NCC200313_NOI Application_20200124

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/23/2020 9:41:32 AM (NCG01 NOI Submission)
Approve by Morman, Alaina 1/24/2020 9:06:40 AM (Review- Construction NOI 21048)
• The task was assigned to Morman, Alaina by round robin distribution 1/23/2020 9:41 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 27, 2020 5:00
PM 1/23/2020 9:41 AM
Submit by McCoy, Suzanne 1/24/2020 2:57:17 PM (Payment Verification for NCC200313)
* Jeff P Grote
• McCoy, Suzanne assigned the task to McCoy, Suzanne 1/24/2020 2:56 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: March 6, 2020 5:00 PM
1/24/2020 9:06 AM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name *
Hillcrest Subdivision - Phase 1
2. County*
Franklin
3. Highway or Street
Cedar Creek Road
Address *
Street narre only is acceptable if no address number assigned yet
4. City or Township* Youngsville
5. State * NC
6. Zip Code * 27596
7. Latitude * Enter the latitude in decimal degrees
36.0431
8. Longitude* Enter the longitude in decinal degrees (M. ST be negative)
-78.4395
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*
02/24/2020
Estimated Construction Project Start Date
10. Date to End*
02/24/2023
Estimated Construction Project End Date
11. SIC (Primary) *
Residential, Single
Family Houses (SFE)
(1521)
Standard Industrial aassification for Developrrent
12. Acres to be
21.60
disturbed*
(including off -site borrow and waste areas)
13. Total site area 21.60
(acres) *
14. Post- 5.60
construction (Estimated)
impervious area
(acres)*

NCC Project NCC-FRANK-2020-Hillcrest Subdivision - Phase 1
Tracking ID Assigned autocratically
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 Cedar Creek
Wate rbody* %rre of waterbody into which stornwater runoff will discharge
15b. Waterbody 28-29-(2)
Index No. * NCWaterbody Index Minter
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 Greenpointe, LLC
Name *
2. First Name* Jeff
IF Corporation, enter Fbgistered Agent First Barre
3. Last Name* Grote
If Corporation, enter Registered Agent Last %rre
3b. Title Manager
4. Permitee E-mail [e-mail]
Address *
5. Permittee [phone]
Telephone No.*
6. Permittee Mailing Street Address
Address* 7201 Creedmoor Road, Suite 140
Address Line 2
City State / Frovince / Region
Raleigh NC
Fbstal / Zip Code Country
27613 USA
Check box if the rJ Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 7201 Creedmoor Road, Suite 140
Address Line 2
City
State / Frovince / Fbgion
Raleigh
NC
Fbstal / Zip Code
Country
27613
USA

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
_...........................................................................................................................................................
1. Type of
Non -Government
Ownership *
2. Primary Site
Tom
Contact - First
Name *
3. Primary Site
Spaulding, PE
Contact - Last
Name *
4. Title
Consultant Engineer
5. Site Contact E-
[e-mail]
mail Address*
6. Site Contact
[phone]
Telephone No.*
7. Organization
The Spaulding Group, PA
Name
8. Site Contact
Street Address
Mailing Address*
1611 Jones Franklin Road, Suite 101
Address Line 2
City
Raleigh
Fbstal / Zip Code
27606
9. Consultant Name
(Optional)
Justin Rohde
First and Last narre
10. Consultant E-
[e-mail]
mail
This person will be copied on all correspondence.
11. Consultant
[phone]
Telephone No.
State / Rovince / Fbgion
NC
Country
USA

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 11/05/2019
Approved *
2. E&SC Plan Project FRANK-2020-005
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 FRANK-2020-005 LOA 20191105 Approval Letter
Approval 623.22KB
signed.pdf
letter/documentation
Mist be R7Fforrrat
6. NOI Certification 860-17 Hillcrest NCG01.pdf 423.97KB
Form Mist be PDFfon-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
04�e:�Pm-e
Type Name *
Jeff Grote
Title
Manager
Organization
Greenpointe, LLC
Date *
01 /23/2020

F. Tracking and COC Info
NOI Tracking No. 21048
NC Reference No. NCG01-2020-0313
Uses 'count number' variable (incremrented by SP)
Certificate of NCC200313
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 313
Sequential number for submittal that is incremented by Stored Frocedure
COC Year 2020
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)