be RDFfornat
This is an Express F 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:* r The Legally Responsible Person named on this Notice of Intent
r 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* Matt Eaker
Title EPC - Project Manager
Organization Legally Plesponsible Entity
Cabin Creek Solar, LLC
Date * 09/15/2021

F. Tracking and COC Info
NOI Tracking No. 64919
NC Reference No. NCG01-2021-5221
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of NCC215221
Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5221
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. NCC215221-2021
Invoice Due Date 10/16/2021
Initial Fee $ 100.00
Invoice Status OPEN