NCC213551_NOI Application_20210615

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/9/2021 3:41:43 PM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 6/10/2021 8:27:04 AM (Review- Construction NOI 55245)
. The task was assigned to Broussard, Brooklyn C by round robin distribution 6/9/2021 3:43 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: June 11, 2021 5:00 PM
6/9/2021 3:43 PM
Submit by Selkane, Aziza 6/15/2021 6:58:18 AM (Payment Verification for NCC213551)
* Lucas L Woodburn
• Selkane, Aziza assigned the task to Selkane, Aziza 6/15/2021 6:57 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: July 22, 2021 5:00 PM
6/10/2021 8:27 AM

.• SThF� ';
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 54393
NOI No.
Prior Reviewer Paul Clark
Name
1a. Project Name * Commons at Farmington
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) 5506141031
2. County* Cabarrus
3. Highway or Street Clear Creek Lane & Farmington Ridge Parkway
Address* Street name only is acceptable if no address number assigned yet
4. City or Township* Harrisburg
5. State * NC
6. Zip Code* 28213
7. Latitude* Enter the latitude in decimal degrees
35.2930
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-80.6730
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* 03/01/2022
Estimated Construction Project End Date

11. SIC (Primary)*
Residential, Single Family Houses (SFE) (1521)
Standard Industrial aassification for Development
12. Acres to be
24.00
disturbed*
(including off -site borrow and waste areas)
13. Total site area
29.79
(acres) *
14. Post- 10.32
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-CABAR-2021-Commons at Farmington
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 Fuda Creek
Waterbody* %rreof waterbody into which stormwater runoff will discharge
15b. Waterbody 13-17-7-1
Index No. * NCWaterbody Index Nunber
Stormwater F No
discharges will flow 17 Yes
to additional
wate rs *
15c. Additional Back Creek
Receiving Waterbody narre
Waterbody
15d. Waterbody 13-17-7
Index No. NCWaterbody Index Nunber
15e. Additional Rocky River
Receiving Waterbody narre
Waterbody
15f. Waterbody 13-17b3
Index No. NCWaterbody Index Nunber
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. ^
Fl rnittee 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 * TriPointe Homes
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 * Luke
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Woodburn
It Corporation, enter F;bgistered Agent Last %rre
3b. Title Director of Land Development
4. Permitee E-mail [e-mail]
Address*
5. Permittee 803-431-6188
Telephone No.*
6. Permittee Mailing Street Address
Address* 3436 Toringdon Way
Address Line 2
Suite 210
Cty
Charlotte
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
Fbstal / Zip Code
28277
V Yes
Street Address
3436 Toringdon Way
Address Line 2
Suite 210
city
Charlotte
Fbstal / Zip Code
28277
State / Ffovince / Fbgion
NC
Country
United States
State / Ftovince / 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
Luke
Contact - First
Name *
2. Primary Site
Woodburn
Contact - Last
Name *
3. Title
Director of Land Development
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
803-431-6188
Telephone No.
6. Organization
TriPointe Homes
Name
7. Site Contact
Street Address
Mailing Address*
3436 Toringdon Way
Address Line 2
Suite 210
city
Charlotte
Postal / Zip Code
28277
8. Consultant Name
(Optional)
Robert M. Reddick Jr., PE
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
704-527-0800
Telephone No.
11. Billing E-mail
(For Annual Fee correspondence)
[e-mail]
Default is legally responsible person a-rrail
12. Billing
(For Annual Fee correspondence)
Telephone
803-431-6188
Default is legally responsible person telephone
State / Rovince / Region
NC
Country
United States

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 05/11/2021
Approved *
2. E&SC Plan Project CABAR-2020-045
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 * Mooresville (MRO)
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
Commons at Farmington (REVISED) CABAR-2020-
Approval letter or
045. pdf 197.51KB
Grading Permit
Mast be RDFfon-rat
6. Site Location Map
Mist be FDFfornat (lint 201VB)
Overall Site Plan - 2021-01-12 Town of Harrisburg -
2.93MB
Approved Set.pdf
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.
8. NOI Certification
NCG01-eNO1-Certification-Form-20210212-DEMLR-
Form
942.39KB
SW.pdf
Mist be FDFfornat
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 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:* IT 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
l�r� I�rr�df
Type Name* Luke Woodburn
Title Director of Land Development
Organization Legally Responsible Entity
TriPointe Homes
Date * 06/09/2021

F. Tracking and COC Info
NOI Tracking No. 55245
NC Reference No. NCG01-2021-3551
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of NCC213551
Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 3551
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. NCC213551-2021
Invoice Due Date 7/10/2021
Initial Fee $ 100.00
Invoice Status OPEN