NCC205609_NOI Application_20201218

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/4/2020 12:32:56 PM (NCG01 NOI Submission)
Approve by Clark, Paul 12/7/2020 10:29:33 AM (Review- Construction NOI 38130)
• Morman, Alaina reassigned the task to Clark, Paul 12/4/2020 4:43 PM
• The task was assigned to Morman, Alaina by round robin distribution 12/4/2020 12:33 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: December 8, 2020 5:00
PM 12/4/2020 12:33 PM
Submit by Selkane, Aziza 12/18/2020 3:24:59 PM (Payment Verification for NCC205609)
* Villages of Denver
• Selkane, Aziza assigned the task to Selkane, Aziza 12/18/2020 3:24 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: January 18, 2021 5:00 PM
12/7/2020 10:29 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 38115
NOI No.
Prior Reviewer Paul Clark
Name
1a. Project Name * Villages of Denver Phase 3C
1 b. Specific Lot This field may be used to list specffc lot numbers.
Numbers
1 c. Parcel ID List all PIS associated w ith this project.
Number(s) (PIN)
2. County* Lincoln
3. Highway or Street Kenyon Drive
Address* Street name only is acceptable if no address nunber assigned yet
4. CityorTownship* Denver
5. State * NC
6. Zip Code* 28037
7. Latitude* Enter the latitude in decinal degrees
35.4890
8. Longitude * Enter the longitude in decinal degrees (MJSTbe negative)
-81.0090
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* 12/07/2020
Estinated Construction Project Start late
10. Date to End * 05/15/2021
Estirrated Construction Project End late

11. SIC (Primary)* Residential, Single Family Houses (SFE) (1521)
Standard Industrial aassification for Development
12. Acres to be 5.00
disturbed* (including off -site borrow and waste areas)
13. Total site area 9.70
(acres) *
14. Post- 3.50
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-LINCO-2020-Villages of Denver Phase 3C
Tracking ID 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 Forney Creek
Waterbody* %rreof waterbody into which storrrwater runoff will discharge
15b. Waterbody 11-119-2-3
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 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 * Villages of Denver LLC
It 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 * Robert
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Goldberg
It Corporation, enter Pbegistered Agent Last %rre
3b. Title Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee [phone]
Telephone No.*
6. Permittee Mailing Street Address
Address* 25700 Science Park Drive
Address Line 2
Suite 365
City
Beachwood
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
Fbstal / Zip Code
44122
F Yes
Street Address
25700 Science Park Drive
Address Line 2
Suite 365
city
Beachwood
Fbstal / Zip Code
44122
State / Rovince / F;bgion
OH
Country
USA
State / Ftovince / Region
OH
Country
USA
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
Tom
Contact - First
Name *
2. Primary Site
Scott
Contact - Last
Name *
3. Title
Authorized Agent
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
704-907-7425
Telephone No.*
6. Organization
Scott Development Group
Name
7. Site Contact
Street Address
Mailing Address*
813 Pecan Treet Lane
Address Line 2
City
State / Rovince / Region
Fort Mill
SC
Postal / Zip Code
Country
2871
USA
8. Consultant Name
(Optional)
Bill Rice
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)
Default is legally responsible person e-n-ail (older NOts rray not populate)
12. Billing (For Annual Fee correspondence)
Telephone Default is legally responsible person telephone (older NOls rray not populate)

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 07/24/2019
Approved *
2. E&SC Plan Project 19-SUB-01
Number/ID * Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* Lincoln 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 Letter of Approval 7-24-19.pdf 103.64KB
Approval letter or Mist beRDFformat
Grading Permit
6. Site Location Map Mist be RDFforrrat (lint 20 NB)
Map.pdf 32.69KB
Rease do not upload entire set of E&SC plans.
7. Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded documents support
the application. Include additional waterbodies for linear projects if necessary.
8. NOI Certification NCG01 NOI Certification Form for Phase 3C 12-3-
Form 20.pdf 453.84KB
Mast be FDFformat
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 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 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* Robert Goldberg
Title Manager
Organization Legally Pesponsible Entity
Villages of Denver LLC
Date * 12/04/2020

F. Tracking and COC Info
NOI Tracking No. 38130
NC Reference No.
NCG01-2020-5609
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC205609
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5609
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. NCC205609-2020
Invoice Due Date 1/6/2021
Initial Fee $ 100.00
Invoice Status OPEN