NCC204462_NOI Application_20201006

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/5/2020 12:02:39 PM (NCG01 NOI Submission)
Approve by Meloy, Michael 10/5/2020 12:39:39 PM (Review- Construction NOI 32545)
• The task was assigned to Meloy, Michael by round robin distribution 10/5/2020 12:03 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 7, 2020 5:00
PM 10/5/2020 12:03 PM
Submit by Selkane, Aziza 10/6/2020 11:48:29 AM (Payment Verification for NCC204462)
* Robuck Homes Triangle, LLC
• Selkane, Aziza assigned the task to Selkane, Aziza 10/6/2020 11:44 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 16, 2020 5:00
PM 10/5/2020 12:39 PM

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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 32448
NOI No.
Prior Reviewer Lauren Garcia
Name
1a. Project Name*
Seaforth Place
1 b. Specific Lot
This field may be used to list specifc lot numbers.
Numbers
17
2. County*
Chatham
3. Highway or Street 2543 Seaforth Road
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* Pittsboro
5. State * NC
6. Zip Code * 27312
7. Latitude * Enter the latitude in decimal degrees
35.7107
8. Longitude* Enter the longitude in decimal degrees (M. ST be negative)
-79.0737
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* 10/15/2020
Estimated Construction Project Start Date
10. Date to End* 02/28/2021
Estimated Construction Project End Cute
11. SIC (Primary)* Residential, Single Family Houses (SFE) (1521)
Standard Industrial aassification for Developrrent

12. Acres to be 8.00
disturbed* (including off -site borrow and waste areas)
13. Total site area 64.10
(acres) *
14. Post- 4.84
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-CHATFI-2020-Seaforth Place
Tracking ID Assignedautorraticaly
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 Haw River
Waterbody * %rre of waterbody into which stornwater runoff will discharge
15b. Waterbody 16-(37.5)
Index No.* NCWaterbody Index Nunber
Stormwater r No
discharges will flow Pf Yes
to additional
wate rs *
15c. Additional New Hope River Arm of B. Everett Jordan
Receiving Lake
Waterbody Waterbody name
15d. Waterbody 16-41-(3.5)
Index No. NCWaterbody Index Nunber
15e. Additional Waterbody narre
Receiving
Waterbody
15f. Waterbody NCWaterbody Index Nunber
Index No.
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 * Robuck Homes Triangle, LLC
IF 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 *
Jessica
IF Corporation, enter Faegistered Agent First Wre
3. Last Name*
Head
IF Corporation, enter F;bgistered Agent Last %rre
3b. Title
Treasurer of Robuck Homes Inc; Manager of Robuck Homes
Triangle LLC
4. Permitee E-mail
[e-mail]
Address*
5. Permittee 919-876-9200
Telephone No.*
6. Permittee Mailing Street Address
Address* P.O. Box 17102
Address Line 2
city
Raleigh
Fbstal / Zip Code
27619
Check box if the r Yes
street address the
same as mailing
address
State / Ftovince / Faegion
NC
Country
us
7. Permittee Street
Street Address
Address*
6131 Falls of Neuse Rd
Address Line 2
Suite 200
City
State / Frovince / Fbgion
Raleigh
NC
Fbstal / Zip Code
Country
27609
us
8. Type of
Non -Government
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Joe
Contact - First
Name *
2. Primary Site
Cebina
Contact - Last
Name *
3. Title
Director
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
919-876-9200
Telephone No.
6. Organization
Robuck Homes, Inc
Name
7. Site Contact
Street Address
Mailing Address*
P.O. Box 17102
Address Line 2
city
Raleigh
Fbstal / Zip Code
27619
8. Consultant Name
(Optional)
Jeff Foster, PE
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
919-367-8790
Telephone No.
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 07/10/2020
Approved *
2. E&SC Plan Project 2020-03930
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. 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 124-02 Seaforth Place - Letter of Approval.pdf 287.73KB
Approval letter or Mast beRDFforml
Grading Permit
6. Site Location Map Helpful for linear project review
(Optional) 124-02_DA-01 Basin and Pond Drainage Areas -
999.06KB
200707. pdf
Mast be RDF format. 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 w aterbodies for linear projects if necessary.
8. NOI Certification 124-02 Seaforth Place - NCG01.pdf 302.57KB
Form Mast be RDFformat
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 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 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
C%�dllw�
Type Name* Jessica Head
Title Treasurer of Robuck Homes Inc; Treasurer of Robuck Homes
Triangle LLC
Organization Legally Responsible Entity
Robuck Homes Triangle, LLC
Date * 10/05/2020

F. Tracking and COC Info
NOI Tracking No. 32545
NC Reference No.
NCG01-2020-4462
Uses 'count_nunber' variable (increrrented by SP)
Certificate of
NCC204462
Coverage (COC)
Uses 'count nurrber' variable (increrrented by SP)
No.*
Count Number 4462
Sequential nunber for subnittal 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. NCC204462-2020
Invoice Due Date 11/4/2020
Initial Fee $ 100.00
Invoice Status OPEN