NCC192129_NOI Application_20191008

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/30/2019 11:32:10 AM (NCG01 NOI Submission)
Approve by Farkas, Jim J 10/l/2019 9:04:41 AM (Review- Construction NOI 16441)
• The task was assigned to Farkas, Jim J by round robin distribution 9/30/2019 11:32 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 2, 2019 5:00
PM 9/30/2019 11:32 AM
Submit by McCoy, Suzanne 10/8/2019 2:30:09 PM (Payment Verification for NCC192129)
* Land Design Inc.
• McCoy, Suzanne assigned the task to McCoy, Suzanne 10/8/2019 2:29 PM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 12, 2019 5:00
PM 10/l/2019 9:04 AM

STME
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1. Project Name * Weddington Pointe
2. County* Union
3. Highway or Street Weddington Road
Address * Street name only is acceptable if no address nurrtrer assigned yet
4. City or Township* Wesley Chapel
5. State * NC
!1i)iTiT7i)ilf1Iif_T1IIa10141
6. Zip Code* 28110
7. Latitude * Enter the latitude in decirral degrees
35.0050
8. Longitude * Enter the longitude in decirral degrees (MIST be negative)
-80.6470
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*
12/30/2019
Estimated Construction Project Start Date
10. Date to End*
12/31 /2020
Estimated Construction Project End Date
11. SIC (Primary)*
Residential, Single
Family Houses (SFE)
(1521)
Standard Industrial aassification for Development
12. Acres to be
61.78
disturbed*
(including off -site borrow and waste areas)
13. Total site area 77.30
(acres)*
14. Post- 30.84
construction (Estimated)
impervious area
(acres) *

NCC Project NCC-UNION-2019-Weddington Pointe
Tracking ID Assigned autocratically
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 East Fork Tvelvemile Creek
Waterbody* %n-e of Waterbody into which stornwater runoff will discharge
15b. Waterbody 11-138-2
Index No. * NCWaterbody Index Nurrber
Stormwater fJ 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 Century Communities Southeast, LLC
Name *
2. First Name* Andrew
ff Corporation, enter Registered Agent First l\b e
3. Last Name * Rouzer
ff Corporation, enter Registered Agent Last Barre
3b. Title Vice President of Land Acquisitions
4. Permitee E-mail [e-mail]
Address*
5. Permittee 7049121374
Telephone No.*
6. Permittee Mailing Street Address
Address* 7401 Carmel Executive Park Drive
Address Line 2
Suite 310
City State / Province / Region
Charlotte NC
Rastal / Zip Code Country
28226 us
Check box if the r% Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 7401 Carmel Executive Park Drive
Address Line 2
Suite 310
City
State / Province / Region
Charlotte
NC
Pastal / Zip Code
Country
28226
us

C. Site Contact Information
Part C.
Roiect Site Contact Information
1. Type of Non -Government
Ownership*
2. Primary Site Andrew
Contact - First
Name *
3. Primary Site Rouzer
Contact - Last
Name *
4. Title Vice President of Land Acquisitions
5. Site Contact E- [e-mail]
mail Address*
6. Site Contact 7049121374
Telephone No.*
7. Organization Century Commnunities
Name
8. Site Contact Street Address
Mailing Address* 7401 Carmel Executive Park Drive
Address Line 2
Suite 310
City
Charlotte
Pbstal/ Zip Code
28226
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 / Pegion
NC
Country
us

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 07/30/2019
Approved *
2. E&SC Plan Project UNION-2019-075
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 * Mooresville (MRO)
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 Weddington Pointe_ESC Plan Approval (2019-07-
Approval 30).pdf 4.67MB
letter/documentation
Mist be RJF forrrat
6. NOI Certification Weddington Pointe_NCGO1 Notice of Intent Cert
Form 1.25MB
Form.pdf
Mist 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
d'em,V) - D'e �'t
Type Name *
Andrew Rouzer
Title
Vice President of Land Acquisitions
Organization
Century Communities Southeast, LLC
Date *
09/30/2019

F. Tracking and COC Info
NOI Tracking No. 16441
NC Reference No. NCG01-2019-2129
Uses 'count number variable (incremrented by SP)
Certificate of NCC192129
Coverage (COC) Uses 'count _nunber'variable (increrrented bySP)
No. *
Count Number 2129
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.)