NCC191716_NOI Application_20190904

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/4/2019 11:28:54 AM (NCG01 NOI Submission)
Approve by Georgoulias, Bethany 9/4/2019 11:39:17 AM (Review- Construction NOI 15543)
• The task was assigned to Georgoulias, Bethany by round robin distribution 9/4/2019 11:29 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 6, 2019 5:00
PM 9/4/2019 11:29 AM
Submit by McCoy, Suzanne 9/4/2019 2:19:25 PM (Payment Verification for NCC191716)
* Kenneth A Hornbeck
• McCoy, Suzanne assigned the task to McCoy, Suzanne 9/4/2019 2:18 PM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 16, 2019 5:00 PM
9/4/2019 11:39 AM

1r-G)a�T7i)MIlia Ii(-_ToIa10141
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1. Project Name * Mallard Pointe multifamily
2. County* Mecklenburg
3. Highway or Street 11030 David Taylor Drive
Address * Street name only is acceptable if no address nurrber assigned yet
4. City or Township* Charoltte
5. State * NC
6. Zip Code* 28262
7. Latitude * Enter the latitude in decirral degrees
35.3410
8. Longitude * Enter the longitude in decirral degrees (MJSTbe negative)
-80.7640
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*
09/16/2019
Estimated Construction Project Start Date
10. Date to End*
06/01 /2021
Estimated Construction Project End Date
11. SIC (Primary)*
Residential, Other
than SFE (1522)
Standard Industrial Gassification for Development
12. Acres to be
11.00
disturbed*
(including off -site borrow and waste areas)
13. Total site area
11.00
(acres)*
14. Post-
6.36
construction
(Estimated)
impervious area
(acres) *
NCC Project
NCC-MECKL-2019-Mallard Pointe multifamily
Tracking ID
Assigned autorratically

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. You may
enter up to 3 waterbodies.
15a. Receiving Stony Creek
Wate rbody* Name of waterbody into which storawater runoff will discharge
15b. Waterbody 13-17-5-5
Index No.* NC Waterbody Index Nanber
Stormwater rJ No
discharges will flow r Yes
to additional
wate rs *
16a. Is this project r Yes
subject to the NC f No, not subject to NC SPCA
Sediment Pollution
Control Act?*

B. Permittee Information
Part B.
Porrrittee Information - Legally Responsible Entity and Individual
.....................................................................................................................................................................
h
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 High Properties LP
Name *
2. First Name* Ken
ff Corporation, enter Registered Agent First l\b e
3. Last Name * Hornbeck
ff Corporation, enter Registered Agent Last Barre
3b. Title SVP - Development
4. Permitee E-mail [e-mail]
Address*
5. Permittee 717-209-4010
Telephone No.*
6. Permittee Mailing Street Address
Address* 1853 William Penn Way
Address Line 2
City
Lancaster
Postal / Zip Code
17601-6713
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
fJ Yes
Street Address
1853 William Penn Way
Address Line 2
City
Lancaster
Fbstal / Zip Code
17601-6713
State / Province / Region
PA
Country
us
State / Province / Region
PA
Country
us

C. Site Contact Information
Part C.
Roiect Site Contact Information
1. Type of Non -Government
Ownership*
2. Primary Site by
Contact - First
Name *
3. Primary Site Nguyen
Contact - Last
Name *
4. Title Senior Superintendent
5. Site Contact E- [e-mail]
mail Address*
6. Site Contact
7043321204
Telephone No.*
7. Organization
CBG Building Company
Name
8. Site Contact
Street Address
Mailing Address*
420 Hawthorne Lane
Address Line 2
125 S Brevard St
City
Charlotte
Fbstal / Zip Code
28202
9. Consultant Name (optional)
Hy Nguyen
First and Last nave
10. Consultant E- [e-mail]
mail This person will be copied on all correspondence.
11. Consultant 7043321204
Telephone No.
State / Province / Region
North Carolina
Country
United States

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 05/08/2019
Approved *
2. E&SC Plan Project LDGP-2019-00089
Number/ID* Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by r Local Program
4. Local Program* City of Charlotte
Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a
complete application.
5. E&SC Plan Letter of Approval modified April 2019 Mallard
Approval 27.74KB
Pointe MultiFamily.pdf
letter/documentation
Mist be R7F forrret
6. NOI Certification NOI Cert Form - Mallard Pointe multifamily.pdf 74.32KB
Form Mist be RDFfornet
This is an Express r No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.6B (1) provides that:
Anyperson who knowinglymakes any false statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained under this Article or a rule implementing this Article; or who knowinglymakes a false statement
of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring deice or method required to be operated or maintained under this Article or rules of the
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine not to exceed ten thousand
dollars ($10,000).
Under penalty of law, I certify that:
rJ 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.
* V 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.
* I7 I will abide by all conditions of the NCG010000 General Permit and the
approved Erosion and Sediment Control Plan.
* V 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.
* I7 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
r Authorized Responsible Person*
Important: The person who signs this Certification above and signs the NOI Certification Form should be the same
person (or authorized responsible person within the same organization) as listed in Section B (Permittee Information)
of this form. *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
'A1071/- A91
Type Name* Kenneth Hornbeck
Title SVP - Development
Organization High Associates Ltd.
Date * 09/04/2019

F. Tracking and COC Info
NOI Tracking No. 15543
NC Reference No. NCG01-2019-1716
Uses 'count number variable (incremrented by SP)
Certificate of NCC191716
Coverage (COC) Uses'count_nunber'variable (incremented by SF)
No. *
Count Number 1716
Sequential nunber for subrrittal that is incremented by Stored Procedure
COC Year 2019
Year of date reviewed (used to assign YY digits after "NGC' in OOCno.)