NCC191942_NOI Application_20190920

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/17/2019 10:15:21 AM (NCG01 NOI Submission)
Approve by McCoy, Suzanne 9/18/2019 8:20:48 AM (Review- Construction NOI 15978)
• The task was assigned to McCoy, Suzanne by round robin distribution 9/17/2019 10:15 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 19, 2019 5:00
PM 9/17/2019 10:15 AM
Submit by McCoy, Suzanne 9/20/2019 1:09:56 PM (Payment Verification for NCC191942)
* Caviness and Cates
• McCoy, Suzanne assigned the task to McCoy, Suzanne 9/20/2019 1:09 PM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 30, 2019 5:00 PM
9/18/2019 8:21 AM

STME
NORTH CAROLINA
Errvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1r-811ff&T7i)i 1-11(-_TiIa1010
1. Project Name * Anderson Creek Crossing, Phase 8, Section 2C-Lots 12, 13, 42 &
43
2. County* Harnett
3. Highway or Street Timber Skip Drive
Address* Street narre only is acceptable if no address nun-ber assigned yet
4. City or Township* Anderson Creek Township
5. State * NC
6. Zip Code * 28390
7. Latitude* Enter the latitude in decimal degrees
35.2705
8. Longitude * Enter the longitude in decirral degrees (MJST be negative)
-78.9742
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*
09/13/2019
Estimated Construction Project Start Date
10. Date to End *
10/01 /2020
Estimated Construction Project End Date
11. SIC (Primary)*
Residential, Single
Family Houses (SFE)
(1521)
Standard Industrial Classification for Developrrent
12. Acres to be
0.73
disturbed*
(including off -site borrow and waste areas)
13. Total site area 0.73
(acres) *
14. Post- 0.27
construction (Estimated)
impervious area
(acres) *

NCC Project NCC-HARNE-2019-Anderson Creek Crossing, Phase 8, Section
Tracking ID 2C-Lots 12, 13, 42 & 43
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. 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 South Prong Anderson Creek
Wate rbody* Nacre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 18-23-32-2
Index No. * NC Waterbody Index Ninber
Stormwater PF No
discharges will flow r Yes
to additional
wate rs *
16a. Is this project F Yes
subject to the NC r No, not subject to NC SPCA
Sediment Pollution
Control Act?*

B. Permittee Information
Part B.
Perrrittee 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 Caviness & Cates Building and Development Co.
Name *
2. First Name* Christopher
ff Corporation, enter Registered Agent First kbrre
3. Last Name * Cates
ff Corporation, enter Registered Agent Last Barre
3b. Title Vice President
4. Permitee E-mail [e-mail]
Address*
5. Permittee 910-778-7902
Telephone No.*
6. Permittee Mailing Street Address
Address* 639 Executive Place, Suite 400
Address Line 2
City State / Province / Region
Fayetteville NC
Pastal / Zip Code Country
28305 us
Check box if the r% Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 639 Executive Place, Suite 400
Address Line 2
City
State / Province / Region
Fayetteville
NC
Pastal / Zip Code
Country
28305
us

C. Site Contact Information
Part C.
Froiect Site Contact Information
1. Type of
Ownership*
2. Primary Site
Contact - First
Name *
3. Primary Site
Contact - Last
Name *
4. Title
5. Site Contact E-
mail Address*
6. Site Contact
Telephone No.*
7. Organization
Name
8. Site Contact
Mailing Address*
Non -Government
Pamela
Geddie
Start Coordinator
[e-mail]
910-778-7902
Caviness & Cates Building and Development
Co.
Street Address
639 Executive Place, Suite 400
Address Line 2
city
Fayetteville
Fbstal / Zip Code
28305
9. Consultant Name (optional)
First and Last nacre
10. Consultant E- This person will be copied on all correspondence.
mail
11. Consultant
Telephone No.
State / Province / Region
NC
Country
us

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 09/13/2019
Approved *
2. E&SC Plan Project HARNE-2020-016
Number/ID* Assigned by agency or local program
3. E&SC Plan f• State DEQ Office
Approved by r Local Program
4. State DEQ Office * Fayetteville (FRO)
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 APPROVAL HARNE-2020-016 CAVCATES.pdf 69.25KB
Approval Mist be PCFfornat
letter/documentation
6. NOI Certification AC12,13,42 &43 NOI.pdf 583.42KB
Form Mast be RDF format
This is an Express f• No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.613 (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.
* 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.
* I7 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:* r The Responsible Person named on this Notice of Intent
r Authorized Responsible Person*
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 * Christopher E. Cates
Title Vice President
Organization Caviness & Cates Building and Development Company
Date * 09/17/2019

F. Tracking and COC Info
NOI Tracking No. 15978
NC Reference No. NCG01-2019-1942
Uses 'count number variable (incremented by SP)
Certificate of NCC191942
Coverage (COC) Uses'count_nunber'variable (incremented by SF)
No. *
Count Number 1942
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.)