NCC193002_NOI Application_20191206

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 11/27/2019 11:51:23 AM(NCG01 NOI Submission)
Approve by Garcia, Lauren V 12/2/2019 4:09:40 PM(Review-Construction NOI 18946)
• Morman,Alaina reassigned the task to Garcia, Lauren V 12/2/2019 4:03 PM
* Muchas Gracias!!!!!!
• The task was assigned to Morman,Alaina by round robin distribution 11/27/2019 11:51 AM
• The task was assigned to DEMLR NCG01 NOI Review Team.The due date is: November 29,2019 5:00
PM 11/27/2019 11:51 AM
Submit by McCoy, Suzanne 12/6/2019 12:26:58 PM(Payment Verification for NCC193002)
* William Joseph Berry
• McCoy,Suzanne assigned the task to McCoy, Suzanne 12/6/2019 12:26 PM
• The task was assigned to DEMLR NCG01 Payment Team.The due date is:January 13,2020 5:00 PM
12/2/2019 4:09 PM

�ThF1
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* Boone Meadows Subdivision
2.County* Guilford
3. Highway or Street Ellisboro Road
Address* Street nacre only is acceptable if no address number assigned yet
4. City or Township* Stokesdale
5.State* NC
6.Zip Code* 27357
7. Latitude* Enter the latitude in decimal degrees
36.2511
8. Longitude* Enter the longitude in decimal degrees(M.ST be negative)
-79.9909
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* 05/29/2020
Estimated Construction Project End Date
11.SIC(Primary)* Residential, Single
Family Houses(SFE)
(1521)
Standard Industrial aasslfication for Development
12.Acres to be 23.50
disturbed* (including off-site borrow and waste areas)
13.Total site area 26.68
(acres)*
14. Post- 3.10
construction (Estimated)
impervious area
(acres)*

NCC Project NCC-GUILF-2019-Boone Meadows Subdivision
Tracking ID Assignedautorratically
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 Belews Creek
Waterbody* %neof waterbody into which storrrwater runoff will discharge
15b.Waterbody 22-27-(7)
Index No.* NC Waterbody Index I Lrrber
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 WJB Investment Group, LLC
Name*
2. First Name* William
ff Corporation,enter Fbgistered Agent First Barre
3. Last Name* Berry
If Corporation,enter Faegistered Agent Last%rre
3b.Title President
4. Permitee E-mail [e-mail]
Address*
5. Permittee 336-273-8663
Telephone No.*
6. Permittee Mailing Street Address
Address* 2200 E. Bessemer Avenue
Address Line 2
747 Park Lawn Court
City State/F rovince/Faegion
Greensboro NC
Fbstal/Zip Code Country
27405 United States
Check box if the rJ Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 2200 E. Bessemer Avenue
Address Line 2
747 Park Lawn Court
City State/Frovince/Fbgion
Greensboro NC
Fbstal/Zip Code Country
27405 United States

C. Site Contact Information
Part C. ^
Roject Site Contact Inforrration
.......................................................................................................................................................................................................................................................................................................................................................................................
1.Type of Non-Government
Ownership*
2. Primary Site Will
Contact-First
Name*
3. Primary Site Yearns
Contact-Last
Name*
4.Title President
5.Site Contact E- [e-mail]
mail Address*
6.Site Contact 336-202-8514
Telephone No.*
7.Organization Granville Homes, LLC
Name
8.Site Contact Street Address
Mailing Address* 7349 W. Friendly Avenue
Address Line 2
City State/Rovince/Region
Greensboro NC
Fbstal/Zip Code Country
27429 United States
9. Consultant Name (Optional)
Stoltzfus Engineering, Inc., Bruce Nooe, PE
First and Last narre
10. Consultant E- [e-mail]
mail This person will be copied on all correspondence.
11. Consultant 3369040207
Telephone No.

D. E&SC Plan
Part D. ^
Erosion&Sediment Control(E&SC)Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 11/25/2019
Approved*
2. E&SC Plan Project 19-09-STRP-07496
Number/ID* Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* Guilford 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 BooneMeadows_Approval Letter.pdf 186.44KB
Approval Wst be RDFforrrat
letter/documentation
6. NOI Certification Signed NCG01 Notice of Intent Certification.pdf 317.84KB
Form Mist be R7Fforrrat
This is an Express F 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
Wr w tt "'
Type Name* William Berry
Title President
Organization WJB Investment Group, LLC
Date* 11/27/2019

F. Tracking and COC Info
NOI Tracking No. 18946
NC Reference No. NCG01-2019-3002
Uses'count_nurrber'variable(increrrented by SP)
Certificate of NCC193002
Coverage (COC) Uses'count number'variable(increrrented by SP)
No.*
Count Number 3002
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.)