NCC192805_NOI Application_20191121

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 11/15/2019 11:08:04 AM (NCG01 NOI Submission)
Approve by Clark, Paul 11/15/2019 1:01:11 PM (Review- Construction NOI 18524)
• The task was assigned to Clark, Paul by round robin distribution 11/15/2019 11:08 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: November 19, 2019 5:00
PM 11/15/2019 11:08 AM
Submit by McCoy, Suzanne 11/21/2019 12:20:33 PM (Payment Verification for NCC192805)
* Caviness and Cates Building and Development Co
• McCoy, Suzanne assigned the task to McCoy, Suzanne 11/21/2019 12:19 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: December 27, 2019 5:00
PM 11/15/2019 1:01 PM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name * Holden Creek Preserve Phase 4 ( Lots 47-
49, 53, 54, 68, 69, 72, 73, 77, 78, 80-82 )
2. County* Franklin
3. Highway or Street Richlands Cliffs Drive
Address* Street narre only is acceptable if no address number assigned yet
4. City or Township* Youngsville Township
5. State * NC
6. Zip Code* 27596
7. Latitude* Enter the latitude in decimal degrees
36.0229
8. Longitude * Enter the longitude in decimal degrees (MJST be negative)
-78.4912
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*
11/14/2019
Estirrated Construction Project Start Date
10. Date to End*
11/14/2020
Estinated Construction Project End Cate
11. SIC (Primary) *
Residential, Single
Family Houses (SFE)
(1521)
Standard Industrial Classification for Development
12. Acres to be
2.87
disturbed*
(including off -site borrow and waste areas)
13. Total site area 2.87
(acres) *
14. Post- 1.26
construction (Estirrated)
impervious area
(acres) *

NCC Project NCC-FRANK-2019-Holden Creek Preserve Phase 4 ( Lots 47-
Tracking ID 49,53,54,68,69,72,73,77,78,80-82)
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 Richland Creek
Waterbody* Narreof waterbody into which stormwater runoff will discharge
15b. Waterbody 27-21-(0.5)
Index No. * NCWaterbody Index Number
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. ^
Fternittee 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 Caviness & Cates Building and Development Company
Name *
2. First Name* Christopher
IF Corporation, enter Fbgistered Agent First Barre
3. Last Name* Cates
IF Corporation, enter Registered Agent Last %rre
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
Fayetteville
Fbstal / Zip Code
28305
Check box if the rJ Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 639 Executive Place, Suite 400
Address Line 2
City
Fayetteville
Fbstal / Zip Code
28305
State / Frovince / Region
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
Pamela
Contact - First
Name *
3. Primary Site
Geddie
Contact - Last
Name *
4. Title
Starts Coordinator
5. Site Contact E-
[e-mail]
mail Address*
6. Site Contact
910-778-7902
Telephone No.*
7. Organization
Caviness & Cates Building and Development
Name
Company
8. Site Contact
Street Address
Mailing Address*
639 Executive Place, Suite 400
Address Line 2
City
State / Rovince / Region
Salemburg
N.C.
Fbstal / Zip Code
Country
28385
us
9. Consultant Name (Optional)
Johnny Glenn Tew
First and Last narre
10. Consultant E- [e-mail]
mail This person will be copied on all correspondence.
11. Consultant 910-897-3257
Telephone No.

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 11/14/2019
Approved *
2. E&SC Plan Project FRANK-2020-004
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 Holden Creek Phase 4 ( Lots # 47-49 etc. ) Erosion
Approval 262.4KB
Plan Approval.pdf
letter/documentation
Mist be R7Fforrrat
6. NOI Certification Holden Creek Preserve Lots 47-
Form 467.85KB
49, 53, 54, 68, 69, 72 , 73, 77, 78, 80-80. pdf
Mist be RDFfornat
This is an Express r 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 Atide; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case under this Atcle; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring device or method required to be operated or maintained under this Amide or rules of the
Commission implementing this Atcle 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 * Christopher E. Cates
Title Vice President
Organization Caviness & Cates Building and Development Company
Date * 11 /15/2019

F. Tracking and COC Info
NOI Tracking No. 18524
NC Reference No. NCG01-2019-2805
Uses 'count number' variable (incremrented by SP)
Certificate of NCC192805
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 2805
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.)