NCC211221_NOI Application_20210304

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 2/26/2021 8:08:30 AM (NCG01 NOI Submission)
Approve by Meloy, Michael 3/1/2021 11:08:13 AM (Review- Construction NOI 45497)
• Gamble, Aana C reassigned the task to Meloy, Michael 2/26/2021 8:46 AM
• The task was assigned to Gamble, Aana C by round robin distribution 2/26/2021 8:08 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 2, 2021 5:00 PM
2/26/2021 8:08 AM
Submit by Selkane, Aziza 3/4/2021 3:50:58 PM (Payment Verification for NCC211221)
* Earpsboro, LLC
• Selkane, Aziza assigned the task to Selkane, Aziza 3/4/2021 3:50 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: April 12, 2021 5:00 PM
3/1/2021 11:08 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 45392
NOI No.
Prior Reviewer Michael Meloy
Name
1a. Project Name * Earpsboro Road Subdivision Phase 2
1 b. Specific Lot This field may be used to list specffc lot numbers.
Numbers
1 c. Parcel ID List all R% associated w ith this project.
Number(s) (PIN) 271300-09-2585, 271300-08-0559, 271300-18-7006, 271300-28-9307
2. County* Johnston
3. Highway or Street Earpsboro Rd
Address* Street name only is acceptable if no address nunber assigned yet
4. CityorTownship* O'Neals
5. State * NC
6. Zip Code* 27597
7. Latitude* Enter the latitude in decimal degrees
35.7808
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-78.2907
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* 03/01/2021
Estimated Construction Project Start Date
10. Date to End* 03/01/2023
Estimated Construction Project End Date

11. SIC (Primary)*
Residential, Single Family Houses (SFE) (1521)
Standard Industrial aassification for Development
12. Acres to be
63.57
disturbed*
(including off -site borrow and waste areas)
13. Total site area
104.53
(acres) *
14. Post- 12.54
construction (Estinated)
impervious area
(acres) *
NCC Project NCC-JOHNS-2021-Earpsboro Road Subdivision Phase 2
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 Snipes Creek
Waterbody* %rreof waterbody into which stormwater runoff will discharge
15b. Waterbody 27-57-12
Index No. * NCWaterbody Index Nunber
Stormwater r- No
discharges will flow 17 Yes
to additional
wate rs *
15c. Additional Little River
Receiving Waterbody narre
Waterbody
15d. Waterbody 27-57-(8.5)
Index No. NCWaterbody Index Nunber
15e. Additional Waterbody name
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 * River Wild, 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 * Reid
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Smith
It Corporation, enter Pbegistered Agent Last %rre
3b. Title Owner
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-422-6815
Telephone No.*
6. Permittee Mailing Street Address
Address* 114 West Main Street
Address Line 2
Clayton
Fbstal / Zip Code
27520-2321
Check box if the V Yes
street address the
same as mailing
address
State / Frovince / Fbgion
NC
Country
us
7. Permittee Street
Street Address
Address*
114 West Main Street
Address Line 2
city
State / Frovince / Faegion
Clayton
NC
Fbstal / Zip Code
Country
27520-2321
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
Harrison
Contact - First
Name *
2. Primary Site
Smith
Contact - Last
Name *
3. Title
President
4. Site Contact E-
harrison@providence. construction
mail Address*
5. Site Contact
919-697-1101
Telephone No.
6. Organization
Providence Construction
Name
7. Site Contact
Street Address
Mailing Address*
114 West Main Street
Address Line 2
city
Clayton
Fbstal / Zip Code
27520-2321
8. Consultant Name
(Optional)
Ethan Averette
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
252-459-8196
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
919-422-6815
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 02/11/2021
Approved *
2. E&SC Plan Project JC# 20-038-P
Number/ID * Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* Johnston County
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 20-038 Earpsboro Road Subdivision Ph 2 ESC Appr
Approval letter or 399.51KB
2.11.21.pdf
Grading Permit
Mist be FDFforrrat
6. Site Location Map Mist be RDFforrret (lint 201VB)
Site Location Map.pdf 119.58KB
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 docurrents support
the application. Include additional waterbodies if necessary.
8. NOI Certification SIGNED_NCG01-eNO1-Certification-Form-
Form 48.87KB
Earpsboro Road Phase 2.pdf
Mast be FCFfon-rat
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
f 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* Reid Smith
Title Owner
Organization Legally Ibsponsible Entity
River Wild. LLC
Date * 02/26/2021

F. Tracking and COC Info
NOI Tracking No. 45497
NC Reference No. NCG01-2021-1221
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of NCC211221
Coverage (COC) Uses 'count number' variable (increrrented by SP)
No.*
Count Number 1221
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. NCC211221-2021
Invoice Due Date 3/31/2021
Initial Fee $ 100.00
Invoice Status OPEN