NCC200918_NOI Application_20200310

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 3/7/2020 3:08:11 PM (NCG01 NOI Submission)
Approve by McCoy, Suzanne 3/9/2020 7:09:02 AM (Review- Construction NOI 22892)
• McCoy, Suzanne reassigned the task to McCoy, Suzanne 3/9/2020 7:08 AM
• The task was assigned to Farkas, Jim J by round robin distribution 3/7/2020 3:08 PM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 11, 2020 5:00
PM 3/7/2020 3:08 PM
Submit by McCoy, Suzanne 3/10/2020 7:27:22 AM (Payment Verification for NCC200918)
* Jeffrey Wright
• McCoy, Suzanne assigned the task to McCoy, Suzanne 3/10/2020 7:26 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: April 20, 2020 5:00 PM
3/9/2020 7:09 AM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
la. Project Name* McPhail Meadows
1 b. Specific Lot This field rrey be used to list specifc lot nunbers.
Numbers
2. County* Hoke
3. Highway or Street Pittman Grove Church Road
Address* Street name only is acceptable if no address number assigned yet
4. CityorTownship* McLauchlin
5. State * NC
6. Zip Code* 28376
7. Latitude* Enter the latitude in decirral degrees
34.9985
8. Longitude * Enter the longitude in decirral degrees (MJSTbe negative)
-79.1073
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*
03/11/2020
Estirrated Construction Project Start Date
10. Date to End*
01/01/2021
Estirrated Construction Project End Date
11. SIC (Primary)*
Residential, Single
Family Houses (SFE)
(1521)
Standard Industrial Classification for Development
12. Acres to be
18.00
disturbed*
(including off -site borrow and waste areas)
13. Total site area 18.91
(acres)*

14. Post- 22.95
construction (Estirreted)
impervious area
(acres) *
NCC Project NCC-HOKE-2020-McPhail Meadows
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 Puppy Creek
Waterbody* INbrre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 18-31-19
Index No.* NCWaterbody Index Number
Stormwater V No
discharges will flow r Yes
to additional
wate rs *
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. ^
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 Southeastern Construction of Rockfish LLC
Name * If perrrittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name* Jeffrey
IF Corporation, enter Fbgistered Agent First Barre
3. Last Name* Wright
If Corporation, enter Faegistered Agent Last %rre
3b. Title Owner
4. Permitee E-mail [e-mail]
Address *
5. Permittee 9103081534
Telephone No.*
6. Permittee Mailing Street Address
Address* 771 Bostic Rd
Address Line 2
city
State / Ftovince / Region
Raeford
NC
Fbstal / Zip Code
Country
28376
Hoke
Check box if the rJ Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
771 Bostic Rd
Address Line 2
City
State / Ffovince / Fbgion
Raeford
NC
Fbstal / Zip Code
Country
28376
Hoke
8. Type of
Individual
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
.................................................................................................................................................................................................................
1. Primary Site
Jeffrey
Contact - First
Name *
2. Primary Site
Wright
Contact - Last
Name *
3. Title
Owner
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
9103081534
Telephone No.*
6. Organization
Southeastern Construction of Rockfish LLC
Name
7. Site Contact
Street Address
Mailing Address*
771 Bostic Rd
Address Line 2
City
State / Rovince / Region
Raeford
NC
Postal / Zip Code
Country
28376
Hoke
8. Consultant Name
(Optional)
Jarrod Hilliard, PE, CFM
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
9193522834
Telephone No.

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 12/10/2019
Approved *
2. E&SC Plan Project Hoke-2020-020
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. 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 hoke020apMod-1 - 20729.pdf 87.31 KB
Approval letter or Mast beRDFforml
Grading Permit
Site Map (Optional) Helpful for linear project review
Mast be R7Fform3t
Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded documents support
the application. Include additional w aterbodies for linear projects if necessary.
6. NOI Certification McPhail NOI - 20729.pdf 1.3MB
Form Mast be RDFfon-rat
This is an Express F No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.6E (i) 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 Responsible Person named on this Notice of Intent
f 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
Type Name * Jeffrey Wright
Title Owner
Organization Southeastern Construction of Rockfish LLC
Date * 03/07/2020

F. Tracking and COC Info
NOI Tracking No. 22892
NC Reference No. NCG01-2020-0918
Uses 'count number' variable (incremrented by SP)
Certificate of NCC200918
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 918
Sequential number for submittal that is incremented by Stored Frocedure
COC Year 2020
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)