NCC192753_NOI Application_20191115

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 11/12/2019 5:19:29 PM (NCG01 NOI Submission)
Approve by Morman, Alaina 11/13/2019 10:55:31 AM (Review- Construction NOI 18361)
• The task was assigned to Morman, Alaina by round robin distribution 11/12/2019 5:20 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: November 14, 2019 5:00
PM 11/12/2019 5:20 PM
Submit by McCoy, Suzanne 11/15/2019 7:40:47 AM (Payment Verification for NCC192753)
* Jessica Meyer
• McCoy, Suzanne assigned the task to McCoy, Suzanne 11/15/2019 7:40 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: December 25, 2019 5:00
PM 11/13/2019 10:55 AM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name * Worthington Farms - DR Horton Lots
2. County* Nash
3. Highway or Street Jordan Road
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* Elm City
5. State * NC
6. Zip Code * 27803
7. Latitude * Enter the latitude in decimal degrees
35.8626
8. Longitude* Enter the longitude in decimal degrees (MJSTbe negative)
-77.8758
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*
11/13/2019
Estimated Construction Project Start Date
10. Date to End*
11/16/2020
Estimated Construction Project End Cute
11. SIC (Primary) *
Residential, Single
Family Houses (SFE)
(1521)
Standard Industrial aassification for Developrrent
12. Acres to be
4.23
disturbed*
(including off -site borrow and waste areas)
13. Total site area 4.23
(acres) *
14. Post- 1.75
construction (Estimated)
impervious area
(acres)*

NCC Project NCC-NASH-2019-Worthington Farms - DR Horton Lots
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 Tar River
Wate rbody* f\brre of waterbody into which stormwater runoff will discharge
15b. Waterbody 28-(36)
Index No. * NCWaterbody Index N nber
Stormwater V No
discharges will flow r Yes
to additional
wate rs *
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 DR Horton, Inc.
Name *
2. First Name* Jessica
If Corporation, enter Pegistered Agent First Barre
3. Last Name* Meyer
If Corporation, enter Faegistered Agent Last %rre
3b. Title NPDES Technical Compliance Administrator
4. Permitee E-mail [e-mail]
Address *
5. Permittee 919-215-6561
Telephone No.*
6. Permittee Mailing Street Address
Address* 2000 Aerial Center Parkway
Address Line 2
Suite 110A
Qty
Morrisville
Fbstal / Zip Code
27560-9294
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
2000 Aerial Center Parkway
Address Line 2
Suite 110A
Cty
Morrisville
Fbstal / Zip Code
27560-9294
State / Ftovince / Faegion
NC
Country
us
State / Frovince / Fbgion
NC
Country
us

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
...................................................................................................................................................................................................................
1. Type of
Non -Government
Ownership *
2. Primary Site
Jessica
Contact - First
Name *
3. Primary Site
Meyer
Contact - Last
Name *
4. Title
NPDES Technical Compliance Administrator
5. Site Contact E-
[e-mail]
mail Address*
6. Site Contact
919-215-6561
Telephone No.*
7. Organization
DR Horton, Inc.
Name
8. Site Contact
Street Address
Mailing Address*
2000 Aerial Center Parkway
Address Line 2
Suite 110A
C7ty
State / Rovince / Fbgion
Morrisville
NC
Flostal / Zip Code
Country
27560-9294
us
9. Consultant Name
(Optional)
Kristi Anspach, Eco Turf, Inc.
First and Last narre
10. Consultant E-
[e-mail]
mail
This person will be copied on all correspondence.
11. Consultant
919-883-8211
Telephone No.

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 11/08/2019
Approved *
2. E&SC Plan Project NASF-1-2020-003
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.
5. E&SC Plan NASH-2020-003 LOA 20191108 revised.pdf 60.94KB
Approval Wst be RDFfornat
letter/documentation
6. NOI Certification Worthington Farms NOI Certification Form.pdf 660.1 KB
Form Mist be R7Ffon-rat
This is an Express F No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.6E (i) 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:* r The Responsible Person named on this Notice of Intent
f 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 * Jessica Meyer
Title NPDES Technical Compliance Administrator
Organization DR Horton, Inc.
Date * 11 /12/2019

F. Tracking and COC Info
NOI Tracking No. 18361
NC Reference No. NCG01-2019-2753
Uses 'count number' variable (incremrented by SP)
Certificate of NCC192753
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 2753
Sequential number for submittal that is incremented by Stored Frocedure
COC Year 2019
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)