NCC192208_NOI Application_20191008

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 10/4/2019 4:16:33 PM (NCG01 NOI Submission)
Approve by Clark, Paul 10/7/2019 10:03:53 AM (Review- Construction NOI 16766)
• The task was assigned to EADS\pbclark by round robin distribution 10/4/2019 4:16 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 8, 2019 5:00
PM 10/4/2019 4:16 PM
Submit by McCoy, Suzanne 10/8/2019 7:20:36 AM (Payment Verification for NCC192208)
* Lorrie Marro
• McCoy, Suzanne assigned the task to McCoy, Suzanne 10/8/2019 7:20 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 18, 2019 5:00
PM 10/7/2019 10:04 AM

STME
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1. Project Name * 48 Rosewood Ct
2. County* Chatham
3. Highway or Street 48 Rosewood Ct
Address * Street name only is acceptable if no address nurrtrer assigned yet
4. City or Township* Pittsboro
5. State * NC
1r-i)iTII1T7G)MFalif_TiIa10141
6. Zip Code* 27312
7. Latitude * Enter the latitude in decirral degrees
35.7936
8. Longitude * Enter the longitude in decirral degrees (MIST be negative)
-79.2260
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*
10/15/2019
Estimated Construction Project Start Date
10. Date to End*
06/16/2020
Estimated Construction Project End Date
11. SIC (Primary)*
Residential, Single
Family Houses (SFE)
(1521)
Standard Industrial aassification for Development
12. Acres to be
0.32
disturbed*
(including off -site borrow and waste areas)
13. Total site area 0.53
(acres)*
14. Post- 0.13
construction (Estimated)
impervious area
(acres) *

NCC Project NCC-CHATH-2019-48 Rosewood Ct
Tracking ID Assignedautorratically
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 DRY CREEK
Waterbody* Narre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 16-34-(0.7)
Index No. * NC Waterbody Index Ninber
Stormwater r No
discharges will flow pr Yes
to additional
wate rs *
15c. Additional HAW RIVER
Receiving Waterbody nacre
Waterbody
15d. Waterbody 16-(28.5)
Index No. NCWaterbody Index Pbnber
15e. Additional Waterbody narre
Receiving
Waterbody
15f. Waterbody NCWaterbody Index Narrber
Index No.
16a. Is this project F Yes
subject to the NC r No, not subject to NC SPCA
Sediment Pollution
Control Act?*

B. Permittee Information
Part B.
Perrrittee Information - Legally Responsible Entity and Individual
.....................................................................................................................................................................
h
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 Dream Shelters LLC
Name *
2. First Name* Daniel
ff Corporation, enter Registered Agent First l\b e
3. Last Name * Marro
ff Corporation, enter Registered Agent Last Barre
3b. Title Owner/Member
4. Permitee E-mail [e-mail]
Address*
5. Permittee 9197967329
Telephone No.*
6. Permittee Mailing Street Address
Address* [e-mail]
Address Line 2
504 Jamestown Rd
City
Pittsboro
Postal / Zip Code
27312
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
[e-mail]
Address Line 2
504 Jamestown Rd
City
Pittsboro
Fbstal / Zip Code
27312
State / Province / Region
North Carolina
Country
United States
State / Province / Region
North Carolina
Country
United States

C. Site Contact Information
Part C.
Roiect Site Contact hforrration
1. Type of Individual
Ownership*
2. Primary Site Daniel
Contact - First
Name *
3. Primary Site Marro
Contact - Last
Name *
4. Title Owner/Member
5. Site Contact E-
[e-mail]
mail Address*
6. Site Contact
9197967329
Telephone No.*
7. Organization
Dream Shelters LLC
Name
8. Site Contact
Street Address
Mailing Address*
504 Jamestown Rd
Address Line 2
City
Pittsboro
Rbstal / Zip Code
27312
9. Consultant Name (optional)
Daniel Marro
First and Last nave
10. Consultant E- [e-mail]
mail This person will be copied on all correspondence.
11. Consultant 919-796-1426
Telephone No.
State / Rovince / Region
North Carolina
Country
United States

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 10/01/2019
Approved *
2. E&SC Plan Project 2019-07947
Number/ID* Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by r Local Program
4. Local Program* Chatham County
Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a
complete application.
5. E&SC Plan 48 Letter of Approval Soil erosion.pdf 89.6KB
Approval Mist be RDF format
letter/documentation
6. NOI Certification 48 Rosewood NCG01-eNO1-Certification-Form-
Form 809.93KB
20190919-DEML executed.pdf
Mist be PDF format
This is an Express r No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.6B (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 knowinglymakes a false statement
of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring deice or method required to be operated or maintained under this Article or rules of the
Commission implementing this Article 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:
rJ 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.
* V 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.
* I7 I will abide by all conditions of the NCG010000 General Permit and the
approved Erosion and Sediment Control Plan.
* V 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.
* I7 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
r 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
o aAr tad
Type Name* Dan Marro
Title Owner/Member
Organization Dream Shelters LLC
Date * 10/04/2019

F. Tracking and COC Info
NOI Tracking No. 16766
NC Reference No. NCG01-2019-2208
Uses 'count number variable (incremrented by SP)
Certificate of NCC192208
Coverage (COC) Uses 'count _nunber'variable (increrrented bySP)
No. *
Count Number 2208
Sequential nunber for subrrittal that is incremented by Stored Procedure
COC Year 2019
Year of date reviewed (used to assign YY digits after "NGC' in OOCno.)