NCC211935_NOI Application_20210401

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 3/29/2021 12:14:22 PM (NCG01 NOI Submission)
Approve by Gamble, Aana C 3/30/2021 10:35:03 AM (Review- Construction NOI 48843)
• The task was assigned to Gamble, Aana C by round robin distribution 3/29/2021 12:14 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 31, 2021 5:00
PM 3/29/2021 12:14 PM
Submit by Selkane, Aziza 4/1/2021 9:02:42 AM (Payment Verification for NCC211935)
* Brg Builders LLC
• Selkane, Aziza assigned the task to Selkane, Aziza 4/1/2021 9:02 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: May 11, 2021 5:00 PM
3/30/2021 10:35 AM

.• SThF� ';
1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting IT No
an NOI that was r Yes
rejected before?
1a. Project Name *
Chapel Ridge Lots 119 & 122
1 b. Specific Lot
This field may be used to list specifc lot numbers.
Numbers
Lot 119
Lot 122
1 c. Parcel ID
List all Rios associated w ith this project.
Number(s) (PIN)
Lot 119 Parcel 81491 PIN 9734 00 52 0066
Lot 122 Parcel 81494 PIN 9734 00 52 3069
2. County* Chatham
3. Highway or Street 223 High Ridge LN Pittsboro 27312 and 241 High Ridge LN
Address* Pittsboro NC 27312
Street name 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 decinal degrees
35.7887
8. Longitude * Enter the longitude in decimal degrees (MJST be negative)
-79.2189
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* 04/05/2021
Estimated Construction Project Start Rate
10. Date to End * 03/30/2022
Estimated Construction Project End Cate
11. SIC (Primary)* Residential, Single Family Houses (SFE) (1521)
Standard Industrial C]assification for Development

12. Acres to be 0.53
disturbed* (including off -site borrow and waste areas)
13. Total site area 0.88
(acres) *
14. Post- 0.23
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-CHATFI­2021-Chapel Ridge Lots 119 & 122
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
Wate rbody* %rre of waterbody into which stornwater runoff will discharge
15b. Waterbody 16-(28.5)
Index No.* NCWaterbody Index Number
Stormwater rJ 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 * BRG Builders, 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 * Rob
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Robertson
It Corporation, enter Pbegistered Agent Last %rre
3b. Title Managing Member
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-427-5943
Telephone No.*
6. Permittee Mailing Street Address
Address* 101 B North Salem street
Address Line 2
City
Apex
Fbstal / Zip Code
27502
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
101 B North Salem street
Address Line 2
city
Apex
Fbstal / Zip Code
27502
State / Frovince / Fbgion
NC
Country
United States
State / Frovince / Faegion
NC
Country
United States
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
Rob
Contact - First
Name *
2. Primary Site
Robertson
Contact - Last
Name *
3. Title
Managing Member
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
19194275943
Telephone No.
6. Organization
BRG BUilders, LLC
Name
7. Site Contact
Street Address
Mailing Address*
101 B North Salem street
Address Line 2
city
Apex
Fbstal / Zip Code
27502
8. Consultant Name
(Optional)
Ben Smith
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
919-362-7111
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
919-427-5943
Default is legally responsible person telephone
State / Rovince / Region
wake
Country
United States

D. E&SC Plan
Part D.
^
Erosion & Sediment Control
......................................................................................................................................................................................................................................................................................................................................
(E&SC) Ran Approval Information
1. Date E&SC Plan
03/25/2021
Approved *
2. E&SC Plan Project Chapel Ridge Lots 119 & 122 Project # WP-
Number/ID*
21-6
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. 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 Letter of Approval_Chapel Ridge Lots 119 & 122.pdf 287.74KB
Approval letter or Mist beRDFfornat
Grading Permit
6. Site Location Map Wst be RDFfornat (lint 201VB)
119D Revised plot BRG 21.pdf 216.48KB
2019-11-17_161156.pdfBRG Plot Lot 122.pdf 223.59KB
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 if necessary.
uploaded Letter of approval form form Chatham County.
lot 119 plot plan
lot 122 plot plan
8. NOI Certification NCGO1 NOI For CR 2021.pdf 462.11 KB
Form NLst be R7Ffon-rat
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 Atide; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case under this Atcle; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring device or method required to be operated or maintained under this Amide or rules of the
Commission implementing this Atcle 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* Rob Robertson
Title Managing Member
Organization Legally Ibsponsible Entity
BRG Builders. LLC
Date * 03/29/2021

F. Tracking and COC Info
NOI Tracking No. 48843
NC Reference No.
NCG01-2021-1935
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC211935
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 1935
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. NCC211935-2021
Invoice Due Date 4/29/2021
Initial Fee $ 100.00
Invoice Status OPEN