NCC240513_NOI Signed Certification_20240223

2/20/24, 3:17 PM Hubbard Commercial, LLC. Mail-NC DEMLR-FROF Application Approval with Modifications Needed CRM:0197040
HubbardBrant Godfrey<[e-mail]>
Ct)\I\I I:IICI;1I,
NC DEMLR - FROF Application Approval with Modifications Needed CRM:0197040
3 messages
SVC_DoNotReply-DEQPermits <[e-mail]> Tue, Feb 20, 2024 at 2:24 PM
To: "Latham-Walters Engineering, Inc" <[e-mail]>, "Hubbard Realty of W-S, Inc" <[e-mail]>
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North Carolina Department of Environmental Quality
Division of Energy, Mineral & Land Resources
Land Quality Section
Roy Cooper
Governor
Elizabeth S. Biser
Secretary
William Vinson Jr. (Acting)
Director
02-20-2024
Hubbard Realty of W-S, Inc
1598 Westbrook Plaza Drive
Winston Salem, NC 27103
RE: Project Name:Arbor Park
Acres Approved: 13.1
Application ID: PA-002495
Permit Number: DAVID-2024-0119
Address: Nifong Road
City: Clemmons
County: Davidson
River Basin: Yadkin- Pee Dee
Stream Classification: C:Aquatic Life, Secondary Contact Recreation, Fresh water
Plan Type: New Plan
Dear Hubbard Realty of W-S, Inc,
This office has reviewed the subject erosion and sedimentation control plan. We find the plan to be acceptable with
modifications and hereby issue this Letter of Approval with Modifications. The Modifications Required for Approval are listed
below.The Certificate of Approval must be posted at the job site. This plan approval shall expire three (3) years following the
date of approval, if no land-disturbing activity has been undertaken, as is required by Title 15A NCAC 4B .0129.
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2/20/24,3:17 PM Hubbard Commercial, LLC. Mail-NC DEMLR-FROF Application Approval with Modifications Needed CRM:0197040
As of April 1, 2019, all new construction activities are required to complete and submit an electronic Notice of Intent (eNOI)
form requesting a Certificate
of Coverage (COC) under the NCG010000 Construction General Permit.After the form is reviewed and found to be complete,
you will receive a link with payment instructions for the $120 annual permit fee.After the fee is processed, you will receive the
COC
via email.As the Financially Responsible Party shown on the FRO form submitted for this project,you MUST obtain the COC
prior to commencement of any land disturbing activity.The eNOlform may be accessed atdeq.nc.gov/NCG01. Please
direct questions about the eNOlform to the Stormwater Program staff in the Raleigh central office. If the owner/operator
of this project changes in the future,the new responsible party must obtain a new COC.
Title 15A NCAC 4B .0118(a) and the NCGO1 permit require that the following documentation be kept on file at the job site:
1.The approved E&SC plan as well as any approved deviation.
2.The NCGO1 permit and the COC, once it is received.
3. Records of inspections made during the previous 12 months.
Also, this letter gives the notice required by G.S. 113A-61.1(a)of our right of periodic inspection to ensure compliance with the
approved plan.
North Carolina's Sedimentation Pollution Control Act is performance-oriented, requiring protection of existing natural resources
and adjoining properties. If, following the commencement of this project, the erosion and sedimentation control plan is
inadequate to meet the requirements of the Sedimentation Pollution Control Act of 1973 (North Carolina General Statute 113A-
51 through 66), this office may require revisions to the plan and implementation of the revisions to insure compliance with the
Act.
Acceptance and approval of this plan is conditioned upon your compliance with Federal and State water quality laws,
regulations, and rules. In addition, local city or county ordinances or rules may also apply to this land-disturbing activity. This
approval does not supersede any other permit or approval.
Please note that this approval is based in part on the accuracy of the information provided in the Financial
Responsibility/Ownership Form, which you provided. You are requested to file an amended form if there is any change in the
information included on the form. This permit allows for a land-disturbance, as called for on the application and plan, not to
exceed the approved acres. Exceeding the acreage can be a violation of this permit and may require a revised plan and
additional application fee.
In addition, it would be helpful if you notify this office of the proposed starting date for this project.
Modifications Required for Approval:
1. Diversions are proposed to direct flow at sharp angles and for considerable lengths throughout the project. Stormwater
flow is not likely to make sharp turns or change direction as proposed. Please address on the plans. [GS 113A-57(3)]
2. Please provide locations for stockpiles, with measures, if stockpiles will be used. These should not be located within 50 feet
of any storm drain, basin, or stream unless no alternative is feasible. [G.S. 143-215.1]
3. All area required for stockpiling of topsoil, contractor staging,temporary access, haul roads,septic systems, erosion control
measures or other land-disturbing activities associated with this project must be included within the disturbed limits. Please
submit a revised erosion control plan reflecting any additional area, along with any associated fees. [15A NCAC 4B .0118]
4. Please note that all erosion control measures shall be installed prior to any grading work.
General Comments:
1. Please print this email as your Letter of Approval for your NCG010000 Certificate of Coverage application.
2. Please notify this office prior to your pre-construction conference for this project by calling [phone] and asking to
speak with the Land Quality inspector for your county. Permission must be obtained and granted from NC DEQ DEMLR prior to
the removal of any ESC measures. [GS 113A-51, 15A NCAC 4B .0120]
3. Any off-site borrow and waste required for this project must come from a site with an approved erosion control plan, a site
regulated under the Mining Act of 1971, or a landfill regulated by the Division of Solid Waste Management. Trash/debris from
demolition activities or generated by any activities on site must be disposed of at a facility regulated by the Division of Solid
Waste Management or per Division of Solid Waste Management or Division of Water Resources rules and regulations. [15A
NCAC 4B .0110]
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2/20/24,3:17 PM Hubbard Commercial, LLC. Mail-NC DEMLR-FROF Application Approval with Modifications Needed CRM:0197040
4.Additional measures may be required -The applicant is responsible for the control of sediment on-site. If the approved
erosion and sedimentation control measures prove insufficient, the applicant must take those additional steps necessary to
stop sediment from leaving this site. [15A NCAC 4B .0115]
5.The NCGO1 has a $120 yearly fee and our office often receives closure inspection requests days prior to yearly NCGO1 fee
payment due dates. Be advised the project requires a closure inspection report by DEMLR prior to filing the Notice of
Termination (NOT) to terminate NCGO1 coverage. The closure inspection should not be requested until after the site has
achieved full vegetative stabilization and measures have been removed. The removal of temporary ESC measures, including
basins, requires prior approval. Often, a full growing season is necessary between initial seeding/mulching and removal of
measures. Please plan your construction accordingly to avoid contacting our office prematurely for a closure inspection. Also
be advised you may be asked for representative site pictures prior to a closure inspection. [General Comment]
Your cooperation is appreciated.
Sincerely,
Winston-Salem Regional Office - 336-776-9800
North Carolina Department of Environmental Quality
Division of Energy, Mineral & Land Resources
Land Quality Section
Enclosures: Certificate of Approval
Application Report North Carolina Department of Environmental Quality I Division of Energy, Mineral and Land Resources D_E
Qd Winston-Salem Regional Office 1450 West Hanes Mill Road, Suite 300 I Winston-Salem NC,27105
afa�; ,w....,\ r
336-776-9800
Email correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties by an authorized state
official.
2 attachments
pyi Application Report-Tuesday, February 20, 2024 212 PM.pdf
93K
Certificate of Approval -Arbor Park.pdf
117K
Brant Godfrey <[e-mail]> Tue, Feb 20, 2024 at 2:44 PM
To: Justin Nifong <[e-mail]>, John-Lewis Godfrey <[e-mail]>, John Mooney
<[e-mail]>
FYI
[Quoted text hidden]
Brant H. Godfrey, JD
Director, Sales and Development
Hubbard Commercial
1598 Westbrook Plaza Drive, Suite 200
Winston-Salem, NC 27103
336-733-1524, Cell 336-399-0398
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NCGO1 Notice of Intent (NOI) Certification Form
Directions:
Print this form, complete, scan and upload to the electronic NOI.
Then, mail the original form to the NC DEMLR Stormwater Program (with $120 check if paying by check)
at:
Division of Energy, Mineral & Land Resources Stormwater Program
512 N. Salisbury Street, 6th Floor (Office 640K)
1612 Mail Service Center
Raleigh, NC 27699-1612
THE FORM YOU MAIL MUST BE COMPLETED WITH AN ORIGINAL SIGNATURE (NOT DIGITAL) [40 CFR 122.22]
Per NC General Statute 143-215.68(i), any person who knowingly makes any false 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. . . shall be guilty of a Class 2 misdemeanor which may include a fine not to
exceed ten thousand dollars($10,000).
Under penalty of law, I certify that(check all boxes to indicate your agreement):
✓❑ 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.
O 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.
© I will abide by all conditions of the NCG010000 General Permit and the approved Erosion and Sediment Control
Plan.
©' If the approved Erosion and Sediment Control Plan 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.
Q 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.
Project Name (must match Ala): Av6r 'PccK
Specific Lot Numbers (must match Alb):
Permittee (must match 81): kA1ocrd ilaslky 4P (,J-3 (��
Legally Responsible Person (must match 82& 83): r Cr,r"f' 6ocara--,-1
Title of Legally Responsible Person (must match 83b): Pr-o-5ze-tifl
Print Name &Title of Signed if Authorized
Individual Differs from Legally Responsible Person:
Phone Number: 33`r3 ii -431 g
Signature of Legally Respo si erson or Authorized Individual Date
* IMPORTANT NOTE: This form must be signed by a responsible corporate officer that 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 permit.

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land-disturbing activity on one or more acres as covered by the Act, including any
activity under a common plan of development of this size as covered by the NCG01 permit, before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Land
Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the appropriate
Regional Office. (Please type or print and, if the question is not applicable or the e-mail address or phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project Name: Arbor Park
*If this project involves American Rescue Plan Act(ARPA)funds,list the Project Name below under which
you applied for funding through the Division of Water Infrastructure (DWI).
Is Project ARPA Funded ARPA Project Name ARPA Project#
No
2. Location of land-disturbing activity: County: Davidson City or Township: Clemmons
Highway/Street: Nifong Road Latitude: 35.953394 Longitude:-80.340724
3. Approximate date land-disturbing activity will commence: 3/15/2024
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 13.10
6. The application fee of $100.00 per acre (rounded up to the next acre) is assessed without a ceiling
amount (Example: 8.10-acre application fee is $900).
7. Has an erosion and sediment control plan been filed? Yes -Will be Mailed or Hand-Delivered
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name: Brant Godfrey E-mail Address: [e-mail]
Phone: [phone] Mobile: [phone]
9. Landowner(s)of Record:
Landowner(s) of Record
Name Email Business Phone Mobile Phone
Hubbard Realty of W-S, Inc [e-mail] 3367331524
Physical Address Mailing Address
Street 1 City State Zip Street 1 City State Zip
1598 Westbrook Winston NC 27103 1598 Westbrook Plaza Winston NC 27103
Plaza Drive Salem Drive Salem

Part B.
1. Company(ies) who are financially responsible for the land-disturbing activity (Provide a comprehensive list of all
responsible parties on accompanied page.)If the company is a sole proprietorship or if the landowner(s)is an individual(s), the
name(s)of the owner(s)maybe listed as the financially responsible party(ies).
Primary Financially Responsible Party
Company Name Email Business Phone Mobile Phone
Hubbard Realty of W-S, Inc [e-mail] 3367331524
Physical Address Mailing Address
Street 1 City State Zip Street 1 City State Zip
1598 Westbrook Winston NC 27103 1598 Westbrook Winston NC 27103
Plaza Drive Salem Plaza Drive Salem
Additional Financially Responsible Parties
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form the
landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation control
plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
Registered Agent Information
Name = Email Business Phone Mobile Phone
Physical Address Mailing Address
Street 1 City State Zip Street 1 City State Zip
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address of the
designated North Carolina agent who is registered on the NC Secretary of State business registry:
North Carolina Agent Information
Name Email Business Phone ! Mobile Phone
Physical Address Mailing Address
Street 1 City State Zip Street 1 City State Zip
Engineering/Consulting Firm Information
Name Email Business Phone Mobile Phone
Mitchell Latham mitch@Iwen ineer.com 1-(704)-895-8484
Physical Address Mailing Address
Street 1 City State Zip Street:1 City State Zip

Additional Details
1. Stream Classification: C: Aquatic Life, Secondary Contact Recreation, Fresh water
2. Was Express Review Requested: No
The above information is true and correct to the best of my knowledge and belief and was provided
by me under oath. (This form must be signed by the Financially Responsible Person if an individual(s)
or his attorney-in-fact, or if not an individual, by an officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Party). I agree to provide
corrected information should there be any change in the information provided herein.

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