NCC192525_NOI Application_20191101

Action History (UTC-05:00) Eastern Time(US&Canada)
Submit by Anonymous User 10/24/2019 11:57:57 AM(NCG01 NOI Submission)
Approve by Farkas,Jim J 10/25/2019 9:04:05 AM(Review-Construction NOI 17632)
• The task was assigned to Farkas, Jim J by round robin distribution 10/24/2019 11:58 AM
• The task was assigned to DEMLR NCG01 NOI Review Team.The due date is: October 28,2019 5:00
PM 10/24/2019 11:58 AM
Submit by McCoy,Suzanne 11/l/2019 8:10:48 AM(Payment Verification for NCC192525)
* Christopher Raughley
• McCoy, Suzanne assigned the task to McCoy,Suzanne 11/l/2019 8:10 AM
• The task was assigned to DEMLR NCG01 Payment Team.The due date is: December 6,2019 5:00
PM 10/25/2019 9:04 AM

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NORTH CAROLINA
Ernvlronmental QUII
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name* 540 West
2. County* Wake
3. Highway or Street 1700, 1800, 3500 Old Milburnie Road, 1808 Wall Hill Road, 3501
Address* Old Barbee Lane
Street narre only is acceptable if no address nurrber assigned yet
4.City or Township* Raleigh
5. State* NC
6.Zip Code* 27604
7. Latitude* Enter the latitude in decirral degrees
35.8133
8. Longitude* Enter the longitude in decirral degrees(MIST be negative)
-78.5227
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* 10/28/2019
Estimated Construction Project Start Date
10. Date to End* 04/30/2021
Estimated Construction Project End Date
11. SIC(Primary)* Residential, Single
Family Houses(SFE)
(1521)
Standard Industrial aassification for Developrrent
12.Acres to be 150.00
disturbed* (including off-site borrow and waste areas)
13.Total site area 164.01
(acres)*
14. Post- 54.09
construction (Estimated)
impervious area
(acres)*

NCC Project NCC-WAKE-2019-540 West
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 Beaverdam Creek
Waterbody* %rre of waterbody into which stornvvater runoff will discharge
15b.Waterbody 27-29
Index No.* NC Waterbody Index Narrber
Stormwater r No
discharges will flow pr Yes
to additional
wate rs*
15c.Additional Milburnie Creek
Receiving Waterbody nacre
Waterbody
15d.Waterbody 27-31
Index No. NCWaterbody Index Pbnber
15e.Additional Waterbody nacre
Receiving
Waterbody
15f.Waterbody NCWaterbody Index Narrber
Index No.
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
.....................................................................................................................................................................
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 Pulte Home Company, LLC
Name*
2. First Name* Chris
ff Corporation,enter Registered Agent First l\b e
3. Last Name* Raughley
ff Corporation,enter Registered Agent Last Barre
3b.Title VP Land Development
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-816-1100
Telephone No.*
6. Permittee Mailing Street Address
Address* 1225 Crescent Green
Address Line 2
Suite 250
City State/Province/Region
Cary NC
Rastal/Zip Code Country
27518 USA
Check box if the rJ Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 1225 Crescent Green
Address Line 2
Suite 250
City State/Province/Region
Cary NC
Pastal/Zip Code Country
27518 USA

C. Site Contact Information
Part C.
Project Site Contact Information
....................................................................................................................
1.Type of Non-Government
Ownership*
2. Primary Site John
Contact-First
Name*
3.Primary Site Dempsey
Contact-Last
Name*
4.Title
5.Site Contact E- [e-mail]
mail Address*
6.Site Contact 919-816-1100
Telephone No.*
7.Organization Pulte Group
Name
8.Site Contact Street Address
Mailing Address* 1225 Crescent Green
Address Line 2
Suite 250
City State/Province/Pegion
Cary NC
Fbstal/Zip Code Country
27518 USA
9.Consultant Name (optional)
Brad Rhinehalt
First and Last narre
10.Consultant E- [e-mail]
mail This person will be copied on all correspondence.
11. Consultant 919-361-5000
Telephone No.

D. E&SC Plan
Part D.
Erosion&Sediment Control(E&SC)Ran Approval Information
............................................................................................................................................................................. ..................................................................................................
1. Date E&SC Plan 10/09/2019
Approved*
2. E&SC Plan Project 576196-480397-LD-119746
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 Raleigh
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 2019-10-09 Land Disturbance Permit.pdf 22.61 KB
Approval Mist be FDFfornat
letter/documentation
6. NOI Certification NCG01 -State NOI Cert..pdf 87.67KB
Form Mist be RDFfornat
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.
* 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 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 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* Chris Raleigh
Title VP of Land Development
Organization Pulte Group
Date* 10/24/2019

F. Tracking and COC Info
NOI Tracking No. 17632
NC Reference No. NCG01-2019-2525
Uses'count number variable(incremented by SP)
Certificate of NCC192525
Coverage (COC) Uses'count number variable(increrrentedbySP)
No.*
Count Number 2525
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.)