NCC212611_NOI Application_20210503

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 4/27/2021 11:45:39 AM (NCG01 NOI Submission)
Approve by Gamble, Aana C 4/29/2021 8:21:51 PM (Review- Construction NOI 51117)
• Garcia, Lauren V reassigned the task to Gamble, Aana C 4/28/2021 3:14 PM
• The task was assigned to Garcia, Lauren V by round robin distribution 4/27/2021 11:46 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: April 29, 2021 5:00 PM
4/27/2021 11:46 AM
Submit by Selkane, Aziza 5/3/2021 11:05:42 AM (Payment Verification for NCC212611)
* Elton R Ange Ill
• Selkane, Aziza assigned the task to Selkane, Aziza 5/3/2021 11:04 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: June 10, 2021 5:00 PM
4/29/2021 8:22 PM

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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 51097
NOI No.
Prior Reviewer Aana Gamble
Name
1a. Project Name * Hidden Lake Ph 2 - Lot 67 & 68
1 b. Specific Lot
This field may be used to list specifc lot numbers.
Numbers
67 and 68
1 c. Parcel ID
List all R% associated w ith this project.
Number(s) (PIN)
1864-50-2379
1864-50-0590
2. County*
Franklin
3. Highway or Street 227 Forest Bridge Road
Address* Street name only is acceptable if no address number assigned yet
4. Cityor Township* Youngsville
5. State * NC
6. Zip Code * 27596
7. Latitude* Enter the latitude in decimal degrees
36.0590
8. Longitude * Enter the longitude in decimal degrees (M-ISTbe negative)
-78.4400
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* 05/10/2021
Estimated Construction Project Start Date
10. Date to End* 12/10/2021
Estimated Construction Project End Cate

11. SIC (Primary)*
Residential, Single Family Houses (SFE) (1521)
Standard Industrial aassification for Development
12. Acres to be
1.00
disturbed*
(including off -site borrow and waste areas)
13. Total site area
1.26
(acres) *
14. Post- 0.13
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-FRANK-2021-Hidden Lake Ph 2 - Lot 67 & 68
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 Brandy Creek
Waterbody* %rreof waterbody into which stormwater runoff will discharge
15b. Waterbody 28-29-3-(1)
Index No. * NCWaterbody Index Nunber
Stormwater F No
discharges will flow 17 Yes
to additional
wate rs *
15c. Additional Cedar Creek
Receiving Waterbody narre
Waterbody
15d. Waterbody 28-29-(2)
Index No. NCWaterbody Index Nunber
15e. Additional Waterbody name
Receiving
Waterbody
15f. Waterbody NCWaterbody Index Number
Index No.
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 * Ange Construction dba Ange Signature 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 * Elton
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Ange III
It Corporation, enter F;bgistered Agent Last %rre
3b. Title President
4. Permitee E-mail [e-mail]
Address*
5. Permittee 9193883636
Telephone No.*
6. Permittee Mailing Street Address
Address* [e-mail]
Address Line 2
113 EDINBURGH SOUTH DR, Suite 100
City
CARY
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
Fbstal / Zip Code
27511
V Yes
Street Address
[e-mail]
Address Line 2
113 EDINBURGH SOUTH DR, Suite 100
Qty
CARY
Fbstal / Zip Code
27511
State / Ffovince / Fbgion
North Carolina
Country
United States
State / Frovince / Faegion
North Carolina
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
Stacy
Contact - First
Name *
2. Primary Site
McMillan
Contact - Last
Name *
3. Title
Office Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
9193883636
Telephone No.
6. Organization
Ange Construction
Name
7. Site Contact
Street Address
Mailing Address*
113 EDINBURGH SOUTH DR
Address Line 2
Suite 100
Oty
CARY
Fbstal / Zip Code
27511
8. Consultant Name
(Optional)
Salman Moaaam
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
9196781070
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
9193883636
Default is legally responsible person telephone
State / Rovince / 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 04/26/2021
Approved *
2. E&SC Plan Project FRANK-2021-020
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 * Raleigh (RRO)
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 HL67 and 68 Letter of Approval.pdf 227.57KB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Wst be RDFforrret (lint 20 NB)
Location map.pdf 130.71 KB
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 docurrents support
the application. Include additional waterbodies if necessary.
This approval was for Lots 67 & 68. Lat & Long provided are for Lot
67 which is the project we are about to begin
8. NOI Certification HL 67 and 68 NOI Form _000418.pdf 564.32KB
Form Mist be RFformat
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
C11,914 (? k4ge
Type Name* Elton R Ange III
Title President
Organization Legally Responsible Entity
Ange Construction dba Ange Signature Homes
Date * 04/27/2021

F. Tracking and COC Info
NOI Tracking No. 51117
NC Reference No. NCG01-2021-2611
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of NCC212611
Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 2611
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. NCC212611-2021
Invoice Due Date 5/29/2021
Initial Fee $ 100.00
Invoice Status OPEN