NCC192936_NOI Application_20191206

Action History (UTC-05:00)Eastern Time(US&Canada)
Subrrit by Anonymous User 11/25/2019 3:11:14 PM(NCG01 NOI Submission)
Approve by Clark, Paul 11/25/2019 3:17:40 PM(Review-Construction NOI 18875)
• The task was assigned to Clark, Paul by round robin distribution 11/25/2019 3:11 PM
• The task was assigned to DEMLR NCG01 NOI Review Team.The due date is: November 27,2019 5:00
PM 11/25/2019 3:11 PM
Submit by McCoy, Suzanne 12/6/2019 7:37:37 AM(Payment Verification for NCC192936)
* Vance Blanton.
• McCoy,Suzanne assigned the task to McCoy, Suzanne 12/6/2019 7:37 AM
• The task was assigned to DEMLR NCG01 Payment Team.The due date is:January 6, 2020 5:00 PM
11/25/2019 3:17 PM

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1Construction Stormwater: Notice of Intent (NOI)
National Pollutant Discharge Elimination System 'D application for•• - .•-under NorthCarolina's
General Permit 1 1111:STORIMATER DISCHARGES associated with construction activities(or
NORTH CAROLINA
Enrlrnnmenfu�Qr�arlry
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name* Chatham Park Way Extension North
2.County* Chatham
3. Highway or Street Chatham Park Way
Address* Street nacre only is acceptable if no address number assigned yet
4. City or Township* Pittsboro
5.State* NC
6.Zip Code* 27312
7. Latitude* Enter the latitude in decimal degrees
35.7351
8. Longitude* Enter the longitude in decimal degrees(M.ST be negative)
-79.1467
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* 12/02/2019
Estimated Construction Project Start Date
10. Date to End* 12/02/2020
Estimated Construction Project End Cute
11.SIC(Primary)* Other(0000)
Standard Industrial Classification for Ceveloprrent
12.Acres to be 4.65
disturbed* (including off-site borrow and waste areas)
13.Total site area 4.65
(acres)*
14. Post- 1.60
construction (Estimated)
impervious area
(acres)*
NCC Project NCC-CHATH-2019-Chatham Park Way Extension North
Tracking ID Assigned autorratically

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 UT to Haw River
Waterbody* %rre of waterbody into which storrrwater runoff will discharge
15b.Waterbody 16-(36.7)
Index No.* NCWaterbody Index Number
Stormwater r No
discharges will flow Pf Yes
to additional
wate rs*
15c.Additional UT to Robeson Creek
Receiving Waterbody narre
Waterbody
15d.Waterbody 16-38-(3)
Index No. NCWaterbody Index Nurrber
15e.Additional Waterbody narre
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. ^
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 Chatham Park Investors LLC
Name*
2. First Name* Tim
ff Corporation,enter Pegistered Agent First Barre
3. Last Name* Smith
ff Corporation,enter Faegistered Agent Last%rre
3b.Title owner
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-481-3000
Telephone No.*
6. Permittee Mailing Street Address
Address* PO Box3557
Address Line 2
city State/Frovince/Faegion
Cary NC
Fbstal/Zip Code Country
27519 USA
Check box if the r Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 100 Weston Estates Way
Address Line 2
City State/Frovince/Fbgion
Cary NC
Fbstal/Zip Code Country
27513 USA

C. Site Contact Information
Part C. ^
Roject Site Contact Inforrration
.......................................................................................................................................................................................................................................................................................................................................................................................
1.Type of Non-Government
Ownership*
2. Primary Site Andy
Contact-First
Name*
3. Primary Site Johnson
Contact-Last
Name*
4.Title
5.Site Contact E- [e-mail]
mail Address*
6.Site Contact [phone]
Telephone No.*
7.Organization Withers Ravenel
Name
8.Site Contact Street Address
Mailing Address* 55 Grant Drive
Address Line 2
Suite D
C7ty State/Rovince/Fbgion
Pittsboro NC
Fbstal/Zip Code Country
27312 USA
9. Consultant Name (Optional)
Vance Blanton
First and Last narre
10. Consultant E- [e-mail]
mail This person will be copied on all correspondence.
11. Consultant 919-677-2000
Telephone No.

D. E&SC Plan
Part D. ^
Erosion&Sediment Control(E&SC)Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 09/17/2019
Approved*
2. E&SC Plan Project 2019-01245
Number/ID* Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* Chatham County
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 CPW Ext North—Letter of Approval- Revised Plan 9-
Approval 75.35KB
17-19.pdf
letter/documentation
Mist be R7Fforrrat
6. NOI Certification NCG01-eNO1-Certification-Form-20190919-DEMLR-
Form 83.82KB
SW_Signed.pdf
Mist be RDFforrrat
This is an Express r No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.66(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 knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case underthis 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 guiltyofa Class 2 misdemeanor which mayinclude 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 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.
* 17 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
3
Type Name* Tim Smith
Title owner
Organization Chatham Park Investors LLC
Date* 11/25/2019

F. Tracking and COC Info
NOI Tracking No. 18875
NC Reference No. NCG01-2019-2936
Uses'count_nurrber'variable(increrrented by SP)
Certificate of NCC192936
Coverage (COC) Uses'count number'variable(increrrented by SP)
No.*
Count Number 2936
Sequential nurrber for subrrittal that is incremented by Stored Frocedure
COC Year 2019
Year of date reviewed(used to assign YY digits after"NOC'in COCno.)